Background: Pediatric otitis media with effusion is a common and costly condition. Although chiropractors have anecdotally claimed success in treating otitis media, there is little research to ...support their claims.
Objective: A pilot study was undertaken for the purpose of assessing the feasibility of conducting a full-scale randomized clinical trial investigating the efficacy of chiropractic spinal manipulative therapy (SMT) for children with chronic otitis media with effusion.
Methods: This study was a prospective, parallel-group, observer-blinded, randomized feasibility study. Twenty-two patients, ages 6 months to 6 years, received either active chiropractic SMT or placebo chiropractic SMT. Otoscopy and tympanometry were used to create a middle ear status profile, and daily diaries were collected.
Results: Five newspaper advertisements over 6 months generated 105 responses. Twenty patients subsequently qualified and were randomized into the study. Collection of tympanometric and otoscopic data proved to be challenging. Compliance with the treatment and evaluation protocols and daily diaries was excellent. There were no reports of serious side effects as a result of either the active or placebo chiropractic treatments.
Conclusion: Recruitment for a randomized controlled trial is feasible and could be enhanced by medical collaboration. Patients and parents are able and willing to participate in a study comparing active SMT and placebo SMT. Parents were extremely compliant with the daily diaries, suggesting that similar quality-of-life and functional status measures can be successfully used in a larger trial. We found the objective outcomes assessment involving tympanometry and otoscopy extremely challenging and should be performed by experienced examiners in future studies. (J Manipulative Physiol Ther 1999; 22:292–8)
To compare the effectiveness of spinal manipulation and pharmaceutical treatment (amitriptyline) for chronic tension-type headache.
Randomized controlled trial using two parallel groups. The study ...consisted of a 2-wk baseline period, a 6-wk treatment period and a 4-wk posttreatment, follow-up period.
Chiropractic college outpatient clinic.
One hundred and fifty patients between the ages of 18 and 70 with a diagnosis of tension-type headaches of at least 3 months' duration at a frequency of at least once per wk.
6 wk of spinal manipulative therapy provided by chiropractors or 6 wk of amitriptyline treatment managed by a medical physician.
Change in patient-reported daily headache intensity, weekly headache frequency, over-the-counter medication usage and functional health status (SF-36).
A total of 448 people responded to the recruitment advertisements; 298 were excluded during the screening process. Of the 150 patients who were enrolled in the study, 24 (16%) dropped out: 5 (6.6%) from the spinal manipulative therapy and 19 (27.1%) from the amitriptyline therapy group. During the treatment period, both groups improved at very similar rates in all primary outcomes. In relation to baseline values at 4 wk after cessation of treatment, the spinal manipulation group showed a reduction of 32% in headache intensity, 42% in headache frequency, 30% in over-the-counter medication usage and an improvement of 16% in functional health status. By comparison, the amitriptyline therapy group showed no improvement or a slight worsening from baseline values in the same four major outcome measures. Controlling for baseline differences, all group differences at 4 wk after cessation of therapy were considered to be clinically important and were statistically significant. Of the patients who finished the study, 46 (82.1%) in the amitriptyline therapy group reported side effects that included drowsiness, dry mouth and weight gain. Three patients (4.3%) in the spinal manipulation group reported neck soreness and stiffness.
The results of this study show that spinal manipulative therapy is an effective treatment for tension headaches. Amitriptyline therapy was slightly more effective in reducing pain at the end of the treatment period but was associated with more side effects. Four weeks after the cessation of treatment, however, the patients who received spinal manipulative therapy experienced a sustained therapeutic benefit in all major outcomes in contrast to the patients that received amitriptyline therapy, who reverted to baseline values. The sustained therapeutic benefit associated with spinal manipulation seemed to result in a decreased need for over-the-counter medication. There is a need to assess the effectiveness of spinal manipulative therapy beyond four weeks and to compare spinal manipulative therapy to an appropriate placebo such as sham manipulation in future clinical trials.
