Context Previous studies have demonstrated the effectiveness of osteopathic manipulative treatment (OMT) for various headache types, with limited evidence of its use for headaches related to mild traumatic brain injury (MTBI). No studies prior studies were found regarding OMT for headaches in patients with postconcussion syndrome (PCS), defined as symptom persistence for longer than 3 months after MTBI. Objectives To evaluate OMT for headaches in patients with PCS. Methods A controlled pilot study was conducted of patients with PCS who presented to an outpatient interdisciplinary rehabilitation clinic; patients with symptoms lasting longer than 3 months were enrolled and randomly assigned to an OMT treatment group or a control group. Primary outcome measures were immediate change in headache scores according to a Visual Analog Scale (VAS) and change in the six item Headache Impact Test (HIT-6) between baseline and follow up visits. The participants in the control group completed the HIT-6 between baseline and follow up visits but did not receive OMT and did not complete the VAS. Mean immediate VAS score change for the treatment group and mean improvement in HIT-6 scores for both groups between baseline and follow up were analyzed for statistical significance. Results A total of 26 patients were included in this study: 13 (50%) in the treatment group and 13 (50%) in the control group. Six patients (23.1%), three from each group, did not complete the study, so 10 subjects in each group were included in the final analysis. Statistically significant improvement in VAS scores was seen immediately after OMT in the treatment group (mean change, 2.1;p=0.002). Mean HIT-6 scores showed improvement in the treatment group compared with the control group, although the change was not statistically significant (p=0.15) from baseline to follow up visit. No adverse effects from treatments were noted. Conclusions Patients with headaches secondary to PCS showed immediate benefit in headache pain intensity after OMT. However, no sustained benefit was found on the follow up visit compared with the control group.
In the last decade, there has been a significant rise in the number of states engaging in foreign disinformation campaigns. In this paper, I argue that while foreign disinformation campaigns are generally part of a states' broader foreign policy, the tactics, techniques, and procedures (TTPs) used in foreign disinformation campaigns evolve out of a state's domestic disinformation apparatus. I use the history and evolution of the Chinese Communist Party's domestic and foreign disinformation efforts to make this argument. The Chinese case presents a unique opportunity for analysis because of the clear demarcation between domestic and foreign social media: Chinese citizens are blocked from using popular social media platforms used in much of the rest of the world so the CCP must use different platforms and techniques to spread disinformation domestically and abroad. Comparing both sides of this divide since 2012 illuminates that early foreign campaigns mirrored domestic efforts while later campaigns developed distinct characteristics. This finding could allow researchers to use previously identified domestic propaganda and disinformation campaigns to anticipate and mitigate the impact of foreign disinformation campaigns.
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