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Although several studies have suggested that minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) may be especially beneficial in the elderly population due to lower operative morbidity and faster postoperative recovery, there are limited studies investigating the functional outcomes, quality of life, and satisfaction in elderly patients after MIS-TLIF. Furthermore, existing studies had substantial clinical, diagnostic, and surgical heterogeneity.We asked if elderly patients could experience comparable (1) patient-reported pain, disability and quality of life, (2) perioperative complications, and (3) radiological fusion rates as their younger counterparts after MIS-TLIF.Prospectively collected registry data of patients undergoing primary, single-level, MIS-TLIF for degenerative spondylolisthesis between 2012 and 2014 were reviewed. We included 168 patients, 39 of whom were at least 70 years old. Of the 129 patients younger than 70 years old, propensity-score matching was used to select 39 younger controls with adjustment for sex, BMI, American Society of Anesthesiologists score, and baseline clinical outcomes. Perioperative complications and radiologic data were compared.There was no difference in back pain (mean difference -0.3 [95% confidence interval -1.0 to 0.5]; p = 0.52); leg pain (mean difference -0.1 [95% CI to 0.6-0.5]; p = 0.85); Oswestry Disability Index (mean difference -2.9 [95% CI -8.0 to 2.2]; p = 0.26); and SF-36 physical (mean difference 3.0 [95% CI -0.7 to 6.8]; p = 0.107); and mental component summary (mean difference 1.9 [95% CI -4.5 to 8.2]; p = 0.56); up to 2 years postoperatively; 85% of younger patients and 85% of elderly patients were satisfied (p0.99) while 87% and 80%, respectively, had fulfilled expectations (p = 0.36). Four perioperative adverse events occurred in each group. There was also no difference in the rate of fusion (87% in younger patients and 90% in elderly patients; p = 0.135).When clinical and surgical heterogeneity were minimized, elderly patients undergoing minimally invasive transforaminal lumbar interbody fusion not only had comparable rates of perioperative complications but also experienced similar improvements in pain, function, and quality of life. A high rate of satisfaction was achieved.Level II, prognostic study.

States across the country are developing systems for evaluating school principals on the basis of student achievement growth. A common approach is to hold principals accountable for the value added of their schools—that is, schools’ contributions to student achievement growth. In theory, school value added can reflect not only principals’ effectiveness but also other school-specific influences on student achievement growth that are outside of principals’ control. In this paper, we isolate principals’ effects on student achievement growth and examine the extent to which school value added captures the effects that principals persistently demonstrate. Using longitudinal data on the math and reading outcomes of fourth- through eighth-grade students in Pennsylvania, our findings indicate that school value added provides very poor information for revealing principals’ persistent levels of effectiveness.

Since their inception in 1992, the number of charter schools has grown to more than 6,800 nationally, serving nearly three million students. Various studies have examined charter schools’ impacts on test scores, and a few have begun to examine longer-term outcomes including graduation and college attendance. This paper is the first to estimate charter schools’ effects on earnings in adulthood, alongside effects on educational attainment. Using data from Florida, we first confirm previous research (Booker et al., 2011) that students attending charter high schools are more likely to graduate from high school and enroll in college. We then examine two longer-term outcomes not previously studied in research on charter schools—college persistence and earnings. We find that students attending charter high schools are more likely to persist in college, and that in their mid-20s they experience higher earnings. C

Skeptics of the KIPP (Knowledge Is Power Program) charter school network argue that these schools rely on selective admission, attrition, and replacement of students to produce positive achievement results. We investigate this using data covering 19 KIPP middle schools. On average, KIPP schools admit students disadvantaged in ways similar to other local students, and attrition patterns are typically no different at KIPP than at nearby schools. Unlike district schools, however, KIPP schools tend to replace students who exit with higher achieving students, and fewer students are replaced in the later years of middle school. Overall, KIPP’s positive achievement impacts do not appear to be explained by advantages in the prior achievement of KIPP students, even when attrition and replacement patterns are taken into account.

