The Effectiveness of Vestibular Rehabilitation on Balance Related Impairments among Multiple Sclerosis Patients: A Systematic Review

Background: Balance related dysfunction remains a debilitating clinical manifestation among people with Multiple Sclerosis (pwMS) causing significant morbidity and reduced quality of life. Imbalance is found to stem primarily from neurophysiological causes. Current management strategies have shown to have small but clinically insignificant results with little consideration towards vestibular sources of postural instability. Vestibular rehabilitation (VR) provides a promising treatment strategy to mediate balance dysfunction among people with pwMS.Design: Systematic Review, guided by PRISMA guidelines and presenting a best evidence synthesis.Data sources: 10 electronic databases were searched from inception until September 2019.Eligibility criteria for study selection: Article of original research, population of patients with multiple sclerosis aged over 18, interventions detailing VR protocols, measurement of outcomes pre-VR/post-VR.Results: Seven articles satisfied the eligibility criteria. 6/7 studies were rated as high quality and regarded as level one evidence. 5 studies consisted of standardised VR protocols while 2 studies consisted of customised VR. All studies identified improvements of mixed significance in balance, fatigue and dizziness outcomes post VR. Heterogeneity among VR prescription patterns limited optimal prescription guidelines.Conclusions: The available evidence shows promise that VR is a safe and ef- fective strategy to provide short term benefits in balance related dysfunction in pwMS. Recommendations of mixed strength are made based on the quality of current literature. Current evidence for optimal prescription and long-term effects of VR is limited. Further high-level studies evaluating the effects of VR in patients with multiple sclerosis with vestibular and/or balance dysfunction are required

Social Media Marketing in the Film Industry: Using Social Media to Create a Successful Marketing Campaign for the Theatrical Release of a Film

This study analyzes the use of social media as a marketing tool within the film industry including its successes in regards to popular social tactics and campaigns as well as where it may fall short within the realm of marketing as a whole. As the world is racing to be the first to implement the “next biggest thing” and beginning to drift away from traditional marketing practices, social media is potentially the next step to ensuring a successful marketing campaign for any product or service. This study takes a look into how social media can best be used and implemented to create for a successful marketing campaign for the theatrical release of a film

Through a Gender Lens: The Economic Security of Women and Girls in Forsyth County

The first research of its kind to focus specifically on the circumstances and needs of women in Forsyth County, this report draws attention to the individual, social and systemic issues and barriers to economic security by examining poverty rates, wages, educational attainment and occupations as well as the cost of necessary expenses such as housing, utilities, food, transportation, childcare and healthcare

Optimising cueing to improve walking and functional activities in people with Parkinson's disease when on and off medication

Gait problems in Parkinson's disease (PD) are complex and not adequately addressed by current medical and surgical options. The focus of this thesis was a desire to optimise the effectiveness of cues after experience of delivering cueing therapy in the context of a multi-centre RCT. Cues provide information on how to adapt the stepping pattern either through external prompts or internally through focussing attention. Cues are known to improve gait in PD but there is a compromise between strategies which have large effects but limited practical application and those which are easily applied in complex situations but have more modest effects. A laboratory study explored the feasibility of a cueing strategy combining an external rhythmical cue with a focussed instruction to increase step size, targeting both temporal and spatial parameters. A group of 15 PD and 12 age and sex matched controls were tested and gait was measured with an instrumented walkway which uses pressure activated sensors. The combination cue was compared with two single parameter cueing strategies, a rhythmical auditory cue and an attentional strategy asking subjects to walk with large steps. Gait was assessed under single and dual tasks to establish the attentional demands of the different cues. Walking speed and step amplitude significantly increased with the attentional strategy and combination cue in single and dual tasks in PD and controls (see chapter 3). The combination cue had an additional benefit in significantly reducing stride time and double limb support time variability in PD subjects, whilst variability increased in controls (see chapter 4). The effects of cues on and off medication was tested in the home in a group of 50 PD subjects using the same dual task paradigm to explore the mechanisms underlying cueing compared to dopamine on gait control. Gait was measured using an in-shoe footswitch system allowing reliable gait data to be collected in the home. Walking speed and stride amplitude significantly improved with all cues in the single and dual tasks on medication and with the attentional strategy and combination cue off medication suggesting that cues have a different mechanism to dopamine. The greatest improvements were seen with the combination of cues and medication. Gait variability responded differently to cues on and off medication. The combination cue reduced variability on and off medication for single and dual tasks, the auditory cue reduced variability in all conditions except for single task on mediation and the attentional strategy increased variability in the single task on mediation and had no effect in other conditions (see chapter 5). Cues which are delivered externally result in different mechanisms of gait control than those generated internally. Measures of gait variability reflect the attentional cost of movement and underlying neural control but there is limited knowledge on their validity. The final stage of the research examined the clinical characteristics associated with increased gait variability to increase understanding of these variables. Non-cued gait variability was strongly associated with disease severity, but cued gait variability was not adequately explained suggesting involvement of more diverse parameters (see chapter 6). These findings provide new knowledge on the mechanism underlying cued gait, the involvement of dopaminergic pathways and the attentional cost of different cues. Focussed instruction can alter the response to an external cue in the form of a rhythmical auditory tone, targeting both temporal and spatial gait parameters and reducing the attentional cost of walking

Measurement of deuterons at LHCb

A first measurement of deuteron production at the LHCb experiment is presented. The measurement is performed as a function of momentum, using proton-proton collision data from the 2018 data taking period, at a centre-of-mass energy √s =13 TeV. The simulation of deuteron production in proton-proton collisions, which is used extensively in the development of the measurement strategy, is described. The deuteron production cross-section measurement uses a neural network variable, ProbNNd, to discriminate between deuterons and other charged particles, in the momentum range 20 < p < 100 GeV/c, for pseudorapidities 1.89 < η < 4.89. Measurements of deuterons produced in high energy collisions provide important information for the calibration of models used in indirect dark matter searches. Some of these searches use antideuteron signals in cosmic-rays to look for evidence for dark matter annihilation. The measurement at LHCb is found not to be sensitive to a deuteron signal. The steps that should be followed to compute a deuteron production cross-section at LHCb are detailed.Open Acces

Cleopatra: Three visions of her infinite variety

This examination is a study of the characterization of Cleopatra in three early modern English plays. The three plays are the following: Mary Sidney\u27s The Tragedie of Antonie, Samuel Daniel\u27s The Tragedie of Cleopatra, and William Shakespeare\u27s Antony and Cleopatra . Although all three playwrights shared essentially the same cultural environment and historical context, they each created a different vision of the queen of the Nile. Cleopatra\u27s gender and race are the focus of this examination. Sidney presents us with a white-washed version of Cleopatra---in an effort to make her more acceptable to the Elizabethan audience. Daniel is sympathetic to Cleopatra, but does make her take responsibility for the disaster that befalls the couple. Shakespeare creates a Cleopatra that is perfect in her imperfection