The interexaminer reliability of an inclinometer procedure to measure lumbar rotation was evaluated by two chiropractic clinicians who examined 25 chronic (greater than 6 months) low-back pain ...patients and 25 subjects without low-back pain. These groups were compared for differences in mean left, right, and total rotation. Patients who had lumbar spinal surgery were excluded. Twenty-eight men and 22 women, ranging in age from 28-38 years, were evaluated. Reliability between examiners was evaluated by Pearson's correlation coefficient and the intraclass correlation coefficient. All coefficients were significant (P less than 0.01). Errors in prediction and examiner disagreement were evaluated by the standard error of estimate and the interexaminer measurement error. The standard errors of estimate (range: 1.4-4.4) and the interexaminer measurement errors (range: 3.8-10.4) were large compared to the scale of measurement. An analysis of variance of differences between the chronic low-back pain patients and asymptomatics revealed significantly more left rotation in the asymptomatic subjects (F = 8.4; df = 1; P less than 0.006). Also, there was significantly more total rotation in the asymptomatic subjects (F = 4.143; df = 1; P less than 0.048). However, because of the large error attributed to this procedure, it is not possible to say whether the difference between the two groups is a result of the large error or some "real" difference. Therefore, the procedure described in this study should not be used as a clinical outcome measure.
We present a measurement of the ratio of multijet cross sections in p p A= collisions at s = 1.96 TeV at the Fermilab Tevatron Collider. The measurement is based on a data set corresponding to an ...integrated luminosity of 0.7 fb - 1 collected with the D0 detector. The ratio of the inclusive three-jet to two-jet cross sections, R 3 / 2 , has been measured as a function of the jet transverse momenta. The data are compared to QCD predictions in different approximations. Popular tunes of the pythia event generator do not agree with the data, while sherpa provides a reasonable description of the data. A perturbative QCD prediction in next-to-leading order in the strong coupling constant, corrected for non-perturbative effects, gives a good description of the data.
We present measurements of the differential cross section d I / d p T gamma for the associated production of a c-quark jet and an isolated photon with rapidity | y gamma | 15 GeV . The ratio of ...differential cross sections for gamma + c to gamma + b production as a function of p T gamma is also presented. The results are based on data corresponding to an integrated luminosity of 8.7 fb - 1 recorded with the D0 detector at the Fermilab Tevatron p p A= Collider at s = 1.96 TeV . The obtained results are compared to next-to-leading order perturbative QCD calculations using various parton distribution functions, to predictions based on the k T -factorization approach, and to predictions from the sherpa and pythia Monte Carlo event generators.
To study the relative efficacy of three different treatment for chronic low back pain (CLBP). Two preplanned comparisons were made: (a) Spinal manipulative therapy (SMT) combined with trunk ...strengthening exercises (TSE) vs. SMT combined with trunk stretching exercises, and (b) SMT combined with TSE vs. nonsteroidal anti-inflammatory drug (NSAID) therapy combined with TSE.
Interdisciplinary, prospective, observer-blinded, randomized clinical trial with a 1-yr follow-up period. The trial evaluated therapies in combination only and was not designed to test the individual treatment components.
Primary contact, college out-patient clinic.
In total, 174 patients aged 20-60 yr were admitted to the study.
Patient-rated low back pain, disability, and functional health status at 5 and 11 wk.
Five weeks of SMT or NSAID therapy in combination with supervised trunk exercise, followed by and additional 6 wk of supervised exercise alone.
Individual group comparisons after 5 and 11 wk of intervention on all three main outcome measures did not reveal any clear clinically important or statistically significant differences. There seemed to be a sustained reduction in medication use at the 1-yr follow-up. in the SMT/TSE group. Continuance of exercise during the follow-up year, regardless of type, was associated with a better outcome.
Each of the three therapeutic regimens was associated with similar and clinically important improvement over time that was considered superior to the expected natural history of long-standing CLBP. For the management of CLBP, trunk exercise in combination with SMT or NSAID therapy seemed to be beneficial and worthwhile. The magnitude of nonspecific therapeutic (placebo) effects, cost-effectiveness and relative risks of side effects associated with these types of therapy need to be addressed in future studies.
