Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis.

BACKGROUND: Management of degenerative spondylolisthesis with spinal stenosis is controversial. Surgery is widely used, but its effectiveness in comparison with that of nonsurgical treatment has not been demonstrated in controlled trials. METHODS: Surgical candidates from 13 centers in 11 U.S. states who had at least 12 weeks of symptoms and image-confirmed degenerative spondylolisthesis were offered enrollment in a randomized cohort or an observational cohort. Treatment was standard decompressive laminectomy (with or without fusion) or usual nonsurgical care. The primary outcome measures were the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36) bodily pain and physical function scores (100-point scales, with higher scores indicating less severe symptoms) and the modified Oswestry Disability Index (100-point scale, with lower scores indicating less severe symptoms) at 6 weeks, 3 months, 6 months, 1 year, and 2 years. RESULTS: We enrolled 304 patients in the randomized cohort and 303 in the observational cohort. The baseline characteristics of the two cohorts were similar. The one-year crossover rates were high in the randomized cohort (approximately 40% in each direction) but moderate in the observational cohort (17% crossover to surgery and 3% crossover to nonsurgical care). The intention-to-treat analysis for the randomized cohort showed no statistically significant effects for the primary outcomes. The as-treated analysis for both cohorts combined showed a significant advantage for surgery at 3 months that increased at 1 year and diminished only slightly at 2 years. The treatment effects at 2 years were 18.1 for bodily pain (95% confidence interval [CI], 14.5 to 21.7), 18.3 for physical function (95% CI, 14.6 to 21.9), and -16.7 for the Oswestry Disability Index (95% CI, -19.5 to -13.9). There was little evidence of harm from either treatment. CONCLUSIONS: In nonrandomized as-treated comparisons with careful control for potentially confounding baseline factors, patients with degenerative spondylolisthesis and spinal stenosis treated surgically showed substantially greater improvement in pain and function during a period of 2 years than patients treated nonsurgically. (ClinicalTrials.gov number, NCT00000409 [ClinicalTrials.gov].)

Search for Nucleon Decays induced by GUT Magnetic Monopoles with the MACRO Experiment

The interaction of a Grand Unification Magnetic Monopole with a nucleon can lead to a barion-number violating process in which the nucleon decays into a lepton and one or more mesons (catalysis of nucleon decay). In this paper we report an experimental study of the effects of a catalysis process in the MACRO detector. Using a dedicated analysis we obtain new magnetic monopole (MM) flux upper limits at the level of $\sim 3\cdot 10^{-16} cm^{-2} s^{-1} sr^{-1}$ for $1.1\cdot 10^{-4} \le |\beta| \le 5\cdot 10^{-3}$, based on the search for catalysis events in the MACRO data. We also analyze the dependence of the MM flux limit on the catalysis cross section.Comment: 12 pages, Latex, 10 figures and 2 Table

Search for massive rare particles with MACRO

Massive rare particles have been searched for in the penetrating cosmic radiation using the MACRO apparatus at the Gran Sasso National Laboratories. Liquid scintillators, streamer tubes and nuclear track detectors have been used to search for magnetic monopoles (MMs). Based on no observation of such signals, stringent flux limits are established for MMs as slow as a few 10^(-5)c. The methods based on the scintillator and on the nuclear track subdetectors were also applied to search for nuclearites. Preliminary results of the searches for charged Q-balls are also presented.Comment: 20 pages, 9 EPS figures included with epsfi

The Courts in Broadcast Regulatory Policy-Making

In the early decades of broadcast regulation, the regulatory process was dominated by (and largely restricted to) three major participants--Congress, the Federal Communications Commission (FCC), and the industry itself. This balance of forces has now been altered by the increased involvement of three new participants in broadcast regulatory policy making the public, in the form of citizen groups; the White House, by means of special advisory bodies, appointment powers, budgetary control, and active communication-oriented divisions of Cabinet level agencies; and the courts, in the form of judicial opinions prescribing and precluding FCC policy initiatives. These three new activist participants in broadcast regulation have modified the FCC\u27s role from one of making peace with Congress and a dominant industry to one of attempting to placate several, often antagonistic, interests

The politics of electoral college reform /

Includes bibliographical references