Hinkel ruled out for up to 9 months through injury

GLASGOW, Scotland (AP) — Celtic says defender Andreas Hinkel will be out of action for up to nine months after injuring his right knee in training.

The Scottish club said Thursday the 28-year-old Germany international required …

WINE SIPPER

UPSCALE PINOT NOIR

Thanksgiving is on the horizon, which for most people means turkey on the table. At my house, and if you're reading this column, I expect at yours, that also means a few bottles of wine. The good news is that turkey is pretty much wire neutral. Any member of red or white wines pair nicely with the big bird. The bad news is that the accompanying side dishes, from cranberry sauce to oyster dressing to green bean casserole to candied sweet potatoes, make things a bit more difficult. What I look for are fruit-centered wines that have good acidity but are soft on the tannins, and foodfriendly Pinot Noir is always one of my first choices. We tried Pirtots from all …

European Union says economy faces strong headwinds from credit turmoil

The European Commission says the 15-nation eurozone faces "strong headwinds from the turmoil in financial markets and a weakening US economy.

EU monetary affairs chief Joaquin Almunia says it's not clear how long the turmoil will last and how much it …

Hendricks' confidence taking off

Chicago Christian sophomore Ryann Hendricks gets nervous beforebig track meets and admits she was intimidated before the state meetlast season.

But after working with the University of Chicago track club andcompeting in the 400-meter relay last summer at the Junior Olympicsin Omaha, Neb., Hendricks has more confidence in herself and in howshe will do in her events.

Hendricks competes in the triple and long jumps and will run herfavorite event, the 200-meter dash, for the Class A Knights duringthe outdoor season.

[The 200] is a challenge because it's not a long race, yet it'snot short, either,'' said Hendricks, who capped a strong indoorseason by finishing …

Parents to be more involved than ever with CPS report cards

Last Friday's announcement of a new form of report card by Chicago Public Schools Chief Executive Officer Arne Duncan was relatively muted -- as big changes in school policy go -- considering its widespread importance to students.

The revised form will be used for children enrolled in the system's 500 elementary schools. It will affect pre-kindergarten students and for bilingual students, and it will contain a key element enabling parents to more accurately gauge their children's progress and challenges.

It recommends a uniform grading scale for teachers that will relate percentage grades to letter grades from `A' downward, thereby making evaluations much more close to …

Howard leads Orlando to 112-72 win over Toronto

ORLANDO, Fla. (AP) — Dwight Howard had 31 points and 19 rebounds, helping the Orlando Magic rout the reeling Toronto Raptors 112-72 on Friday night.

Ryan Anderson added 21 points for Orlando, which avenged a four-point home loss to the Raptors in November. Howard earned his 31st double-double of the season, J.J. Redick scored 12 points and Brandon Bass finished with 10.

DeMar DeRozan led the Raptors with 16 points. Andrea Bargnani scored all 11 of his points in the first half as Toronto picked up its sixth consecutive loss.

The Raptors were within four in the third quarter, but the Magic dominated the rest of the game. They led 73-57 after three and outscored the Raptors …

French team makes new `miracle' rescue in Haiti

A French search team that wouldn't go home pulled off another "miracle" rescue in Port-au-Prince, lifting a 17-year-old girl alive from beneath this cityscape of rubble. Above ground, hundreds of thousands of other survivors hoped for a breakthrough of another kind _ the delivery of badly needed food aid.

Key players in the Haiti earthquake relief effort, in what may have been a pivotal meeting, decided to better coordinate by dividing up the city among themselves for handing out food.

Food distribution thus far has often been marked by poor coordination, vast gaps in coverage, and desperate, unruly lines of needy people in which young men at times …

Take my president . . . please

Freud explained the joke as the release of tension, and wit asthe bridging of contradictions. Bill Clinton obviously has lots oftension that needs releasing and he loves building bridges. But atthe 84th annual White House Correspondents' Dinner on Saturday, allcontradictions were left unbridged and there were no jokes skeweringpresidential misdemeanors to help relieve the tension. Absolutelynone.

In recent years, the evening's entertainment has been providedby the Fourth Estate's designated presidential satirist of themoment. But this year the organizers chose Ray Romano, the amiablestar of the CBS sitcom "Everybody Loves Raymond," who started his actby admitting that …

Christina Ricci 's Oscars dress goes to Mich. prom

WATERFORD, Mich. (AP) — Lots of teenage girls go all out for their prom, but few get to wear a $25,000 Versace Couture dress designed for actress Christina Ricci.

Ricci wore the sparkling, pale gray, floor-length dress to this year's Oscars.

Kayla Staskiewicz wore it to Waterford Mott High School's May 13 prom.

The Oakland Press of Pontiac reported Sunday that her father, Mike …

Ariz. gov: Most illegal immigrants smuggling drugs

Gov. Jan Brewer said Friday that most illegal immigrants entering Arizona are being used to transport drugs across the border, an assertion that critics painted as exaggerated and racist.

Brewer said the motivation of "a lot" of the illegal immigrants is to enter the United States to look for work, but that drug rings press them into duty as drug "mules."

"I believe today, under the circumstances that we're facing, that the majority of the illegal trespassers that are coming into the state of Arizona are under the direction and control of organized drug cartels and they are bringing drugs in," Brewer said.

"There's …

Women In Leadership: Wendy W. Davis

Wendy Davis, an attorney, is the only female partner at Beckman Lawson, LLP. She embodies all of the characteristics the Women in Leadership Award is designed to recognize. She is an obvious leader in her many roles, including mother, attorney, prosecutor, community citizen and volunteer. What sets her apart is the energy, passion, dedication and positive attitude she injects into every endeavor.

For Davis, it is all about having a vision and staying the course. "I believe that if you focus on being really good at whatever you do, you will get to where you want to go," she explains. "A true leader has a direction in mind and inspires others to achieve higher goats. Couple this with …

Agricultural Futures Down on CBOT

Agricultural futures traded mostly lower Friday on the Chicago Board of Trade.

Wheat for March delivery fell 16 cents to $9.29 a bushel; March corn dropped 3.5 cents to $4.625 a bushel; March oats rose half a cent to $3.26 a bushel; March soybeans fell 12 cents to $12.555 a bushel.

Beef …

A look inside the $1 million a month collision shop

A combination of first-rate employees, a modern repair facility and top-notch customer service produces a dealership repair facility that is second in the nation only to its sister store.

Stories of million-dollar giveaways on the Internet and on TV shows such as "Who Wants to be a Millionaire" have become fairly common these days. But when the story involves a collision shop averaging sales of nearly $1 million per month, the situation is a little more unique, especially because the majority of collision businesses produce less than $1 million in sales each year.

Huffines Collision Center in Lewisville, Texas boasted $3.8 million dollars in sales in the first four months of 2000 and racked up $1.25 million in sales in March alone.Yet, there is no secret ingredient to the business' success. Combining an excellent team, a modern facility and, of course, providing the best service possible to its customers has yielded the best results for this collision business.

In 1999, the shop was listed no. 2 in a ranking of the top 500 dealers ordered by body shop dollars in Ward's Dealer Business. It was second only to its sister store, Ray Huffines Chevrolet, which has a 35,000-sq.-ft. collision shop in Plano, Texas, about 30 miles away.

Huffines Chevrolet-Subaru and Ray Huffines Chevrolet are among five stores owned by the Huffines family. "We're a $500 million dollar company between our five stores," says Darren Huggins, body shop manager for the Lewisville facility. "We're not a mom-and-pop operation, but we're still a family-owned and-operated business."

Huggins is in his 13th year with the company, having started at Huffines Dodge, also in Lewisville. His beginnings in the collision industry occurred by chance. After college, Huggins received an offer to work for IBM. "At the time, IBM was Big Blue," he says. "You had to wear your hair a certain length, blue suit, blue tie and a certain kind of shoes. I went through seven interviews and after the last interview, they offered me a job, but I turned it down. Sometimes things feel right to you, and sometimes they don't."

Instead, he took a job as comptroller at an independent body shop. At first, he was paying the shop's bills and preparing its taxes. His duties soon evolved into writing estimates, ordering parts for customers and helping to run the shop. After a couple of years at the independent shop, he was offered the job at Huffines Dodge, and about four years ago, he began working at Huffines Collision Center. At the time, the shop's best month's sales totaled about $311,000, Huggins says.

