Evaluation ofDementia Special Care Units presents particularchallenges, including measuring the attainment ofgoals for residents with limitedpotentialfor treatment and rehabilitation. Goal Attainment Scaling (GAS) has beenfound to be a sensitive measure ofindividualized tangible outcomes in geriatric rehabilitation and mental health settings. In this study, GAS was used to set individualizedfunctional and recreation goals for 10 residents ofa Dementia Special Care Unit in a chronic care and rehabilitation hospital. Goal attainment was measured over a two monthfollow-up period GAS wasfound to be afeasible and responsive method ofmeasuring individualized client goals. GAS is a promising clinical and research toolfor measurement ofclient-centered outcomes in individuals with dementia.

This study examines the effect of fibrinogen and consequent blood viscosity reduction on cerebral blood flow and cellular injury following severe cerebral ischemia for 30 minutes in 78 Wistar rats. In half of these rats 10 to 15 cc's of blood was removed and replaced with a mixture of 5% albumin and autologous red blood cells maintaining a constant hematocrit but resulting in a 30% decrease in fibrinogen and corresponding reduction in viscosity. Fibrinogen reduction in a slight increase in baseline CBF and the elimination of post-ischemic hyperemia at 24 hours. Both study and control animals showed a similar decrease in CBF at 30 minutes and 2 hours. There was no significant difference in the severity of ischemic cellular change between the fibrinogen reduction group and controls, although there was a significant inverse relationship between the amount of viscosity change and severity of cellular injury within the treatment group. Fibrinogen reduction alone cannot significantly ameliorate ischemic injury in this model. Viscosity reduction therapy should include reduction of hematocrit and alteration of red cell deformability.

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This paper describes the rise of boys’ education as a substantial social and educational issue in Australia in the 1990s, mapping the changes in Australian discourses on boys’ education in this period. Ideas and authors informed by the men’s movement entered the discourses about boys’ education, contributing to a wave of teacher experimentation and new ways of thinking about gender policies in schools. The author suggests that there is currently a policy impasse, and proposes a new multi-disciplinary approach bringing together academic, practitioner, policy, and public discourses on boys’ education.

Back Background ground Mental and behavioral ill-health are growing global problems and while there are promising evidence-based approaches aimed at reducing their impact, availability of services varies greatly, not only across nations, but also between urban, regional, and remote locations. Rural areas face accessibility and acceptability challenges related to mental health services that are similar to barriers experienced in developing countries. Initiatives to address mental health challenges in under-served rural areas can inform global mental health strategies. Methods Methods Using a public health approach, we illustrate how innovations in rural communities build community capacity and capability in areas that are currently, and are likely to remain, under-served by specialist mental health services. We provide examples of initiatives and key principles of action from three locations in Nebraska, United States of American and New South Wales, Australia to highlight similarities of context and practice. R Results esults While each of the initiatives was developed independently, there are striking similarities across them. Similarities in initiatives include: a) recognition that solutions developed in urban settings are not necessarily the most effective in under-served rural areas, b) engagement of community members is needed to ensure acceptance of initiatives in target communities, c) each initiative involved community members acting on their own behalf with an emphasis on prevention and early intervention, and d) research is a key aspect that informs practice and has local relevance. Commonalities of contexts and environments may have played an important role in the similarities. C Conclusions onclusions Linking initiatives within and between countries can expand local, national, and global reach and impacts. If we are to meet lofty global goals related to health and wellbeing, cross-national collaborations are needed to share resources, expand expertise, and stimulate ideas necessary to develop and enhance local and global initiatives. High-income country partnerships addressing mental health in under-served areas, such as rural communities, can play a vital role in contributing to global mental health solutions. GLOBAL CHALLENGES OF MENTAL HEALTH Poor mental health is a global concern. Mental ill-health is the leading cause of disability worldwide, accounting for 175.3 million Years Lost to Disability (YLD). 1 Depression accounts for more YLDs worldwide than any other single condition in any disease category. 1 Mental health conditions alone are less likely than other conditions to result in premature death. However, when years of life lost to premature death are combined with years lost due to disability (referred to as Disability-Adjusted Life Years or DALYs), mental health conditions rank fifth worldwide in DALYs among all disease categories, accounting for 7.4% of the total disease burden. Mental health ranks behind cardiovas