Since the passage of the No Child Left Behind Act (NCLB) in 2002, American policymakers have relied primarily on outcome-based accountability in the form of high-stakes testing to improve public school performance. With NCLB supplanted in 2015 by the Every Student Succeeds Act—which gives states far greater discretion in the design of accountability systems—the time is ripe for policymakers to consider extensive behavioral science literature that shows outcome-based accountability is only one of multiple forms of accountability, each invoking distinct motivational mechanisms. We review rule-based, market-based, and professional accountability alongside outcome-based accountability, using evidence from the laboratory and the field to describe how each can produce favorable or unfavorable effects. We conclude that policymakers should (a) make greater use of professional accountability, which has historically been underutilized in education; (b) use transparency to promote professional accountability; and (c) use multiple, complementary forms of accountability, creating a complete system that encourages and supports the continuous improvement of educational practice.

A growing literature on within-study comparisons (WSC) examines whether and in what context nonexperimental methods can successfully replicate the results of randomized experiments. WSCs require that the experimental and nonexperimental methods assess the same causal estimand. But experiments that include noncompliance in treatment assignment produce a divergence in the causal estimands measured by standard approaches: the experiment-based estimate of the impact of treatment (the complier average causal effect, CACE) applies only to compliers, while the nonexperimental estimate applies to all subjects receiving treatment, including always-takers. We develop a new replication approach that solves this problem by using nonexperimental methods to produce an estimate that can be compared to the experimental intent-to-treat (ITT) impact estimate rather than the CACE. We demonstrate the applicability of the method in a WSC of the effects of charter schools on student achievement. In our example, some me...

One of the modifications of the Elementary and Secondary Education Act (known as the No Child Left Behind Act) gave parents of low-income students in low-performing schools a choice of Supplemental Educational Services (SEdS). SEdS include tutoring or other academic support services offered outside the regular school day, at no charge to students or their families, by public or private organizations that have been approved by the state. We examine the impacts of SEdS on test scores among 24,000 students in school districts where SEdS were oversubscribed in Florida, Ohio, and Connecticut. Oversubscribed school districts are required to make SEdS available to the lowest achieving students among eligible applicants, creating the opportunity to estimate impacts using a regression discontinuity design, which relies on districts’ use of a continuous measure of prior academic achievement to determine which eligible applicants will be offered services. We find no impact of SEdS on student test scores.

The Knowledge Is Power Program (KIPP) is an influential and rapidly growing nationwide network of charter schools serving primarily disadvantaged minority students. Prominent elements of KIPP's educational model include high expectations for student achievement and behavior, and a substantial increase in time in school. KIPP is being watched closely by policy makers and educators as a possible model for urban education, but existing studies of KIPP's effects on students have been subject to methodological limitations, making them less than conclusive. We measure the achievement impacts of forty-one KIPP middle schools across the country, using propensity-score matching to identify traditional public school students with similar characteristics and prior-achievement histories as students who enter KIPP. We find consistently positive and statistically significant impacts of KIPP on student achievement, with larger impacts in math than reading. These impacts persist over four years following admission, and are not driven by attrition of low performers from KIPP schools. © 2014 Association for Education Finance and Policy

In the academic and policy debates over the merits of charter schools, two things are clear: First, they are here to stay and, second, their quality varies widely. Policy makers therefore need to understand how to design charter laws that promote the creation of high-performing schools. Crucial to this discussion is the charter authorizing process, which varies across the nation. In some states, authorizing power is held exclusively by local school districts, whereas other states allow a range of authorizers that may include not only local districts, but also nonprofit organizations, counties, higher educational institutions, or a state agency. In this paper we use individual student-level data from Ohio, which permits a wide range of organizations to authorize charter schools, to examine the relationship between type of authorizer and charter-school effectiveness as measured by students’ achievement trajectories. © 2014 Association for Education Finance and Policy

Since their inception, charter schools have been a lighting rod for controversy, with much of the debate revolving around their effectiveness in improving student achievement. Previous research has shown mixed results for student achievement; this could be the consequence of different policy environments or varying methodological approaches with differing assumptions across studies. In our analysis, we discuss these approaches and their assumptions and estimate charter school achievement effects using a consistent methodology across seven locations.