Working out of a 16,000-sq.-ft. facility, the operation was in need of more space. Huggins was told that if his team could get the volume up, management would consider building a new shop. The business was soon generating $500,000 per month in sales. "It was unbelievable-and we actually did $711,000 in one month before the new shop was built," he says.

In June of last year, the collision center began operating out of its new, 45,000sq.-ft. facility, which includes 80 bays-36 are metal stalls and 44 are refinish stalls. Among the new equipment purchases were four 27-ft. paint booths, four double-- prep stations and a rotary track cutting booth. Also, 26 of the shop's stalls are fully set up for any unibody pull that needs to be done, Huggins says.

With the new facility Huggins admits, "The playing field is tilted our way," and the facility is poised to take over the No. 1 body shop ranking in this year's Ward's Dealer Business Top 500.

The shop employs 22 technicians, which includes two full-time mechanics and two technicians who specialize in glass and trim work. Training its technicians from the ground up is a plan in which Huggins firmly believes. "You're only as good as the people that work for you. If you don't have good people out there, you're in trouble," he says.

Huffines brings in technicians who have been through Wyoming Technical Institute or a local body shop program and starts them out as what they call light-line technicians.As the new recruits acquire more training and certification, they are promoted to mid-line technicians and, eventually, to top-line technicians. The shop has three technicians that have advanced to top-line technicians as part of this program.

The shop's technicians are I-CAR trained and are also trained in Chrysler, Plymouth, Dodge, Subaru and General Motors (GM) repair procedures to serve the Huffines dealerships that feed the collision center.The business is also in the process of becoming an I-CAR Gold shop.

Finding good technicians may be one issue, but retaining them can often be another." One thing about our place is we're always busy, so a technician knows he can always make a paycheck. He can make the same paycheck in June as he can make in November or December," says Huggins, adding that the average employee has been with the facility for more than five years.

About 710 vehicles pass through the facility each month, or an average of 28 to 30 cars per day. To handle the influx of vehicles, the shop employs a team of 65 overall.This includes technicians, porters and administrative staff, making it the largest department in the dealership. "To do the volume, yet keep in mind the quality and service aspects that the customer requires is everything," Huggins says. "That's what we try to do here.

I think that's what sets us apart from the average repair facility"

When approaching the building, the first thing customers may notice is its size. "Our place doesn't look like the average body shop," Huggins says.There is a greeter to welcome customers to the collision center, and the waiting area includes a TV and amenities for the kids, such as a Lego table and coloring books. Huffines is open from 7 a.m. to 7 p.m. Monday through Friday and 8 a.in. to 5 p.m. on Saturday. Enterprise Rent-A-Car is on the premises should the customer need temporary transportation.

To give customers personal attention, each of Huffines' seven estimators has a private office equipped with a workstation. Communication between the production manager, two quality control managers and the estimators during the day is key. They hold two status meetings per day, so the estimators can keep customers up-to-date on the progress of their vehicles.

Huffines also stands behind the work it performs, guaranteeing repairs for as long as the customer owns the vehicle. Huggins estimates that its repeat business is about 90 percent. "People keep coming back because we take care of business," he says. "That's the most important thing. Don't get me wrong, we have 14 DRPs [direct repair programs] here. We're adding two more.We're going to be at 16 DRPs, and you get a lot [of business] from that, but getting that customer, repairing that car and retaining them for life is our goal."

Despite the size of Huffines Collision Center, the elements that make the shop successful are simple-a quality team, a modern facility and the drive to be No. 1. As Huggins emphasizes, "We have the facility. We have the equipment. We are in the collision repair business."

[Author Affiliation]

Glenda Greenberg is formerly an associate editor of a trade publication covering the greenhouse industry. She currently works for a public relations firm serving a number of companies in the marine industry.

Pols: NYC Stiffed Again on Terror Funds

NEW YORK - The city where a terrorist attack destroyed the World Trade Center towers has again been stiffed in the distribution of federal anti-terrorism funding, members of the state's congressional delegation complained Saturday.

The numbers are not official yet, but Sen. Charles Schumer and Rep. Peter King said the city is scheduled to receive about $134 million from an urban security grant program - an increase of about 8 percent from last year but still $73 million less than the city received two years ago.

"Why do they persist in giving money to places that need it a lot less than New York City?" said Schumer, a Democrat. "It's a disgrace. It's confounding. ... It's once again unfair to New York. Our needs are different than any other city."

Last year, New Yorkers complained long and loudly after the Department of Homeland Security slashed anti-terrorism funding for the city by $83 million. The nation's largest city lost 40 percent of its funding just five years after the World Trade Center terrorist attacks, while federal money was increased in such places as Louisville, Ky., and Omaha, Neb.

"They still just don't get it," said King, the ranking Republican on the House Homeland Security Committee. "New York is by far the No. 1 terrorist target in the country, and no one else is even a close second. That's the reality. I'm disappointed and angry."

Word of the $10 million increase over last year was particularly painful since it came around the same time as terrorist activity in Britain, which led New York City officials to heighten security, Schumer said.

Russ Knocke, spokesman for the Department of Homeland Security, declined to comment, saying it was unclear when the anti-terrorism grants would be officially announced.

Both Schumer and King expressed hopes - and doubts - that the funding would be increased before the announcement.

"I doubt it, but hope springs eternal," King said. "We need to keep the pressure on."

Pierce out of season opener with bruised heel

NEW YORK (AP) — Boston forward Paul Pierce missed the NBA season opener at New York because of a bruised right heel, and the Celtics hope he can return Tuesday when they visit Miami.

Sasha Pavlovic started at forward for the Celtics on Sunday. Coach Doc Rivers says Pierce did little during a light practice Saturday, making it an easy decision to sideline the All-Star.

Rivers says he might bring Pierce off the bench when he can play, since he has had only one practice so far.

Knicks coach Mike D'Antoni says he would likely be without backup point guard Mike Bibby because of a sore back.

Gift baskets stolen from church center

Workers at a youth center in Evanston are seeking donations tohelp needy families whose holiday gift baskets were stolen this weekfrom a church basement.

The Youth Organizations Umbrella Inc. said someone made off with35 wrapped gifts Tuesday; valued at $525, including compact discsand sweaters earmarked for Evanston children.

The gifts were taken from the organization's drop-in center inthe basement of Grace Lutheran Church, 1430 South Blvd. They weredonated by members of First United Church of Evanston as part of itsChristmas celebration."It looks like whoever stole the presents ran out of hands tocarry everything because some gifts were left behind and some werefound in an alley," said Melissa Earley, resource developmentcoordinator for the youth center.Evanston police were unsuccessful in obtaining fingerprints fromthe gifts left behind and had no suspects in the theft.The nonprofit Y.O.U. group offers after-school programs,counseling and academic help to about 800 at-risk kids in Evanstonannually."We hope that by getting the word out, other people will makedonations so we can still provide gifts for all the families we hadplanned to help," Earley said.Those interested in helping should first call Y.O.U. at (847)866-7025.Evanston police also will be holding its own gift drive nextweek. On Tuesday; , police will assemble food baskets for needyEvanston seniors and send officers to deliver the gifts.

Machel: Mozambique must tackle broad food crisis

JOHANNESBURG, South Africa (AP) — The widow of independent Mozambique's first president says the debate over food in her impoverished homeland does not end with the government's reversal on bread prices.

Graca Machel, an international advocate for children and the poor, said in an Associated Press interview Friday that she and other activists will press the government to improve food production.

Machel says: "We are forcing the dialogue to happen."

Protests last week in Mozambique's capital, Maputo, over hikes in the costs of bread, water and electricity turned violent, with at least 13 killed. On Tuesday, the government reversed the bread and water increases.

Military: Errors Made in Tillman's Death

WASHINGTON - Nine high-ranking Army officers, including four generals, made critical errors in reporting the friendly fire death of Army Ranger Pat Tillman in Afghanistan, but there was no criminal wrongdoing in the shooting of the former NFL player, the military concluded Monday.

Defense officials and a pair of reports released Monday on the 2004 incident, however, did not rule out criminal action by those who provided misleading information as the military was investigating the killing. They said, however, that they believed there was no orchestrated cover-up.

Army and Defense Department investigators said officers looking into Tillman's death passed along misleading and inaccurate information and delayed reporting their belief that Tillman was killed by fellow Rangers.