We present searches for the anomalous gamma WW and ZWW trilinear gauge boson couplings from WW and WZ production using lepton plus dijet final states and a combination with results from W gamma , WW, ...and WZ production with leptonic final states. The analyzed data correspond to up to 8.6 fb - 1 of integrated luminosity collected by the D0 detector in p p A= collisions at s = 1.96 TeV . We set the most stringent limits at a hadron collider to date assuming two different relations between the anomalous coupling parameters I kappa gamma , I>, and I g 1 Z for a cutoff energy scale I = 2 TeV . The combined 68% C.L. limits are - 0.057 < I kappa gamma < 0.154 , - 0.015 < 0.028 , and - 0.008 < I g 1 Z < 0.054 for the LEP parameterization, and - 0.007 < I kappa < 0.081 and - 0.017 < 0.028 for the equal couplings parameterization. We also present the most stringent limits of the W boson magnetic dipole and electric quadrupole moments.
We present a measurement of the average value of a new observable at hadron colliders that is sensitive to QCD dynamics and to the strong coupling constant, while being only weakly sensitive to ...parton distribution functions. The observable measures the angular correlations of jets and is defined as the number of neighboring jets above a given transverse momentum threshold which accompany a given jet within a given distance IR in the plane of rapidity and azimuthal angle. The ensemble average over all jets in an inclusive jet sample is measured and the results are presented as a function of transverse momentum of the inclusive jets, in different regions of IR and for different transverse momentum requirements for the neighboring jets. The measurement is based on a data set corresponding to an integrated luminosity of 0.7 fb-1 collected with the D0 detector at the Fermilab Tevatron Collider in p p A= collisions at s = 1.96 TeV . The results are well described by a perturbative QCD calculation in next-to-leading order in the strong coupling constant, corrected for non-perturbative effects. From these results, we extract the strong coupling and test the QCD predictions for its running over a range of momentum transfers of 50a400 GeV.
We present a search for the standard model Higgs boson in 9.5 fb-1 of p p A= collisions at s = 1.96 TeV collected with the D0 detector at the Fermilab Tevatron Collider. The final state considered ...contains a pair of b jets and is characterized by an imbalance in transverse energy, as expected from p p A= ? Z H ? ? ? A= b b A= production. The search is also sensitive to the W H ? l ? b b A= channel when the charged lepton is not identified. The data are found to be in good agreement with the expected background. For a Higgs boson mass of 125 GeV, we set a limit at the 95% C.L. on the cross section s (p p A= ? Z / W H) , assuming standard model branching fractions, that is a factor of 4.3 times larger than the theoretical standard model value, while the expected factor is 3.9. The search is also used to measure a combined WZ and ZZ production cross section that is a factor of 0.94 +/- 0.31 (stat) +/- 0.34 (syst) times the standard model prediction of 4.4 pb, with an observed significance of 2.0 standard deviations.
We present a search for pair production of doubly-charged Higgs bosons in the processes qqbar to H++H-- decaying through H++/-- to tau tau, muon tau, muon muon. The search is performed in ppbar ...collisions at a center-of-mass energy of sqrt{s}=1.96 TeV using an integrated luminosity of 7.0 fb-1 collected by the D0 experiment at the Fermilab Tevatron Collider. The results are used to set 95% C.L. limits on the pair production cross section of doubly-charged Higgs bosons and on their mass for different H++/-- branching fractions. Models predicting different H++/-- decays are investigated. Assuming BR(H++ -> tau+ tau+)=1 yields an observed (expected) lower limit on the mass of a left-handed H++/-- boson of 128 (116) GeV and assuming BR(H++ -> mu+ tau+)=1 the corresponding limits are 144 (149) GeV. In a model with BR(H++ -> tau+ tau+)=BR(H++ -> mu+ tau+)=BR(H++ -> mu+ mu+)=1/3, we obtain M(H++(L) > 130 (138) GeV.
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