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Joanne Walsh,1,2 Zena Moore,1 Elaine Mac Hale,2 Garrett Greene,2 Frank Doyle,3 Richard W Costello,2 Bridget Murray1 1School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; 2Clinical Research Centre, Beaumont Hospital and RCSI University of Medicine and Health Sciences, Dublin, Ireland; 3Department of Health Psychology, RCSI University of Medicine and Health Sciences, Dublin, IrelandCorrespondence: Richard W Costello, Clinical Research Centre, Beaumont Hospital and RCSI University of Medicine and Health Sciences, Dublin, Ireland, Tel +353 01-8093761, Email rcostello@rcsi.comPurpose: Educating patients to self-manage chronic diseases such as asthma is a key role for nurses. The success of this education is often limited by low patient self-efficacy. In this study, we hypothesized that the self-efficacy of patients could be enhanced if their education was based on biofeedback of their own self-management, following a nurse led educational intervention.Patients and Methods: Patients with severe and uncontrolled asthma from one centre who participated in an eight-month, nurse-led asthma education and dose adjustment Randomised Control Trial (RCT) were studied (NCT02307669). Inhaler adherence and technique of use were objectively assessed using a validated digital device. The data recorded on this device was used as the basis for the individualised biofeedback. The Asthma Self-efficacy Questionnaire was used to assess self-efficacy.Results: A total of 88 participants (44 in each group) completed the asthma self-efficacy questionnaire at the end of the study. The mean overall level of self-efficacy was high across both groups; 91 (8.7), with both biofeedback and standard care groups having similarly high levels of self-efficacy, biofeedback group: 89 (10) and standard care group 93 (6). Self-efficacy was not related to objective measures of adherence at either the start of the study, 68 (26), p=0.23, or the end of the study, 58 (32), p=0.62. It was also not related to peak expiratory flow (PEF) at the end of the study in either group (r2= 0.0245, p=0.14). Self-efficacy was related to asthma control test (ACT), 18 (5.5), p=0.0014 and quality-of-life measures; EuroQol (EQ5D3L) 6.4 (1.5) p=0.02.Conclusion: Repeated nurse-delivered education results in high levels of self-efficacy among patients with severe asthma. A high level of perceived self-efficacy should not be assumed to result in higher inhaler adherence.Keywords: nursing education, patient education and self-management

Elissa Burton,1,2 N Frances Horgan,3 Vanda Cummins,3,4 Austin Warters,5 Lauren Swan,6,7 Maria O’Sullivan,7 Dawn A Skelton,8,9 Bex Townley,9 Frank Doyle,10 Samira B Jabakhanji,11 Jan Sorensen,11 Debbie Rooney,6 Lisa Murphy,6 Rose Galvin12 1Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia; 2enAble Institute, Curtin University, Perth, Western Australia, Australia; 3School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland; 4Primary Care Physiotherapy Services CHO9, Health Service Executive (HSE), Dublin, Ireland; 5Older Person Services CHO9, Health Service Executive (HSE), Dublin, Ireland; 6North Dublin Home Care (NDHC), Dublin, Ireland; 7Department of Clinical Medicine, Trinity College Dublin (TCD), Dublin, Ireland; 8School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland; 9Later Life Training Ltd, Killin, Scotland; 10Department of Health Psychology, RCSI University of Medicine and Health Sciences, Dublin, Ireland; 11Healthcare Outcomes Research Centre (HORC), RCSI University of Medicine and Health Sciences, Dublin, Ireland; 12School of Allied Health, Ageing Research Centre, Health Research Institute, University of Limerick (UL), Limerick, IrelandCorrespondence: Elissa Burton, Curtin School of Allied Health, Curtin University, GPO Box U1987, Bentley, Western Australia, 6845, Australia, Tel +61 8 9266 4926, Fax +61 8 9266 3699, Email E.Burton@curtin.edu.auPurpose: Physical activity has been shown to improve older adults’ functional capacity, independence, and quality of life. In a feasibility study, we embedded a movement approach within older adults existing home care services through “Care to Move” (CTM). The aim of this qualitative study is to explore older adults’ experiences of CTM within their home care support services and to identify the strengths and barriers of engaging in CTM from the perspective of the older recipient.Materials and Methods: We conducted semi-structured telephone interviews with 13 older adults and one informal carer. Topics covered included participants’ overall experiences of CTM, changes to their overall activity and participation, aspects of CTM that they found valuable and issues that were challenging. Interview transcripts were coded and analyzed thematically to capture barriers and facilitators to the approach delivery.Results: Four themes were developed: i) “I have good days and bad days”, ii) “safety and security is the name of the game”, iii) “we’re a team as it stands’, iv) “it’s [COVID-19] depressing for everybody at the moment”. Older adults identified benefits of CTM engagement including improvements in physical and psychological wellbeing. However, subjective frailty and self-reported multimorbidity influenced overall engagement. Participants expressed concerns around the logistics of delivering CTM and competing care staff interests. The broader role of care staff in supporting CTM was highlighted, as well as the emotional support that staff provided to older adults. Care staff continuity was identified as a barrier to ongoing engagement. The impact of COVID-19 on older adults physical and mental health negatively impacted the delivery of the approach.Conclusion: Our findings suggest that embedding CTM within home care services is feasible and that older adults enjoyed engaging in CTM. Addressing care staff continuity and adopting individual approaches to CTM delivery may enhance the implementation of services.Keywords: movement, older people, community care, motivation, barriers, home support