The investigators recommended the Army take action against the officers, but suggested no specific punishments and left that decision to the Army. Possible steps could include demotions, dishonorable discharges, jail or letters of reprimand. Acting Army Secretary Peter Geren has asked Gen. William Wallace, who oversees training for the Army, to review the actions of the officers and to provide a progress report in 30 days.

The Army will take corrective action and hold people accountable, said Geren, who also issued an apology.

"We as an Army failed in our duty to the Tillman family, the duty we owe to all the families of our fallen soldiers: Give them the truth, the best we know it, as fast as we can," Geren told reporters at the Pentagon. "Our failure in fulfilling this duty brought discredit to the Army and compounded the grief suffered by the Tillman family. For that, on behalf of the Army, I apologize to the Tillman family."

Investigators said there was no broad effort to conceal information. Though dozens of soldiers knew quickly that Tillman had been killed by his fellow troops, the Army said initially that he was killed by enemy gunfire when he led his team to help another group of ambushed soldiers. It was five weeks before his family was told the truth, a delay the Army has blamed on procedural mistakes.

"We thought there was never an attempt to cover up that we saw," Defense Department Acting Inspector General Thomas F. Gimble said during a Pentagon briefing as the military released two reports, one by the Army Criminal Investigation Command and the other by the inspector general.

Tillman's death received worldwide attention because he had walked away from a huge contract with the National Football League's Arizona Cardinals to enlist in the Army after the terrorist attacks of Sept. 11, 2001.

The highest current ranking officer blamed in the incident is Lt. Gen. Stanley McChrystal, commander of the Joint Special Operations Command. Investigators said he was "accountable for the inaccurate and misleading assertions" contained in the papers recommending that Tillman get the Silver Star award.

Also criticized in the investigation were Lt. Gen. Philip Kensinger, the now-retired three-star general who was in charge of Army special operations, as well as Tillman's regimental commander, now-Brig. Gen. James C. Nixon, who was a colonel at the time. Nixon is now director of operations at the Center for Special Operations at MacDill Air Force Base in Florida.

Using photographs, charts and a video reenactment of the day's events, investigators walked reporters through a minute-by-minute accounting of Tillman's death in the rocky Afghanistan hills on April 22, 2004.

The inspector general investigation also recommended that the Army review its award of the Silver Star to Tillman, but Geren said the award would stand. Gimble said some information provided to justify the citation was inaccurate.

Republican presidential hopeful John McCain, campaigning in Texas on Monday, called it a "travesty" that the events surrounding Tillman's death were "covered up, if not distorted." McCain emphasized that he hadn't actually seen the report but said he was familiar with it.

"An inexcusable cover-up took place regarding the circumstances of Pat Tillman's death," said McCain, R-Ariz.

President Bush has been keeping apprised of developments in the Tillman case and "wants to learn more," White House spokeswoman Dana Perino said. She said the president, like Defense Secretary Robert Gates, has "very serious concerns" about the events surrounding Tillman's death, his family's notification and the performance of military personnel.

---

Associated Press writers Robert Burns in Washington and Scott Lindlaw in San Jose, Calif., contributed to this story.

Effect of Alzheimer's Training on Multicultural Personal Care Aides

This article reports on the first 2 years of an ongoing project that examined the efficacy of a 10-hour dementia training provided to entry-level personal care aide (PCA) trainees from the Hispanic, White, African American, and Asian communities in New York City. Participants were enrolled in a 90-hour PCA training program offered by the New York City Department for the Aging and were either recipients of public assistance, displaced employees from September 11, or recent immigrants to the United States from China. Classes were conducted in Spanish, English, and Mandarin/Cantonese. An 11-item Knowledge of Alzheimer's Disease instrument was developed for the purposes of this project and administered before and after the dementia training and at 3 months following graduation. All groups, regardless of language, showed a significant increase in knowledge of Alzheimer's disease at the conclusion of the training and retention of this knowledge at 3 months follow-up. Age was strongly correlated with an increase in knowledge, while gender and education were not.

Keywords: home care; Alzheimer's disease; multicultural; training

The projected growth in the numbers of older adults in the United States by 2050 will include a significant increase from the current 4.5 million individuals with Alzheimer's disease to an estimated 12 million (Wilmoth & Longino, 2006). The care and management of persons with dementia of the Alzheimer's type requires a specialized knowledge and understanding of home care provision. This project examined the efficacy of efforts by the New York City Department for the Aging (DFTA) to enhance the capabilities of ethnically diverse trainees enrolled in the department's WEP/BEGIN program to train personal care aides (PCAs). It involved a 10-hour dementia training designed to increase trainees' factual and practice knowledge of Alzheimer's disease. The project also examined associations between trainee sociodemographic characteristics and increased knowledge about Alzheimer's disease. A secondary intent of the training was to foster development of a culturally competent direct care workforce by providing trainees with the opportunity to enhance their marketability and subsequent earning power.

The expectancy-value theory of achievement motivation (Atkinson & Raynor, 1978, in Glynn, Aultman, & Owens, 2005) predicts that learning behavior is motivated by the perceived value of a goal and expectation of attaining that goal, contingent on completion of specified activities. Utilizing this framework, it was hypothesized that the PCA trainee would recognize the applied value of increased Alzheimer's knowledge as demonstrated by self-report and improvement in scores from pretest to posttest and by retention of that knowledge at the 3-month follow-up.

LITERATURE REVIEW

The literature on aging is replete with forecasts of an increased population within the next 30 to 40 years (Berkman, Gardiner, Zodikoff, & Harootyan, 2006; Knickman & Snell, 2002; U.S. Census Bureau, 2005). By 2030, the cohort between 65 and 84 years of age and the 85+ cohort are expected to double in number, growing to 72 million and 9.6 million, respectively (U.S. Census Bureau, 2005). The largest percentage of growth will occur in the 85+ age-group (Wang, 2004); by 2050, it is estimated that this oldest cohort will make up 34% of all elderly (Alecxih, 2001). The U.S. Census Bureau also projects that minorities will make up 25% of the elderly population in 2030 (Bonder, Martin, & Miracle, 2001), with notable increases among Hispanics and Asians (Gallagher-Thompson, Solano, Coon, & Are�n, 2003; Herrick & Brown, 1998; Wallace & Lew-Ting, 1992).

A surge in the incidence of Alzheimer's disease is also anticipated (Evans et al., 1989; New York State Department of Health, 2006; Wang, 2004) because the prevalence rate of the disease increases with age. Up to 50% of adults aged 80 and older exhibit some degree of cognitive impairment (Alzheimer's Association, 2004; Anderson, Wendler, & Congdon, 1996). Disproportionate frequency of Alzheimer's disease has been found among Caribbean Hispanics and African Americans (Evans et al., 1989; Tang et al., 2001). Limited information is available on the incidence of Alzheimer's disease in the Chinese population, as stigmatization of the disease in Chinese American communities discourages participation in Alzheimer's research or help-seeking behaviors (Mahoney, Cloutterbuck, Neary, & Zhan, 2005).

It is estimated that caregivers of older persons provide approximately 80% of the assistance needed to maintain them at home (Rosenbaum, Karuza, Katz, & Harazin, 2000). The number of informal caregivers, 2.2 million in 1982 (Anastas, Gibeau, & Larson, 1990), increased to 44.4 million individuals by 2004 (National Alliance for Caregiving & AARP, 2004). The challenges of caring for individuals with Alzheimer's disease have been well documented as caregivers struggle to cope with behavioral changes associated with various stages of the disease (Kuhn, 1990; Souren, Franssen, & Reisberg, 1997). Families frequently draw on their own physical, emotional, and financial resources in an effort to forestall nursing home placement by sustaining the person with dementia in the home (Mittelman et al., 1993; Robinson, Kiesler, & Looney, 2003).

A study of more than 400 caregivers in New York City (Levine et al., 2000) found that more than 58% felt that they were unprepared to care for their family member after a hospital discharge. As the incidence of Alzheimer's increases and as physical and/or cognitive care demands exceed individual and family capacity, the formal caregiving system will play an increasingly important role in providing needed support.

Paraprofessionals are the backbone of the formal care system. They comprise the certified nursing assistants (CNAs), orderlies, home health attendants, and PCAs who provide direct help to individuals with activities of daily living and instrumental activities of daily living. Approximately 600,000 paraprofessionals are employed in nursing homes and assist with bathing, dressing, grooming, feeding, and toileting, while an undetermined number of direct care workers are employed in the home setting (Wilner & Wyatt, 1998). These workers in the home setting are generally employed by a certified home health agency or are independent contractors who additionally shop, cook, and perform light household chores (Paraprofessional Healthcare Institute, 2003).

