This study evaluated an internet-based training module, CARES,® (Connect with the resident; Assess behavior; Respond appropriately; Evaluate what works; Share with the team;) to determine its feasibility for certified nurse assistants in 3 nursing homes and 1 assisted living facility. Preand post-test questionnaires were administered to certified nurse assistants (CNAs; N = 40) to determine improvements in dementia care knowledge and perceptions of competence in dementia care. Dementia care knowledge improved significantly after CARES® training. Over 85% of the sample agreed or strongly agreed that the CARES® protocol improved mastery, care competency, and reduced stress related to dementia resident care. Open-ended feedback indicated that CARES® provided new information and skills to CNAs pertaining to dementia care. The results suggest that internet-based programs such as CARES® represent time-and cost-efficient methods to deliver dementia care training in long-term care settings.

[1] The Integrated Ocean Drilling Program (IODP) Arctic Coring Expedition (ACEX) Hole 4C from the Lomonosov Ridge in the central Arctic Ocean recovered a continuous 18 m record of Quaternary foraminifera yielding evidence for seasonally ice-free interglacials during the Matuyama, progressive development of large glacials during the mid-Pleistocene transition (MPT) $1.2-0.9 Ma, and the onset of high-amplitude 100-ka orbital cycles $500 ka. Foraminiferal preservation in sediments from the Arctic is influenced by primary (sea ice, organic input, and other environmental conditions) and secondary factors (syndepositional, long-term pore water dissolution). Taking these into account, the ACEX 4C record shows distinct maxima in agglutinated foraminiferal abundance corresponding to several interglacials and deglacials between marine isotope stages (MIS) 13-37, and although less precise dating is available for older sediments, these trends appear to continue through the Matuyama. The MPT is characterized by nearly barren intervals during major glacials (MIS 12, 16,(22)(23)(24) and faunal turnover . Abundant calcareous planktonic (mainly Neogloboquadrina pachyderma sin.) and benthic foraminifers occur mainly in interglacial intervals during the Brunhes and very rarely in the Matuyama. A distinct faunal transition from calcareous to agglutinated foraminifers 200-300 ka in ACEX 4C is comparable to that found in Arctic sediments from the Lomonosov, Alpha, and Northwind ridges and the Morris Jesup Rise. Down-core disappearance of calcareous taxa is probably related to either reduced sea ice cover prior to the last few 100-ka cycles, pore water dissolution, or both.

Background Research in chronic alcoholics on memory, decision making, learning, stress and reward circuitry has increasingly highlighted the importance of subcortical brain structures. In addition, epidemiological studies have established the pervasiveness of co-occurring psychiatric diagnoses in alcoholism. Subcortical structures have been implicated in externalizing pathology, including alcohol dependence, and in dysregulated stress and reward circuitry in anxiety and mood disorders and alcohol dependence. Most studies have focused on active or recently detoxified alcoholics, while subcortical structures in long-term abstinent alcoholics (LTAA) have remained relatively uninvestigated. Methods Structural MRI was used to compare volumes of eight subcortical structures (lateral ventricles, thalamus, caudate, putamen, pallidum, hippocampus, amygdala and nucleus accumbens) in 24 female and 28 male long-term abstinent alcoholics (LTAA) (mean abstinence = 6.3 years, mean age = 46.6 years) and 23 female and 25 male nonalcoholic controls (NAC) (mean age = 45.6 years) to explore relations between subcortical brain volumes and alcohol use measures in LTAA, and relations between subcortical volumes and psychiatric diagnoses and symptom counts in LTAA and NAC. Results We found minimal differences between LTAA and NAC in subcortical volumes. However, in LTAA, but not NAC, volumes of targeted subcortical structures were smaller in individuals with vs. without comorbid lifetime or current psychiatric diagnoses, independent of lifetime alcohol consumption. Conclusions Our finding of minimal differences in subcortical volumes between LTAA and NAC is consistent with LTAA never having had volume deficits in these regions. However, given that imaging studies have frequently reported smaller subcortical volumes in active and recently detoxified alcoholics compared to controls, our results are also consistent with recovery of subcortical volumes with sustained abstinence. The finding of persistent smaller subcortical volumes in LTAA, but not NAC, with comorbid psychiatric diagnoses, suggests that the smaller volumes are a result of the combined effects of chronic alcohol dependence and psychiatric morbidity, and suggests that a comorbid psychiatric disorder (even if not current) interferes with the recovery of subcortical volumes.

Background Disturbed gait and balance are among the most consistent and salient sequelae of chronic alcoholism. Results of small sample longitudinal investigations have provided evidence that partial recovery of gait and balance functions in alcoholics may be achieved with abstinence. However, abstinence durations reported have been limited, and their power and generalizability have suffered from small sample sizes. Methods In the present study we employed a cross-sectional approach to assess gait and balance functions in short-term (6 to 15 weeks) abstinent (STAA; n = 70) and long-term (minimum 18 months, mean = 7.38 years) abstinent (LTAA; n = 82) alcoholics. STAA and LTAA did not differ with respect to lifetime alcohol consumption, family drinking density, or years of education. In addition, we examined effects of gender and alcohol use variables. Results Our main findings were 1) persistent disturbed gait and balance in STAA, and disturbed standing balance in LTAA, 2) overall less impaired performance of LTAA compared to STAA on gait and balance measures, and 3) worse performance of STAA (but not LTAA) women, compared to men, on standing balance without visual control. Conclusions Our results suggest that alcoholics’ gait and balance can continue to recover with long abstinence from alcohol, but that deficits persist, especially in eyes-closed standing balance. In addition, our results are consistent with more severe alcohol-induced ataxia in women than in men but suggest that, with extended abstinence, women recover gait and balance function to a level comparable with men.