Spinal deformities can result in increasing thoracic kyphosis or loss of lumbar lordosis, leading to imbalance in the sagittal plane. Such deformities can be functionally and psychologically debilitating. The Smith-Petersen osteotomy can achieve approximately 10 degrees of correction in the sagittal plane at each spinal level at which it is performed. This osteotomy is beneficial for patients who have a degenerative imbalance in the sagittal plane. The pedicle subtraction osteotomy can achieve approximately 30 degrees to 40 degrees of correction in the sagittal plane at each spinal level at which it is performed. It is the preferred osteotomy for patients with ankylosing spondylitis who have an imbalance of the spine in the sagittal plane. The cervical extension osteotomy is performed in the cervical spine, at the cervicothoracic junction, in patients who have a cervical flexion deformity that impedes their ability to look straight ahead while walking or who have difficulty swallowing. The vertebral column resection is used when the imbalance is severe enough that the other osteotomies cannot correct the deformity, especially in patients who have a combined sagittal and coronal spinal imbalance. Neurologic problems, whether transient or permanent, are the most commonly encountered complications following these procedures. Recent results have shown a high patient satisfaction rate and good functional outcomes after spinal osteotomies done to treat a variety of disorders.

Background: Antifibrinolytic agents have been shown to decrease the blood loss associated with major orthopaedic surgical procedures. Spine surgery, particularly procedures performed for deformity correction and procedures involving long arthrodesis constructs, can be associated with a large amount of blood loss requiring blood transfusions. The purpose of the present study was to determine if antifibrinolytic agents reduced blood transfusions in patients managed with spine surgery and to see if one agent had a greater effect than another. Methods: A systematic review and meta-analysis of the available literature were performed to investigate the efficacy of aprotinin, tranexamic acid, and epsilon-aminocaproic acid in terms of reducing blood loss and blood transfusions in patients undergoing spine surgery. This meta-analysis was focused on the role of these agents in major spine operations as reported in eighteen clinical trials that included information on the drug dosage, the age of the patient, blood loss, blood transfusions, surgery complexity, and complications. Results: Compared with control groups, the treatment groups for all three antifibrinolytic agents maintained lower levels of total blood loss and transfusions associated with spine surgery. The effect size ( d) of the differences in total blood loss between the treatment and control groups ranged from −0.668 (95% confidence interval, −0.971 to −0.365) to −0.936 (95% confidence interval, −1.240 to −0.632) across all three agents. The effect size ( d) of the differences in total blood transfusions between the treatment and control groups ranged from −0.466 (95% confidence interval, −0.764 to −0.167) to −0.749 (95% confidence interval, −1.046 to −0.453) across all three agents. Conclusions: Aprotinin, tranexamic acid, and epsilon-aminocaproic acid are effective for reducing blood loss and transfusions in patients managed with spine surgery. With the exception of aprotinin, the side-effect profiles of these agents have not been shown to cause any substantial morbidity or to increase the rate of thromboembolic events. Epsilon-aminocaproic acid had a greater effect on reducing blood transfusions as the complexity of surgery increased. The surgeon and/or the anesthesiologist should consider the use of antifibrinolytic agents for patients undergoing spinal procedures in which a large amount of blood loss can be expected; however, at the present time, this is not a United States Food and Drug Administration-approved indication for these agents. Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.

Background: Osteoporosis with subsequent osteoporotic vertebral compression fractures is an increasingly important disease due not only to its significant economic impact but also to the increasing age of our population. Pain reduction and stabilization are of primary importance with osteoporotic vertebral compression fractures. Although many patients heal with conservative treatment consisting of rest or activity modification, analgesics, and bracing, the management of severe pain compels some patients to seek surgical intervention via 2 procedures: vertebroplasty and kyphoplasty. Although there is abundant support in the literature for both procedures, there remains debate over which procedure can most successfully reduce patients’ perception of pain. Objective: To determine the amount of pain reduction using the visual analog scale (VAS) with kyphoplasty and vertebroplasty in the treatment of osteoporotic vertebral compression fractures. Design: Meta-analysis Methods: A systematic review and meta-analysis of the available literature was performed to quantify the amount of pain reduction using the visual analog scale (VAS) between vertebroplasty and kyphoplasty for osteoporotic vertebral compression fractures. Results: Twenty-one studies, 14 vertebroplasty and 7 kyphoplasty, qualified for inclusion representing totals of 1,046 vertebroplasty and 263 kyphoplasty patients treated, respectively. Kyphoplasty and vertebroplasty resulted in a more than 5 point drop in the VAS in the immediate postoperative period (p