Close to two-thirds of consumers of paraprofessional services are 75 years of age and older (Alecxih, 2001). The number of elderly needing paraprofessional help is expected to increase exponentially as the population ages and as the model of home- and community-based service provision gathers momentum. In order to meet demand, it is estimated that between 5.7 million and 6.5 million paraprofessionals are needed by 2050 (Department of Health and Human Services & Department of Labor, 2003). Furthermore, given the increasing cultural diversity in the older population and the anticipated increase in Alzheimer's disease as people live longer, this labor force will need to be culturally competent (Alecxih, 2001) and possess some degree of familiarity with Alzheimer's disease and its management.

To develop the workforce to meet this demand, it will be necessary to address factors contributing to an anticipated decrease in the pool of available workers, such as attrition, low wages, lack of incentives, and few opportunities for professional advancement (National Center for Health Workforce Analyses, 2004). It will also be necessary to prepare workers better for the challenges they will encounter in patient care for the elderly.

Very little empirical research has been conducted about direct care workers in the home setting (Stone, 2001), although publications of the Paraprofessional Health Institute have done much to raise awareness about the value of the direct care workforce in general. Evidence-based analyses that address efficacy of dementia training for the home care worker are few. Most studies involving the paraprofessional have been conducted with CNAs in the nursing home or other structured settings.

Two studies described in the literature specifically explored offering dementia training to paraprofessionals in the nursing home environment. Peterson, Berg-Weger, McGillick, and Schwartz (2002) utilized a pretest/posttest/follow-up design to consider the benefits of a dementia course developed by the St. Louis Alzheimer's Association. The 6-hour training for CNAs, nurses, and facility administrators proposed to increase their knowledge of dementia along with their ability to identify nonthreatening approaches to hands-on care and cope with challenging behaviors. Outcome ben-efits were modest, with significance found only for increased knowledge of dementia. Two subscales of a 17-item Dementia Quiz and a Formal Caregiver Stress Index gauged training efficacy.

The second study involved a 6-hour communication skills program aimed at improving the dementia knowledge and caregiv-ing responses of CNAs and at reducing staff turnover (McCallion, Toseland, Lacey, & Banks, 1999). Conducted in three waves (baseline, 3 months, and 9 months), this study additionally looked at improvement in the well-being of nursing home residents as a result of CNA participation in the program. Standardized measures used in this study included a 33-item Knowledge of Alzheimer's Test, the Penn State Mental Health Questionnaire, the Cornell Scale for Depression in Dementia, the Cohen-Mansfield Agitation Inventory, and the Multidimensional Observation Scale for Elderly Subjects. Outcomes were improved caregiving responses and resident well-being as well as reduction in staff turnover. An increased knowledge of dementia was not supported, a finding the authors partially attributed to a training emphasis on behavior management.

A third report examined training intended to increase the home care worker's fundamental knowledge of aging. Researchers in Hawaii recognized the importance of a learning curriculum that validated and empowered the direct care worker new to the field of aging (Braun, Cheang, & Shigeta, 2005). Utilizing adult learning strategies, the curriculum included role playing, use of multimedia, field experience, and group discussion. The study's pretest/posttest design measured increased knowledge of aging, assessment and reporting skills, ability to manage stress, and empathic understanding of the older direct care client. A 20-item What's Your Aging IQ, a 7-point semantic differential attitude scale, and a 20-item five-module posttest supported an increase in overall aging knowledge and improved attitude toward older adults. Participants also affirmed a greater sense of self-esteem and appreciation for the role of the direct care worker by participants. However, since the curriculum touched only marginally on Alzheimer's disease and included nothing about clinical skills, no findings on these dimensions were reported.

Two chapters of the Alzheimer's Association across the country have reported conducting Alzheimer's-specific trainings for the home care worker for many years. In 1989, the New York City Chapter developed a 15- to 20-hour dementia specialist curriculum for home care workers that provided classroom and field experience (Thomas, 1990). This program has since expanded to a 40-hour training, with graduates receiving a certificate of attendance on course completion. In 1998, the Eastern North Carolina Chapter also began offering dementia training to home care workers. While anecdotal feedback has been largely positive, empirical studies have not been conducted to document the efficacy of this project.

In 1991, the George G. Glenner School of Dementia Care in San Diego, California, began providing basic skills training for paraprofessionals with an optional 9-hour dementia care specialist component. The program targeted individuals who were low income, unemployed, or on public assistance. Program success was measured by subjective reports from local nursing homes and home care agencies that hired graduates, with a reported 80% employment rate 6 months postgraduation.

Although there are similarities between the training efforts described in the literature, particularly the Glenner School's, and the subject of this paper, DFTA's conduct of dementia training in the native language of the PCA trainee is unique. There is a void in the literature regarding language-competent dementia trainings. Given the urgency of understanding Alzheimer's disease and its management within the context of a rapidly expanding minority older population, culturally and linguistically competent dementia training of a multiethnic direct care paraprofessional workforce is important.

METHODS

The target population for this project consisted of PCAs working with older adults with Alzheimer's disease-participants in the English, Spanish, and Chinese PCA training classes of the New York City DFTA and New York City Human Resource Administration's BEGIN program. The sampling frame was the roster of participants accepted into the PCA training class from October 2004 through October 2006; inclusion criterion was acceptance into an English, Spanish, or Chinese PCA training class.

A total of 21 classes received training. Seven PCA classes participated in the first year of the study: two English speaking, two Spanish speaking, and three Chinese speaking. In year 2 of the study, a total of 14 PCA classes were conducted: five English speaking, five Spanish speaking, and four Chinese speaking. Participants were assigned to classes by stated language preference.

Procedures

English- and Spanish-speaking individuals were recruited to the WEP PCA training program from the New York City Human Resource Administration's BEGIN Adult Basic Education and ESL Work Experience Program. As recipients of public assistance, these individuals self-selected to participate in PCA training. The Chinese trainees were workers displaced from the garment industry as a result of the September 11 terrorist attacks or recent immigrants to the United States who learned about this training by word of mouth.

Participants were introduced to the purpose of the 10-hour dementia training at a general orientation to the PCA classes and were provided with greater detail on the requirements of participation prior to the start of the dementia training. In the classroom setting and speaking the respective language of members of each class, research staff explained informed consent, participant confidentiality, the three waves of data collection, and instructions for questionnaire completion. Staff also informed participants that they would receive a nominal stipend on return of the 3-month follow-up questionnaire. Participants were reassured that they would still receive the PCA training should they decide not to participate in the study. All PCAs elected to participate.

The dementia training was conducted by a nurse and a social worker contracted through the Alzheimer's Association, New York City Chapter, and nursing staff from the BEGIN program. Classes were conducted in English, Spanish, and Mandarin/Cantonese, which accommodated the dialects of Chinese students. The initial design of the training was 3 days for all classes with concurrent field placement. In year 2, English and Spanish classes completed the dementia training within 2 days, while the Chinese class completed training within 3 days. Instruction involved an experiential mixed-methods use of lecture, video, role play, group exercises, and case discussion. At designated intervals during the field experience, trainees returned to the classroom to discuss questions or concerns with instructors. Each PCA trainee received a certificate of attendance for this aspect of his or her training. Trainees were guaranteed job placement with a home care agency on graduation.

Data were collected through self-administered questionnaires in three waves: prior to the start of the dementia training, on completion of the dementia training, and 3 months after graduation. Research staff remained in the room during completion of pretest and posttest questionnaires and collected completed instruments. The average completion time was 20 minutes. Tests were coded by class, and each participant had a unique identifier known only to one research staff member. The completed questionnaires were secured in a locked file drawer in a different building.

Follow-up questionnaires were mailed to each participant's home with a linguistically appropriate explanatory letter and a stamped, self-addressed envelope in which to return the survey. On receipt of the completed 3-month follow-up questionnaire, participants were mailed a stipend of $5.

