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Background. There is short-term evidence for treatment of cervicogenic dizziness with Mulligan sustained natural apophyseal glides (SNAGs) but no evidence for treatment with Maitland mobilizations. Objective. The purpose of this study was to compare the effectiveness of SNAGs and Maitland mobilizations for cervicogenic dizziness. Design. A double-blind, parallel-arm randomized controlled trial was conducted. Setting. The study was conducted at a university in Newcastle, Australia. Participants. Eighty-six people with cervicogenic dizziness were the study participants. Interventions. Included participants were randomly allocated to receive 1 of 3 interventions: Mulligan SNAGs (including self-administered SNAGs), Maitland mobilizations plus range-of-motion exercises, or placebo. Measurements. The primary outcome measure was intensity of dizziness. Other outcome measures were: frequency of dizziness, the Dizziness Handicap Inventory (DHI), intensity of pain, and global perceived effect (GPE). Results. Both manual therapy groups had reduced dizziness intensity and frequency posttreatment and at 12 weeks compared with baseline. There was no change in the placebo group. Both manual therapy groups had less dizziness intensity posttreatment (SNAGs: mean difference=-20.7, 95% confidence interval [95% CI]=-33.6, -7.7; mobilizations: mean difference=-15.2, 95% CI=-27.9, -2.4) and at 12 weeks (SNAGs: mean difference=-18.4, 95% CI=-31.3, -5.4; mobilizations: mean difference=-14.4, 95% CI=-27.4, -1.5) compared with the placebo group. Compared with the placebo group, both the SNAG and Maitland mobilization groups had less frequency of dizziness at 12 weeks. There were no differences between the 2 manual therapy interventions for these dizziness measures. For DHI and pain, all 3 groups improved posttreatment and at 12 weeks. Both manual therapy groups reported a higher GPE compared with the placebo group. There were no treatment-related adverse effects lasting longer than 24 hours. Limitations. The therapist performing the interventions was not blind to group allocation. Conclusions. Both SNAGs and Maitland mobilizations provide comparable immediate and sustained (12 weeks) reductions in intensity and frequency of chronic cervicogenic dizziness. INSET: The Bottom Line. [ABSTRACT FROM AUTHOR]

Seizures occur in approximately one-third of children with cerebral palsy. This study aimed to determine epilepsy syndromes in children with seizures and cerebral palsy due to vascular injury, anticipating that this would inform treatment and prognosis. We studied a population-based cohort of children with cerebral palsy due to prenatal or perinatal vascular injuries, born 1999–2006. Each child's MRI was reviewed to characterize patterns of grey and white matter injury. Children with syndromic or likely genetic causes of cerebral palsy were excluded, given their inherent association with epilepsy and our aim to study a homogeneous cohort of classical cerebral palsy. Chart review, parent interview and EEGs were used to determine epilepsy syndromes and seizure outcomes. Of 256 children, 93 (36%) had one or more febrile or afebrile seizures beyond the neonatal period and 87 (34%) had epilepsy. Children with seizures were more likely to have had neonatal seizures, have spastic quadriplegic cerebral palsy and function within Gross Motor Function Classification System level IV or V. Fifty-six (60%) children with seizures had electroclinical features of a self-limited focal epilepsy of childhood; we diagnosed these children with a self-limited focal epilepsy-variant given the current International League Against Epilepsy classification precludes a diagnosis of self-limited focal epilepsy in children with a brain lesion. Other epilepsy syndromes were focal epilepsy—not otherwise specified in 28, infantile spasms syndrome in 11, Lennox–Gastaut syndrome in three, genetic generalized epilepsies in two and febrile seizures in nine. No epilepsy syndrome could be assigned in seven children with no EEG. Twenty-one changed syndrome classification during childhood. Self-limited focal epilepsy-variant usually manifested with a mix of autonomic and brachio-facial motor features, and occipital and/or centro-temporal spikes on EEG. Of those with self-limited focal epilepsy-variant, 42/56 (75%) had not had a seizure for >2 years. Favourable seizure outcomes were also seen in some children with infantile spasms syndrome and focal epilepsy-not otherwise specified. Of the 93 children with seizures, at last follow-up (mean age 15 years), 61/91 (67%) had not had a seizure in >2 years. Children with cerebral palsy and seizures can be assigned specific epilepsy syndrome diagnoses typically reserved for normally developing children, those syndromes commonly being age-dependent and self-limited. Compared to typically developing children with epilepsy, self-limited focal epilepsy-variant occurs much more commonly in children with cerebral palsy and epilepsy. These findings have important implications for treatment and prognosis of epilepsy in cerebral palsy, and research into pathogenesis of self-limited focal epilepsy. [ABSTRACT FROM AUTHOR]