Lauren Swan,1,2 N Frances Horgan,3 Vanda Cummins,4 Elissa Burton,5 Rose Galvin,6 Dawn A Skelton,7,8 Bex Townley,8 Frank Doyle,9 Samira B Jabakhanji,10 Jan Sorensen,10 Debbie Rooney,2 Lisa Murphy,2 Austin Warters,11 Maria O’Sullivan1 1Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland; 2North Dublin Home Care (NDHC), Dublin, Ireland; 3School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland; 4Primary Care Physiotherapy Services CHO9, Health Service Executive (HSE), Dublin, Ireland; 5Curtin School of Allied Health, Curtin University, Perth, Australia; 6School of Allied Health, Ageing Research Centre, University of Limerick (UL), Limerick, Ireland; 7School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland; 8Later Life Training, Killin, UK; 9Department of Health Psychology, RCSI University of Medicine and Health Sciences, Dublin, Ireland; 10Healthcare Outcomes Research Centre (HORC), RCSI University of Medicine and Health Sciences, Dublin, Ireland; 11Older Person Services CHO9, Health Service Executive (HSE), Dublin, IrelandCorrespondence: Maria O’Sullivan, Email maria.osullivan@tcd.ieIntroduction: In Ireland, over 55,000 older adults are supported in their community by formal home support, amounting to an estimated 23 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) program through existing home support services. This qualitative study aimed to explore the experience and perceptions of Health Care Assistants (HCAs), who were trained in and delivered the CTM program.Methods: We conducted semi-structured telephone interviews with 22 HCAs [mean age 49.0 ± 10.7 years and female 21/22] involved in the delivery of the program with older adults [n = 35, mean age 82.8 (7.8) years]. Interview transcripts were coded and analyzed thematically to capture barriers and enablers to program delivery.Results: Barriers and enablers were identified under three themes i) the CTM approach ii) the home support setting, iii) older adults and physical activity, with iv) delivering care in a crisis and v) future directions further identified. Overall, there was a positive perception of the program’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-orientated nature of home support were reported as recurring barriers for CTM. Many HCAs commented on the value and perceived positive benefits of the program for their clients. Though negative perceptions of older adults’ motivation or ability to engage with physical activity were noted. Risk, such as injury or pain, was identified but was not a dominant theme.Conclusion: Our 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 aging in place.Keywords: aging, physical activity, integrated care, frailty, aging in place

C Lewis,1 Z Moore,1 F Doyle,2 A Martin,3 D Patton,1 LE Nugent1 1School of Nursing and Midwifery, Royal College of Surgeons Ireland, 2Department of Psychology, Royal College of Surgeons in Ireland, 3Beaumont Hospital, Dublin, Ireland Background: Globally the older population is increasing rapidly. As a result there is an increase in frail older persons living within the community, with increased risks of a hospital admission and higher mortality and morbidity rates. Due to complexity of care, health care professionals face challenges in providing effective case management and avoiding unplanned admissions to hospital. A community virtual ward (CVW) model was developed to assist health care professionals to support older persons at home during periods of illness and/or functional decline.Methods: A quantitative observational study was conducted to examine if a CVW model of care reduced unplanned hospital admissions and emergency department (ED) presentations in 54 patients over a 12-month period. The sign-rank test examined matched data on bed days, ED presentations, and unplanned hospital admissions pre- and post-CVW implementation. Other risk factors for admission to hospital were examined using the Mann–Whitney test pre- and post-CVW admission, including falls, living alone, and cognition. Correlations between hospital admission avoidances and unplanned hospital admissions and ED presentations were tested using Spearman’s p test.Results: There was a reduction in ED presentations post-CVW admission (P