Measures

An 11-item Knowledge of Alzheimer's Disease index was created for the purpose of this study and was used at pretest, posttest, and follow-up. The instrument was translated from English into Spanish and Chinese and back translated in order to ensure accuracy of meaning. Index items had face validity and consisted of questions that were developed on the basis of a review of the literature, expert opinion, and consensus. The index was designed to assess overall knowledge of Alzheimer's disease, care provision, communication, and behavior management.

Each item had four answer choices: one correct choice, two incorrect choices, and a choice of "don't know." Each correct choice contributed 1 point toward the total score. The theoretical range of scores was 0 to 11, with 11 indicating a high knowledge of Alzheimer's disease, provision of care, communication, and behavior management. If a respondent selected more than one choice or no choice was indicated, the answer was scored as incorrect and contributed 0 points toward the total score.

At pretest, participants were additionally asked to provide socio-demographic information and to indicate previous experience working with demented persons, prior receipt of formal caregiv-ing training, and length of time since formal caregiving training. Responses were open ended. At posttest, degree of satisfaction with the training was measured by asking if the training was useful to the participants' work as a PCA, if the material was easy to understand, if the participant felt more confident as a PCA because of this training, if the participant would be interested in more dementia training, and if the participant would recommend this training. Responses were agree, not sure, and disagree. Participants were also asked about the perceived helpfulness of the training format of lecture, role plays, video, and handouts; responses ranged from very helpful to not very helpful.

At 3 months, participants were asked if they had cared for anyone with dementia since graduation from the PCA training program, if the participant was currently caring for a person with dementia, if the participant felt the dementia training was helpful in caring for the client, and if the participant had subsequently reviewed any of the material received during training. Response categories were yes, no, and unsure. Space was provided for participants to comment briefly on the perceived value of the training.

RESULTS

Sociodemographics

A total of 144 trainees participated in the project, 37 in the English-speaking classes, 54 in the Spanish-speaking classes, and 53 in the Mandarin/Cantonese classes. All three waves of data collection were completed by 42.5% of participants (61 persons). Close to 32% completed pretest and posttest only. The majority of respondents were female (88.3%), with a mean age of 43.8 years ( SD = 11.3). Slightly more than 10% of participants were between the ages of 60 and 73. More than half the participants were Hispanic (55.8%), and more than one-third, 34.5%, were Asian. Of the remaining participants, 7.1% were Black/African American, and 1.8% were White (1.8%). The majority of respondents had at least some level of high school education (62.3%).

Knowledge of Alzheimer's Disease

The 61 participants who completed all three waves of data collection gained and retained a significant amount of knowledge as a result of the training. The mean index score prior to training was 7.16. This score significantly increased to 9.23 ( p < .001) at posttest and 9.26 ( p < .001) at 3-month follow-up, supporting the hypotheses of improved knowledge of Alzheimer's disease as a result of this training and retention of knowledge from pretest to 3-month follow-up. While posttest and follow-up scores were significant for all classes, Chinese participants scored higher at posttest and at follow-up than did the English- and Spanish-speaking groups.

PCA performance on a question about response to an Alzheimer's client who hits out during bathing illustrates the gain in knowledge. Answer choices were to "Give her a sponge and ask her to help with the bathing" (correct), "Tell her to stop because it's not nice to behave this way," and "Slap her back so she knows how it feels." At pretest, 11.5% answered incorrectly; at posttest and at 3 months, 100% responded correctly.

Although gender and education were not associated with greater knowledge of Alzheimer's disease, there was a strong positive correlation between age and knowledge posttest and follow-up scores, r = .552 and .501, respectively. The older the participant, the higher the knowledge score.

Satisfaction With Training

Although 15% of respondents indicated that they had previously provided care ranging from 1 month to 5 years for older relatives who were cognitively impaired, almost 62% of participants reported no prior dementia training. A little more than three-fourths (79%) viewed the training as being useful to their work as a PCA. Similarly, 77.8% reported that their self-confidence as a PCA increased as a result of this training.

The degree of difficulty in understanding the information as presented was not a barrier to understanding for three-quarters (75%) of the participants. Over three-quarters of the participants viewed lecture, video, and handouts as the most helpful modalities of learning, with role play the least helpful (68%). More than three-fourths of the participants (77.8%) wanted more dementia training, and 76.4% would recommend this training to others. At 3-month follow-up, slightly more than one-quarter (26.7%) of participants had cared for or were currently caring for persons with dementia. The majority of participants (90.7%) viewed the training to be helpful in preparation for their work with dementia clients.

DISCUSSION

Unique features of this study were the provision of dementia training in three languages to meet participants' linguistic preferences and guaranteed employment as PCAs on completion of the program. It is important to note that the PCA trainees recognized the potential value of learning about Alzheimer's disease, as every trainee chose to participate in the offered dementia component. The success of this project was demonstrated by the overall increase in dementia knowledge and its retention at 3 months.

The 2-point increase in average score for all classes speaks to the receptivity of the students as well as to the educators' ability to convey pertinent information adequately. Nonetheless, the higher scores in the Chinese-speaking classes warrant further discussion. It is possible that the 3-day training for the Chinese classes allowed more in-depth exploration of thoughts, questions, and subsequent discussion than the condensed 2-day training of the English- and Spanish-speaking classes, thus reinforcing learning. It is also likely that the additional day of training encouraged better assimilation of material, particularly where there had been no prior experience with dementia. Participants in the English- and Spanish-speaking classes may have felt more fatigued as a result of shorter dementia class time, which was coupled with field placement and clinical skills training.

Inspired by the "teach a man to fish and he eats for life" philosophy, it was hoped that this dementia training would be a catalyst for participants to expand their marketability beyond home care into potentially more stable and lucrative employment situations such as those found in nursing homes or other long-term-care facilities. Although it was beyond the scope of this study to ascertain whether the training actually produced this result, there are grounds for expecting that at least some participants will use the training to further their careers. Since its inception 17 years ago, an estimated 80% of graduates from the BEGIN program have continued their education to become home health aides, with another 10% becoming CNAs or LPNs. One PCA founded and maintains her own home care agency in Puerto Rico.

Of interest was the range in age of participants. Enrollment of trainees in their 20s, 30s, 40s, and even 50s could have been anticipated. While there were only 10 participants in the 60-73 age-group, the presence of older adults in the training group was nevertheless unexpected because direct care work is physically demanding and to begin a career of this nature later in life is unusual.

These older PCAs bear witness to a change in the aging population with implications for the direct care workforce. Active older adults are seeking postretirement jobs or continuing employment in greater numbers than ever before. At the same time, increasing longevity, coupled with a declining birthrate, makes it apparent that there will be more individuals in need of care than there will be persons available to provide that care into the foreseeable future. The participation of older persons in the PCA dementia training suggests that it may be advantageous to look to the older worker to provide an appreciable amount of the care needed by frail elderly in the coming years. Older workers' sense of responsibility to their community and their personal understanding of the aging process can bring added value to their participation in the direct care workforce.

Limitations

In preparing for this project, the challenges presented by its multilingual focus soon became clear. Identification of linguistically proficient trainers from the non-English-speaking communities with a working knowledge of Alzheimer's disease, the skills to convey that knowledge, and the availability of time to participate was the first hurdle. Ultimately, two nurses employed by the BEGIN program were trained to conduct the training by the local chapter of the Alzheimer's Association.

Locating culturally appropriate and validated measures of dementia knowledge was a challenge that remained unresolved. Investigation highlighted the enormous lack of culturally relevant and language-specific instruments available for replicable research in this area. Despite the precaution of back translating the Knowledge of Dementia index, it became clear from a number of responses in the first year that one particular question in all three languages warranted modification for greater clarity of understanding. This change was made at the beginning of year 2.

Possible difficulty in conceptual understanding, observed in select responses to two other questions on the Knowledge of Alzheimer's Disease index, was noted with several trainees in the English-speaking classes. It is likely that these individuals were linguistically stronger in Spanish, although they chose to participate as English speakers.

Not all PCA trainees completed all three waves of data collection, as some participants arrived in the classroom after testing began or did not return the survey.

It had been anticipated that the majority of participants would provide care for clients with dementia during the course of their employment, but only slightly more than one-quarter of the PCAs were found to have done so between graduation and 3-month f ollow-up. As there was no subsequent contact with participants, it is unknown if this percentage has changed.

Implications

The importance of developing a dementia-trained, culturally competent home care workforce cannot be overstated. Home care providers properly trained to support the efforts of family caregivers are vital. As the trend moves away from long-term services in institutional settings and toward community-based care, it is imperative that home care professionals be prepared to provide optimum care for their current and future clients.