This article contributes to a growing body of research on the police reforms in Scotland. It examines the particular place given to prevention in public policy and its impact on police practice. We show how public policy reconfigured the place and purpose of prevention for the police, with a focus on safety, wellbeing, and the prevention of harm. The research draws on qualitative data collected in four areas as part of a 4-year evaluation of the police reforms. We refine a public health typology of prevention and operationalize it empirically for the first time to analyse cases of innovative practice. We distinguish a pattern of prevention practice heavily weighted towards secondary prevention, focused predominantly on issues of crime and disorder. In fewer cases, the police applied primary and tertiary prevention, with a focus on vulnerability and harm. Looking in detail at two cases, we illustrate the importance of collaboration for the police, which created opportunities and brought additional resources and expertise to support new prevention approaches which had a significant impact on effectiveness. The police realized collaborative advantage through common aims, trust-building, and leadership. We do not suggest this demonstrates a transformation in police prevention; it illustrates successful police innovation, and identifies the potential to go further. The implications for policy and practice are to recognize the value to the police of investing in new partnerships. They create opportunities for the police to collaborate, innovate, and focus more sharply on the prevention of harm. [ABSTRACT FROM AUTHOR]

In 2011, the Scottish Government took the decision to create a single, national police force, reconfiguring a structure of regional police forces, which had prevailed since the 19th century. Despite a strong narrative around localism in the legislation establishing Police Scotland, the new force that was established in 2013 quickly found itself at the centre of a debate around an emerging 'crisis of localism' as critics expressed concerns over the centralization of decision-making and a lack of sensitivity to local contexts. Drawing on qualitative research carried out in four communities across Scotland in 2016, the analysis presented in this article examines the experience of organizational change from the perspective of officers in local policing teams and from local stakeholders. The analysis is structured around the strategic aims of reform of improved local service delivery, more equal local access to specialist expertise, and enhanced connections with local communities. The article highlights the sense of exclusion from the decision-making surrounding the organizational changes associated with the implementation of reform experienced by local, rank-and-file officers. [ABSTRACT FROM AUTHOR]

Background. The ulnar nerve upper limb neurodynamic test (ULNT3) uses upper limb positioning to investigate symptoms arising from the ulnar nerve. It is proposed to selectively increase tension of the nerve; however, this property of the test is not well established. Objective. The aim of this study was to determine the upper limb position that results in: (1) the greatest tension of the ulnar nerve and (2) the greatest difference in tension between the ulnar nerve and the other 2 major nerves of the upper limb: median and radial. Design. This was an observational cadaver study. Methods. Tension (in newtons) of the ulnar, median, and radial nerves was measured simultaneously using 3 buckle force transducers in 5 upper limb positions in 10 embalmed human cadavers (N=20 limbs). Repeated-measures analysis of variance (ANOVA) with Bonferroni post hoc tests determined differences in tension among nerves and among limb positions. Results. The addition of shoulder horizontal abduction (H.Abd; 12.62 N; 95% confidence interval [95% Cl] = 10.76, 14.47) and combined shoulder abduction and internal rotation (H.Abd + IR; 11.86 N; 95% CI=9.96, 13-77) to ULNT3 (scapular depression, shoulder abduction and external rotation, elbow flexion, forearm pro nation, and wrist and finger extension) produced significantly greater ulnar nerve tension compared with the ULNT3 alone (8.71 N; 95% CI=7.25, 10.17). The ULNT3+H.Abd test demonstrated the greatest difference in tension among nerves (mean difference between ulnar and median nerves= 11.87 N; 95% CI=9.80, 13.92; mean difference between ulnar and radial nerves=8.47 N; 95% CI=6.4l, 10.53). Limitations. These results pertain only to the biomechanical plausibility of the ulnar nerve neurodynamic test and do not account for other factors that may affect the clinical application of this test. Conclusions. The ULNT3 +H.Abd is a biomechanically plausible test for detecting peripheral neuropathic pain related to the ulnar nerve. In situations where the shoulder complex will not tolerate the combination of shoulder external rotation in abduction, performing upper limb neurodynamic tests with internal rotation instead of external rotation is a biomechanically plausible alternative. [ABSTRACT FROM AUTHOR]