Lisa Mellon,1 Frank Doyle,1 Daniela Rohde,1 David Williams,2 Anne Hickey1 1Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland; 2Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland Background: Patient delay in presenting to hospital with stroke symptoms remains one of the major barriers to thrombolysis treatment, leading to its suboptimal use internationally. Educational interventions such as mass media campaigns and community initiatives aim to reduce patient delays by promoting the signs and symptoms of a stroke, but no consistent evidence exists to show that such interventions result in appropriate behavioral responses to stroke symptoms. Methods: A systematic literature search and narrative synthesis were conducted to examine whether public educational interventions were successful in the reduction of patient delay to hospital presentation with stroke symptoms. Three databases, MEDLINE, CINAHL, and PsycINFO, were searched to identify quantitative studies with measurable behavioral end points, including time to hospital presentation, thrombolysis rates, ambulance use, and emergency department (ED) presentations with stroke. Results: Fifteen studies met the inclusion criteria: one randomized controlled trial, two time series analyses, three controlled before and after studies, five uncontrolled before and after studies, two retrospective observational studies, and two prospective observational studies. Studies were heterogeneous in quality; thus, meta-analysis was not feasible. Thirteen studies examined prehospital delay, with ten studies reporting a significant reduction in delay times, with a varied magnitude of effect. Eight studies examined thrombolysis rates, with only three studies reporting a statistically significant increase in thrombolysis administration. Five studies examined ambulance usage, and four reported a statistically significant increase in ambulance transports following the intervention. Three studies examining ED presentations reported significantly increased ED presentations following intervention. Public educational interventions varied widely on type, duration, and content, with description of intervention development largely absent from studies, limiting the potential replication of successful interventions. Conclusions: Positive intervention effects were reported in the majority of studies; however, methodological weaknesses evident in a number of studies limited the generalizability of the observed effects. Reporting of specific intervention design was suboptimal and impeded the identification of key intervention components for reducing patient delay. The parallel delivery of public and professional interventions further limited the identification of successful intervention components. A lack of studies of sound methodological quality using, at a minimum, a controlled before and after design was identified in this review, and thus studies incorporating a rigorous study design are required to strengthen the evidence for public interventions to reduce patient delay in stroke. The potential clinical benefits of public interventions are far-reaching, and the challenge remains in translating knowledge improvements and correct behavioral intentions to appropriate behavior when stroke occurs. Keywords: acute stroke treatment, prehospital delay, onset to door times, public education, professional education, interventions

Millisecond scale benzotriazole (BTA) adsorption kinetics in acidic aqueous solution containing 0.01 M glycine and 0.01 M BTA have been investigated. Chronoamperometry was used to measure current densities on the surface of a micro-copper electrode in pH 4 aqueous solutions containing 0.01 M glycine with or without 0.01 M BTA. In the presence of BTA the current density decreased as the inverse of the square root of time for a few seconds due to adsorption of BTA. At potentials above 0.4 V saturated calomel electrode the current leveled off after a second or so due to the formation of a Cu(I)BTA monolayer on the copper surface. Based on these data a governing equation was constructed and solved to determine the initial kinetics of BTA adsorption. Analysis shows that material removal during copper chemical mechanical planarization (CMP) in this slurry chemistry occurs mostly by direct dissolution of copper species into the aqueous solution rather than mechanical removal of oxidized or pure copper species and that each interaction between a pad asperity and a given site on the copper removes only a small fraction of the Cu(I)BTA species present at that site.

During copper CMP, abrasives and asperities interact with the copper at the nano-scale, partially removing protective films. The local Cu oxidation rate increases, then decays with time as the protective film reforms. In order to estimate the copper removal rate and other Cu-CMP output parameters with a mechanistic model, the passivation kinetics of Cu, i.e. the decay of the oxidation current with time after an abrasive/copper interaction, are needed. For the first time in studying Cu-CMP, microelectrodes were used to reduce interference from capacitive charging, IR drops and low diffusion limited currents, problems typical with traditional macroelectrodes. Electrochemical impedance spectroscopy (EIS) was used to obtain the equivalent circuit elements associated with different electrochemical phenomena (capacitive, kinetics, diffusion etc.) at different polarization potentials. These circuit elements were used to interpret potential-step chronoamperometry results in inhibiting and passivating solutions, notably to distinguish between capacitive charging and Faradaic currents. Chronoamperometry of Cu in acidic aqueous glycine solution containing the corrosion inhibitor benzotriazole (BTA) displayed a very consistent current decay behavior at all potentials, indicating that the rate of current decay was controlled by diffusion of BTA to the surface. In basic aqueous glycine solution, Cu (which undergoes passivation by a mechanism similar to that operating in weakly acidic hydrogen peroxide slurries) displayed similar chronoamperometric behavior for the first second or so at all anodic potentials. Thereafter, the current densities at active potentials settled to values around those expected from polarization curves, whereas the current densities at passive potentials continued to decline. Oxidized Cu species typically formed at ‘active’ potentials were found to cause significant current decay at active potentials and at passive potentials before more protective passive films form. This was established from galvanostatic experiments.

CMP faces numerous challenges, as we move towards 45-nm and 32-nm nodes. The most important of these, as identified by ITRS [1], are: a) reliably predicting and controlling post-CMP topography (dishing and erosion loss should be limited to within 10% of the interconnect height throughout the die); b) Integration of ultra low-Kdielectric materials, including predicting stresses and damage, and designing very low stress polishing processes; and c) designing new planarization processes for new materials and new requirements.To address these, a multi-scale (feature/die/wafer) CMP modeling framework is being developed for enabling Design for Manufacturing (DfM) and Manufacturing for Design (MfD). Topographic evolution has been studied for Shallow Trench Isolation CMP and is now being extended to copper CMP. A detailed, quantitative understanding of the mechanism(s) of CMP is being elucidated, using fundamental experiments and a mechanistic model based on physical data. Stress issues in low-K dielectric during copper CMP, which can lead to fracture and delamination, are being studied using Finite Element Modeling.