Training about cultural issues must be part of this preparation. Provision of service in a linguistically and culturally competent manner can lead only to improved quality of care (DeSavorgnani & Haring, 1999) and better psychological health of the caregiving family (Janevic & Connell, 2001) since caregivers are more likely to accept help from outside the family system when it comes in the form of a qualified individual who shares the cultural understanding and linguistic nuances of the client. It is equally important that training itself meet the linguistic needs of the trainees who will be providing this care.

Preparation must also include a dementia component. Although continuing education is required for all health care workers, Alzheimer's disease and associated behavior management techniques are generally not among the mandated topics. Training to enhance direct care worker's knowledge of and ability to manage the symptoms of Alzheimer's disease needs to be routinely incorporated into the educational curriculum provided to all health care workers. To sustain the knowledge and employability gained from training, the recommendation offered by McCallion et al. (1999) to conduct booster training sessions for paraprofessionals at regular intervals merits consideration.

Further research is necessary to identify training content and methods best suited to achieving better outcomes for workers and, by extension, clients and family. Replication of multilingual education projects involving PCAs, such as that described by this project, will lead to further refinement of content, format, and evaluation methodology and possible expansion of dementia training to other types of paraprofessionals who provide care in the home. One of the difficulties facing researchers in this regard is the challenge of establishing replicable study conditions for home care workers in particular. Nonetheless, in order to validate the different aspects of training usefulness, viable research designs must be developed.

Additional areas for further research include the creation of valid and reliable linguistic- and culture-specific measures of Alzheimer's disease and associated spheres of knowledge, perception, functioning, and well-being relative to client, worker, and family.

Another important focus is the role of older persons in the direct care workforce. Creating conditions conducive to training and employing this valuable resource makes political and economic sense. Investigation is needed to understand better how to accommodate their needs and make the best use of their contribution.

This project was a win-win for all stakeholders, as individuals received the tools to enable them to rely less on government assistance and move toward becoming independent, self-sufficient members of a valuable workforce. State and local governments reduced the number of individuals on public assistance, persons previously unemployed found employment, and older adults dependent on assistance from others acquired home care workers with enhanced ability to provide high-quality services.

The stories of personal heroism in overcoming numerous social and economic obstacles to participate in this program and the sight of very proud family members on graduation day spoke volumes about the meaning of this training to the graduates and their families. With a 91% retention rate of trainees employed from this project 3 months after graduation, it is clear that there is a humanitarian and economic interest in continuing to prepare an elder-responsive workforce.

[Reference]

REFERENCES

Alecxih, L. (2001, Spring). The impact of sociodemographic change on the future of long-term care. Generations, 7-11.

Alzheimer's Association. (2004). Hispanics/Latinos and Alzheimer's disease. Retrieved February 12, 2007, from http://www.alz.org/national/documents/HispanicReportEnglish.pdf.

Anastas, J., Gibeau, J., & Larson, P. (1990). Working families and elder-care: A national perspective in an aging America. Social Work, 35 (5), 405-411.

Anderson, M., Wendler, M., & Congdon, J. (1996, November). Entering the world of dementia: CNA interventions for nursing home residents. Journal of Gerontological Nursing, 31-37.

Atkinson, J., & Raynor, J. (1978). Personality: Motivation and achievement. Hoboken, NJ: Wiley.

Berkman, B., Gardiner, D., Zodikoff, B., & Harootyan, L. (2006). Social work and aging in the emerging health care world. Journal of Geron-tological Social Work, 48 (1/2), 203-217.

Bonder, B., Martin, L., & Miracle, A. (2001, Spring). Achieving cultural competence: The challenge for clients and healthcare workers in a multicultural society. Generations, 35-42.

Braun, K., Cheang, M., & Shigeta, D. (2005, February). Increasing knowledge, skills, and empathy among direct care workers in elder care: A preliminary study of an active-learning model. The Gerontologist, 45 (1), 118-124.

Department of Health and Human Services & Department of Labor. (2003, May 14). The future supply of long-term care workers in relation to the aging baby boom generation. Retrieved September 2, 2006, from http://www.directcareclearinghouse.org/l_art_det.jsp?res_ id=59410

DeSavorgnani, A., & Haring, R. (1999, April). The impact of cultural issues on home care personnel and patients. Caring, 22-27.

Evans, D., Funkenstein, H., Albert, M., Scherr, P., Cook, N., Chown, M., et al. (1989). Prevalence of Alzheimer's disease in a community population of older persons: Higher than previously reported. Journal of the American Medical Association, 262 (18), 2551-2556.

Gallagher-Thompson, D., Solano, N., Coon, D., & Are�n, P. (2003). Recruitment and retention of Latino dementia family caregivers in intervention research: Issues to face, lessons to learn. The Gerontologist, 43 (1), 45-51.

Glynn, S., Aultman, L., & Owens, A. (2005). Motivation to learn in general education programs. Journal of General Education, 54 (2), 150-170.

Herrick, C., & Brown, H. (1998). Underutilization of mental health services by Asian-Americans residing in the United States. Issues in Mental Health Nursing, 19, 225-240.

Janevic, M., & Connell, C. (2001). Racial, ethnic, and cultural differences in the dementia caregiving experience: Recent findings. The Gerontologist, 41 (3), 334-347.

Knickman, J., & Snell, E. (2002, August). The 2030 problem: Caring for aging baby boomers. Health Services Research, 37 (4), 849-884.

Kuhn, D. (1990). The normative crises of families confronting dementia. Families in Society: The Journal of Contemporary Human Services, 71 (7), 451-459.

Levine, C., Kuerbis, A., Gould, D., Waliser, M., Feldman, P., & Donelan, K. (2000). A survey of family caregivers in New York City: Findings and implications for the health care system. A United Hospital Fund Special Report, in partnership with the Visiting Nurse Service of New York. New York: United Hospital Fund.

Mahoney, D., Cloutterbuck, J., Neary, S., & Zhan, L. (2005). African American, Chinese, and Latino family caregivers' impressions of the onset and diagnosis of dementia: Cross-cultural similarities and differences. The Gerontologist, 45 (6), 783-792.

McCallion, P., Toseland, R., Lacey, D., & Banks, S. (1999). Educating nursing assistants to communicate more effectively with nursing home residents with dementia. The Gerontologist, 39 (5), 546-558.

Mittelman, M., Ferris, S., Steinberg, G., Shulman, E., Mackell, J., Ambinder, A., et al. (1993). An intervention that delays institutionalization of Alzheimer's disease patients: Treatment of spouse-caregivers. The Gerontologist, 33 (6), 730-740.

National Alliance for Caregiving & AARP. (2004, April). Caregiving in the U.S. Report funded by Metlife Foundation. Washington, DC: AARP; Bethesda, MD: NAC.

National Center for Health Workforce Analyses. (2004). Nursing aides, home health aides and related health care occupations: National and local workforce shortages and associated data needs. Rockville, MD: Health Resources Service Administration.

New York State Department of Health. (2006, January). Alzheimer's disease: Frequently asked questions. Electronic dementia guide for excellence (EDGE) project. Retrieved February 9, 2007, from http://192.135.176.25/diseases/conditions/dementia/alzheimer/alzheimer_qaa.htm

Paraprofessional Healthcare Institute. (2003). Training quality home care workers. A PHI Technical Series Publication. Bronx, NY: National Clearinghouse on the Direct Care Workforce.

Peterson, D., Berg-Weger, M., McGillick, J., & Schwartz, L. (2002). Basic care I: The effect of dementia-specific training on certified nursing assistants and other staff. American Journal of Alzheimer's Disease and Other Dementias, 17 (3), 154-164.

Robinson, K., Kiesler, K., & Looney, S. (2003, November/December). Effect of respite care training on the knowledge, attitude, and self-esteem of volunteer providers. American Journal of Alzheimer's Disease and Other Dementias, 18 (6), 375-382.

Rosenbaum, J., Karuza, J., Katz, P., & Harazin, M. (2000). Long term care. In The future of aging in New York State: Project 2015 (pp. 59-67). Albany: New York State Office for the Aging.

Souren, L., Franssen, E., & Reisberg, B. (1997). Neuromotor changes in Alzheimer's disease: Implications for patient care. Journal of Geriatric Psychiatry and Neurology, 10 (3), 93-98.

