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Purpose In this pilot study, we aimed to investigate the efficacy of an electronic medical record (EMR) order set for lubricating ointment (four times daily) in the prevention of exposure keratopathy in ventilated patients in the intensive care unit (ICU) at the University of Utah. We attempted to capture the magnitude of morbidity, cost, and care burden in ventilated patients, as well as the utility of a systematic EMR-based preventative lubrication protocol in the ICU setting. Methods After implementation of the order set, a retrospective chart review was performed to capture all ventilated ICU patients pre- and postintervention. Three separate study periods were used: (1) Six months prior to coronavirus disease 2019 (COVID-19) and prior to the ocular lubrication intervention; (2) the subsequent 6-month period including COVID-19 patients but prior to any intervention; and (3) the subsequent 6-month period postintervention, including COVID-19 patients. The primary endpoint of ointment use per day was analyzed with a Poisson regression model. Secondary endpoints including rates of ophthalmologic consultation and exposure keratopathy were compared with Fisher's exact test. A poststudy survey of ICU nurses was included. Results A total of 974 ventilated patients were included in the analysis. Ointment use per day increased by 155% (95% confidence interval [CI] 132–183%, p Conclusion These preliminary data show a statistically significant increase in the rates of lubrication in mechanically ventilated patients using an EMR-based order set in the ICU setting. There was no statistically significant decrease in the rates of exposure keratopathy. Our preventative protocol with lubrication ointment was of minimal cost burden to the ICU. Further longitudinal and multicenter studies are needed to better assess the efficacy of such a protocol.

Understanding the dominant climate forcings in the Pliocene is crucial to assessing the usefulness of the Pliocene as an analogue for our warmer future. Here, we implement a novel yet simple linear factorisation method to assess the relative influence of CO2 forcing in seven models of the Pliocene Model Intercomparison Project Phase 2 (PlioMIP2) ensemble. Outputs are termed “FCO2” and show the fraction of Pliocene climate change driven by CO2. The accuracy of the FCO2 method is first assessed through comparison to an energy balance analysis previously used to assess drivers of surface air temperature in the PlioMIP1 ensemble. After this assessment, the FCO2 method is applied to achieve an understanding of the drivers of Pliocene sea surface temperature and precipitation for the first time. CO2 is found to be the most important forcing in the ensemble for Pliocene surface air temperature (global mean FCO2=0.56), sea surface temperature (global mean FCO2=0.56), and precipitation (global mean FCO2=0.51). The range between individual models is found to be consistent between these three climate variables, and the models generally show good agreement on the sign of the most important forcing. Our results provide the most spatially complete view of the drivers of Pliocene climate to date and have implications for both data–model comparison and the use of the Pliocene as an analogue for the future. That CO2 is found to be the most important forcing reinforces the Pliocene as a good palaeoclimate analogue, but the significant effect of non-CO2 forcing at a regional scale (e.g. orography and ice sheet forcing at high latitudes) reminds us that it is not perfect, and these additional influencing factors must not be overlooked. This comparison is further complicated when considering the Pliocene as a state in quasi-equilibrium with CO2 forcing compared to the transient warming being experienced at present.

In this brief paper, offered as a policy viewpoint, I introduce what I believe to be a novel concept for supporting individual citizen interaction with the U.S. Federal government, termed the individual social account. I explore whether and how the concept might be implemented so as to strengthen the U.S. social safety net and further citizen trust and responsibility in e-government interactions. I illustrate and develop the concept as a platform for reform and suggest and discuss design criteria, surfacing various issues. I conclude with additional thoughts with which to stimulate further research and discussion of the concept and its practicalities.

Background In Ireland, over 53,000 older adults are supported in their community by formal home support, amounting to an estimated 19 million care hours annually. There is a growing need to move beyond care, to more proactive approaches to maintain physical function. In a feasibility study, we delivered the ‘Care to Move’ (CTM) programme through existing home support services. The aim of the present qualitative study was to explore the experience and perceptions of Health Care Assistants (HCAs), who were trained in, and delivered the CTM programme. Methods We conducted semi-structured telephone interviews with 22 HCAs involved in the delivery of the programme among older adults [n = 35, mean age 82.8 (7.8) years]. Interview transcripts were coded and analysed thematically to capture barriers and facilitators to programme delivery. Results Barriers and facilitators were identified under three main themes i) the programme ii) the care setting, iii) the clients. Overall, there was a positive perception of the programme’s focus on ‘movement prompts and motivators’, the ‘fit’ within home support services, and the training provided. Practical challenges of limited time and the task-orientation nature of home support were reported as recurring barriers for CTM. Many HCAs commented on the value and perceived positive benefits of the programme for their clients. Though negative perceptions of older adult’s motivation or ability to engage with physical activity also emerged. Risk, such as injury or pain, was identified but was not a dominant theme. Conclusion Our preliminary findings suggest that embedding physical activity initiatives within home support services could be feasible. Restructuring of services, engaging HCAs, and moving beyond traditional ‘task-oriented' care models to more personalised proactive approaches may facilitate this initiative and support ageing in place.

Background Physical activity programmes have been shown to improve older adults’ functional capacity, independence and quality of life. Research around structured exercise programmes has been completed in different groups of community-dwelling older people, however few studies have focused on the older population receiving formal home care. In a feasibility study, we embedded physical activity within older adults existing home care services through the ‘Care to Move’ (CTM) programme. The aim of this qualitative study is to explore older adults’ experiences of the CTM programme. Methods We conducted semi-structured telephone interviews with 13 older adults and one carer. Topics covered included participants overall experiences of the CTM programme, changes to their overall activity and participation, aspects of the programme that they liked or found valuable and issues that they found challenging. Interview transcripts were coded and analysed thematically to capture barriers and facilitators to programme delivery. Results Four themes emerged: i) ‘I’m feeling good about it’, ii) ‘safety and security is the name of the game’, iii) ‘we’re a team as it stands’, iv) ‘it’s [COVID] depressing for everybody at the moment’. Older adults identified benefits of CTM participation including improvements in physical and psychological wellbeing. However, frailty and multimorbidity influenced overall engagement. Participants expressed concerns around the logistics of programme delivery and competing healthcare assistant (HCA) interests. The broader role of HCA’s in supporting the CTM programme was highlighted as well as the emotional support that HCAs provided to older adults. HCA continuity was identified as a barrier to ongoing programme engagement. The impact of COVID on older adults physical and mental health negatively impacted programme delivery. Conclusion Our findings suggest that embedding the CTM programme within home support services is feasible. Restructuring of services, addressing HCA continuity, and adopting individual approaches to programme delivery may enhance the implementation of services.

Understanding the conditions when litter beds will ignite from firebrands is critical for predicting spot fire occurrence. Such research is either field- or laboratory-based, with limited analysis to compare the approaches. We examined the ability of a laboratory method to represent field-scale ignitability. The laboratory method involved collecting litter-bed samples concurrently with the field experiments and then reconstructing and burning the litter-bed samples in the laboratory. We measured the number of successful and sustained ignitions in the laboratory (n = 5) and field (n = 30 attempts). The laboratory and field results were more similar for successful (bias = 0.05) than sustained ignitions (bias = 0.08). Wind, fuel structure (in the field) and near-surface fuel moisture influenced the differences between the methods. Our study highlights the value in conducting simultaneous laboratory and field experiments to understand the scalability of laboratory studies. For our ignitability method, our results suggest that small-scale laboratory experiments could be an effective substitute for field experiments in forests where litter beds are the dominant fuel layer and where the cover of the near-surface fuel is low.