Stone, R. (2001, Spring). Research on frontline workers in long term care. Generations, 49-57.

Tang, M., Cross, P., Andrews, H., Jacobs, D., Small, S., Bell, K., et al. (2001). Incidence of AD in African-Americans, Caribbean Hispanics, and Caucasians in Northern Manhattan. Neurology, 56 (1), 49-56.

Thomas, A. (1990). The Alzheimer's Association dementia specialist training program. Pride Institute Journal, 9 (4), 10-15.

U.S. Census Bureau. (2005). 65+ in the United States. Washington, DC: Author.

Wallace, S., & Lew-Ting, C. (1992, September). Cross-cultural medicine a decade later. Getting by at home. Community-based long-term care of Latino elders. Western Journal of Medicine, 157 (3), 337-344.

Wang, D. (2004). Service delivery and research considerations for the 85+ population. Journal of Gerontological Social Work, 43 (1), 5-17.

Wilmoth, J., & Longino, C. (2006). Demographic trends that will shape U.S. policy in the twenty-first century. Research on Aging, 28 (3), 269-288.

Wilner, M., & Wyatt, A. (1998, September 10 &11). Paraprofessionals on the front lines: Improving their jobs, improving the quality of long-term care. Unpublished manuscript.

[Author Affiliation]

Robin C. Fenley, MSW

Sarah J. Bober, MS, MA

Mebane E. Powell, MSW

Jacquelin Berman, PhD

Barbara N. Altman, MSW

[Author Affiliation]

Robin C. Fenley, MSW, is director, Alzheimer's and Caregiver Resource Center, New York City Department for the Aging. Sarah J. Bober, MS, MA, is director, Alzheimer's Grants, Aging in New York Fund. Mebane E. Powell, MSW, is research associate, New York City Department for the Aging. Jacquelin Berman, PhD, is director, Research, New York City Department for the Aging. Barbara N. Altman, MSW, is special assistant, Aging in New York Fund.

Acknowledgments. The authors gratefully thank Edwin M�ndez Santiago, commissioner, New York City Department for the Aging, for his encouragement, support, and leadership in addressing aging issues in a diverse society and the Aging in New York Fund, the Department's not-for-profit arm, for their administrative support. Thanks also to Rebecca Rodriguez, director; Michael Giannadeo, assistant director; and staff of the Work Experience Program, New York City Department for the Aging: Nancy Aponte, Beatriz Fab-regas, Miuhing E. Yuen, and Polly Woodard. Staff of the Alzheimer's and Caregiver Resource Center, New York City Department for the Aging, contributed their translation skills to this project. Gail Evans, senior issues writer for the Department's Public Affairs Office, provided editorial assistance. Finally, ongoing collaboration with the Alzheimer's Association, New York City Chapter, in particular Jed Levine, Della Frazier-Rios, and Paulette Michaud, continues to make this project possible. This project was supported, in part, by grant number 90AZ2791 from the Administration on Aging, Department of Health and Human Services, Washington, DC 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration on Aging policy.

Correspondence regarding this article should be directed to Robin C. Fenley, MSW, Alzheimer's and Caregiver Resource Center, New York City Department for the Aging, 2 Lafayette Street, 15th Floor, New York, NY 10007. E-mail: rfenley@aging.nyc.gov

California rocket firm has its first space tourist

A Danish adventurer is first in line to ride aboard a privately funded, two-seat rocket ship designed by a California rocket maker to fly about 37 miles (60 kilometers) above Earth.

Xcor Aerospace said Tuesday that Per Wimmer, an investment banker based in London, will be the first passenger aboard Lynx, a space tourism vehicle designed to take off and land like an airplane. He's also an investor in the Mojave, California-based company.

Wimmer hopes his flight will come in 2011, after a series of test flights. Officials said tickets are selling for $95,000 each and reservations have been made for 20 flights.

Xcor's main competitor is building SpaceShipTwo, an eight-seat craft that will take passengers some 62 miles (100 kilometers) above Earth for $200,000 each.

Rosanne Cash recovers after brain surgery to correct benign condition

Singer Rosanne Cash was recovering at her New York home following brain surgery last month for a rare but benign condition.

Cash was back home Dec. 4 and "recovering comfortably from her surgery, which took place on November 27," said a posting on her Web site. "She extends thanks and appreciation for all the love, good wishes, prayers and kindness."

The 52-year-old singer is expected to make a full recovery and will resume recording her debut album for Manhattan Records early next year, the EMI Group-owned label said Wednesday in a statement. She will resume her touring schedule in the spring and finish writing a book to be published in early 2009.

Cash decided to have the surgery after being diagnosed with chiari I malformation, her manager said last month.

According to the American Syringomyelia Alliance Project, a nonprofit clearinghouse for information about chiari and related disorders, the disorder is a congential malformation of the skull that affects the brain and spinal cord.

Symptoms, which include severe head and neck pain, are worsened by coughing, sneezing or straining, and often do not show up until adulthood, the organization said.

Cash is the daughter of the late Johnny Cash. Her hits include the crossover "Seven Year Ache" and "The Way We Make a Broken Heart."

___

On the Net:

Rosanne Cash:

http://rosannecash.com/

Car parts found as pupils clean beach

PUPILS from Ysgol Dyffryn Taf have taken part in a clean up of abeauty spot.

The youngsters joined volunteers in cleaning Marros beach insupport of the Tidy Towns project.

Over 100 bags of litter was removed during the day.

Among some of the discarded items found were car parts, tyres andchildren's play equipment.

Phenomenal The cleanup was a joint effort between Keep WalesTidy, Carmarthenshire Council, Pembrokeshire County Council andYsgol Dyffryn Taf.

Keep Wales Tidy's project officer for Carmarthenshire, DanielSnaith said: "The effort made by those attending was phenomenal whenyou consider that there were about 20 people there during the day.Marros beach is very secluded and has access issues, so when we hadthe chance to clean it up, we took it.

"It would seem that the majority of the litter we found on thebeach was brought in with the tides, and once again the issue of seaborne plastic was evident.

"People may not realise that when they drop a drinks bottle onthe floor inland, it can end up out at sea, where it poses a threatto wildlife that dwell there."

?For information on the Tidy Towns project, or if you would liketo get involved, call Daniel on 07824 504805 or emaildaniel.snaith@keepwalestidy.org

Agassi tops Chang to take ATP crown

Olympic gold medalist Andre Agassi defeated Michael Chang 7-6(7-4), 6-4 Sunday to win the ATP Championship in Mason, Ohio, for thesecond consecutive year.

The sixth-seeded Agassi used a strong serve and a powerfulforehand to beat the third-seeded Chang in the final of thetournament for the second year in a row. Agassi won 7-5, 6-2 lastyear.

Agassi displayed the same form he used to defeat second-seededThomas Muster in the semifinals, combining a strong serve andforehand returns to move his opponent from side to side. He took a2-0 lead in the first set before Chang battled back with patientgroundstrokes, only to lose the tiebreaker.

Agassi took leads of 2-0 and 3-1 in the second set, but Changagain rallied and knotted the set at 4. Agassi then used a dominantserving game and a sparkling return game to close out the match. Top-seeded Monica Seles won the du Maurier Open in Montreal for thesecond consecutive year by defeating second-seeded Arantxa SanchezVicario 6-1, 7-6 (7-2) with a masterful performance.

Seles, who shares the world's No. 1 ranking with Steffi Graf,went through the tournament without dropping a set at the packed duMaurier Stadium.

It was the first meeting between the players since Seles beatSanchez Vicario in the 1992 U.S. Open final. Seles holds an 11-1career record against Sanchez Vicario.

The defeat continued a disturbing trend for Sanchez Vicario, whois playing with an elbow injury. She came into the tournament havinglost in the final of her last three events - the French Open,Wimbledon and the Olympics. She also lost in the final of threeGrand Slam tournaments last year. Russian sets swim mark

Dennis Pankratov of Russia set a world record of 23.68 secondsin the 50-meter butterfly at an international swim meet Saturday inMulhouse, France. The previous record of 24.05 was set by ByronDavis of the United States in March.

Pankratov won the 100-meter and 200-meter butterfly events atthe Atlanta Olympics and holds world records in those events. Dallas Stars center Todd Harvey and right wing Grant Marshall wereamong four men charged with sexually assaulting a 20-year-old womanat a house party in Winnipeg, Manitoba. Harvey, 21, and Marshall,23, were arrested early Friday, inspector Art Stannard said.

"Right now, I'm unaware of the incident," Stars spokesman LarryKelly said. "I have no comment until we can make some phone callsand find out what happened."

Novo Nordisk Q4 profits jump but outlook lowered

COPENHAGEN, Denmark (AP) — Danish pharmaceutical company Novo Nordisk A/S on Wednesday said fourth-quarter profits soared 70 percent on strong sales, but lowered its outlook for the coming year due to competition from generic drug makers and healthcare reform in the U.S. and Europe.

The world's biggest insulin maker said net profit in the last three months of 2010 reached 3.95 billion kroner ($724 million), up from 2.32 million kroner in the same period of 2009.

Quarterly sales rose 23 percent to 16.12 billion kroner ($2.96 billion) from 13.06 billion. The cost of sales and distribution, meanwhile, rose 24 percent to 5.27 billion kroner.

Despite the quarterly gains, Novo Nordisk lowered its outlook for 2011, saying it expects sales to grow 8-10 percent in local currencies, due to tougher competition from generics and healthcare reform in the U.S. and Europe. Three months ago it forecast a sales growth of 11-12 percent this year.

Company shares dropped 2 percent to 609 kroner ($111.65) in Copenhagen after the release of the earnings report.

Sydbank analyst Soeren Loentoft Hansen said lowering the outlook and a full year net profit below market expectations of 14.6 billion kroner ($2.70 billion) "can explain the drop. It was a bit disappointing."

The Copenhagen-based company said its full-year net profit increased by 34 percent to 14.40 billion kroner from 10.77 billion kroner in 2009. Organic sales grew by 19 percent, driven by its new diabetes drug Victoza, among others.

However, "2010 was a very good year for Novo Nordisk with strong organic sales growth," Chief Executive Lars Rebien Soerensen said in a statement. "We expect continued sales growth from these products."

Sales of modern insulins, human insulins and protein-related products in 2010 increased by 17 percent to 40,642 million kroner compared to 2009. The company said it held 51 percent of the total insulin market.

Waits isn't chipper about imitator's ad

Singer Tom Waits "was stunned" when he heard a gravelly voicethat sounded just like his own, singing in a corn chip commercial ona Texas radio station, his attorney told a federal jury on the firstday of testimony in a trademark infringement lawsuit. He said othersreacted the same way.

The singer in the commercial for Frito-Lay Inc.'s SalsaRioDorito chips is Stephen Carter, a Dallas area vocalist who hasimpersonated Waits in performances for a decade.

Waits suit is based on a 1988 federal appeals court ruling thatsinger Bette Midler successfully used to win a $400,000 judgmentagainst an ad agency in a dispute over a car commercial tune based ona Midler hit, "Do You Wanna Dance."

An attorney for the defense told jurors his clients' ad imitatedonly Waits' gruff, bluesy singing style. "It had nothing to do withthe voice," he said.

Waits' hits include the single "Jersey Girl" and the album "RainDogs." -

China Bans 'Pornographic' Radio Shows

BEIJING - Chinese authorities said two late-night radio shows that discussed sex and drugs have been banned for damaging young people and being "extremely pornographic."

The latest order from China's broadcast watchdog follows a ban on television shows about cosmetic surgery and sex changes, and the shutdown of a talent show that regulators deemed coarse.

The stations, both in the southwestern province of Sichuan, "aired programs about sex and drugs for two to three hours after 9 p.m. every day," the State Administration of Radio, Film and Television said on its Web site Wednesday.

"The programs contained extremely pornographic material, caused great harm to the psychological development of young people, fouled the social air, and damaged the reputation of China's broadcasting institutions," the administration said.

The two stations were ordered to suspend the shows immediately and punish the producers.

The broadcast watchdog statement did not include the titles of the shows. Late-night call-in programs featuring sexually explicit conversations and ads for enhancement drugs are common.

Most are advice shows that help callers with issues such as sexual performance or sexually transmitted diseases. They are tame compared to programs in the U.S. and callers generally do not go into explicit detail.

The administration said its ban covered all programs that "flout the code of ethics, violate science and civilization or feature sexual content."

That aimed to create "created a harmonious cultural environment for the youth," it said.

Calls to the stations, Sichuan People's Broadcasting and Chengdu People's Broadcasting, went unanswered Thursday.

The administration last month also banned a talent show, "The First Time I Was Touched," calling it vulgar and lacking in artistic standards.

Olympic sport: Bribing

Congratulations, Chicago, on winning the U.S. bid to host the2016 Olympics! Now let the bribing begin. It's a political windfallfor Chicago area politicians. One can only imagine the wheeling anddealing that will take place in back rooms.

A multitude of contracts will be up for grabs for the proposedvenues and other construction projects planned for the events andathletes. This, even though it's still not a done deal for Chicagountil 2009. The political coffers will be overflowing with campaigncontributions from possible suitors for those bids, and our own ToddStroger will be able to appoint yet another relative to a six-figure salary as "Chief [silent] Spokesperson for Matters Concerningthe Impact of the 2016 Olympics."

Again, congratulations, Chicago. Let's hope the best comes outand not the worst. It is a great opportunity to showcase what is oneof the finest cities in the United States, despite its politicalreputation.

Donald Figura, West Elsdon

Jasmine is the top pick

A teenager has proved herself to be a budding floral artist.

Jasmine Rhodes won the under-16 flower arranging contest at theAbbey House open day earlier this month.

The Abbey House, with its spectacular views over the neighbouringruins and grounds, was built in 1830 for James Austin who livedthere with his wife and nine children. The vast majority of centralSomerset residents have never seen behind the impressive facade ofthe gentleman's residence, as it was known when it was put up forauction more than a century ago.

However many took a chance to glimpse life behind the tall walls at an open day earlier this month.

Warden Liz Pearson said that despite the poor weather, 250 peoplevisited.

"The winner of the under-16s flower arranging contest was JasmineRhodes, a local girl, who was awarded her prize by our chairman RevPeter Martin," she said.

For more details about the Abbey House in Glastonbury, see itshttp://abbeyhouse.org/index website.

Stephen M. Treacy, WWII pilot

At the end of the Second World War, one of the first victoriousAmerican military men to set foot in Japan was fighter pilot StephenM. Treacy, who landed his P-51 Mustang near a Japanese airfield justdays after the atomic bomb was dropped on Nagasaki.

Mr. Treacy, 79, who died at his home in Tuscon July 28, laterbecame a successful Chicago executive in the flour milling business.

But first he had to get through the war as an Army Air Corps pilotwhose job escorting bombers to Japan often involved 14-hour flights,at the end of which he had to be lifted from the airplane, unable towalk from hours sitting in the cramped cockpit.

Mr. Treacy almost didn't make it into the air. At first hiseyesight kept him from being accepted, so he went to Canada andjoined the air force there, shifting back to the U.S. Army Air Corpsafter requirements were changed.

"He was destined to become a pilot," said his son, Stephen Jr.

He rose to the rank of lieutenant and was credited with shootingdown 2 1/2 planes. He flew escort duty around the USS Missouri duringthe formal signing of the Japanese surrender on Sept. 2, 1945.

After the war, Mr. Treacy was offered the opportunity to be a testpilot for the new generation of jet aircraft. He declined. "I hadjust spent too many hours crammed in that tiny cockpit, flying overwater," he said.

He never flew a plane again.

He returned to his native Minnesota and attended the University ofMinnesota, where he was captain of the golf team and a member of ChiPsi fraternity.

He spent his entire career in the flour milling business, movingto Chicago in 1965, where he joined Archer Daniels Midland as vicepresident for sales. Mr. Treacy lived in Wilmette and retired in1985.

He was an avid golfer, with a passion for the Bears and Notre Damefootball. Two years ago he moved with his wife to a home on the fifthhole of the Green Course at Tuscon National Golf Club.

Survivors include his wife, Rosalie; sons Stephen Jr., Timothy,Mike and Pat; daughters Mary, Ann and Lisa; sisters Mary Turner, PatGreen, and Peggy Greer; brother William, and 15 grandchildren.

Services will be at 10 a.m. Saturday at St. Francis CatholicChurch, Wilmette. Burial will be at All Saints Cemetery with areception following at the North Shore Country Club in Glenview.