Isolated distal fibular fractures most commonly result from a supination-external rotation injury of the ankle. Deltoid ligament ruptures can also be associated with these injuries, resulting in an unstable ankle fracture due to incompetent lateral and medial restraints. We hypothesized that a gravity stress radiograph is equivalent to a manual stress radiograph for the detection of deltoid ligament injury in association with an isolated fibular fracture.All patients presenting to a level-1 trauma hospital emergency department with an isolated fibular fracture were screened. Ankle stability was determined on the basis of radiographic measurements of the medial clear space and talar shift. A manual stress radiograph and a gravity stress radiograph of the injured ankle were made for each patient. The manual stress radiograph was used to determine whether the ankle was stable or unstable.A total of twenty-five patients (thirteen with a supination-external rotation type-II fracture and twelve with a supination-external rotation type-IV-equivalent injury) were enrolled in the study. In the type-II group, the average medial clear space was 4.15 and 4.26 mm on the manual and gravity stress radiographs, respectively (p = 0.50). In the type-IV group, the average medial clear space was 5.21 and 5.00 mm on the manual and gravity stress radiographs, respectively (p = 0.69).The gravity stress radiograph is equivalent to the manual stress radiograph for determining deltoid ligament injury in association with an isolated distal fibular fracture, and thus it can be used to determine ankle stability in patients who present with an isolated distal fibular fracture.

Services such as the National Student Clearinghouse StudentTracker for High Schools provide states, districts, and schools with the capability to examine college enrollment, persistence, and completion data on students they previously served in K–12 settings. This issue brief (1) summarizes the uses and limitations of postsecondary data in raw form, (2) describes three sophisticated ways that K–12 officials can use these data to inform K–12 policy and practice, and (3) discusses the importance of dissemination.

Throughout the country, school districts are scrambling to adhere to new state requirements for teacher evaluation. More than 40 states have mandated that some measure of student achievement growth be included in teacher evaluations.

The year after the U.S. Department of Education tightened credit standards for Parent Loans for Undergraduate Students (PLUS), both the share of PLUS participants and the loan dollar amounts declined substantially at historically Black colleges and universities (HBCUs). Other types of federal financial aid did not fully make up for the decline. Enrollment at HBCUs decreased more than enrollment at other institutions, corresponding to the larger decline in PLUS recipients at HBCUs.

The federal Parent Loans for Undergraduate Students (PLUS) program provides loans to parents of dependent undergraduate students to help pay for education expenses. To bring the standards in line with those used by banks, the U.S. Department of Education tightened the credit standards for PLUS loans in October 2011. In the first full school year that the new standards were in place (2012/13), the total dollar amount of federal loans approved for parents decreased substantially.

INTRODUCTION An entire section of this volume is devoted to issues related to school choice and educational privatization, including charter schools, the public funding of private schools, and educational management organizations that operate public schools under contract. Nonetheless, the use of market forces in education is an appropriate topic for this section as well, because market-based educational policies may aff ect the productive use of resources across the educational system. In particular, many supporters of marketbased approaches believe that the competitive pressures they create will promote an increase in school productivity (see, e.g., Friedman, 1955; Chubb & Moe, 1990; Hoxby, 2000). If so, benefi ts might be seen not only by students enrolled in schools of choice (whether private, charter, or privately managed), but also by students who remain in conventional public schools and by taxpayers. At the same time, the adoption of market mechanisms in schooling raises questions about the extent to which schools operating under a competitive model will productively serve public as well as private purposes (see, e.g., Fiske & Ladd, 2000; Fuller, Elmore, & Orfi eld, 1996; Gill et al., 2007; Gutmann, 1987; Lake & Miller, 2012; Levin, 2000; Wells, 1993; Wolf & Macedo, 2004). How will competition aff ect the stratifi cation of students across schools, by race, social class, and ability? Will privately operated schools eff ectively promote education in the knowledge, skills, and values needed for eff ective citizenship in a democracy?

Total hip arthroplasty is associated with significant blood loss that often requires allogenic blood transfusions. Tranexamic acid and aprotinin have been shown to reduce blood loss and transfusions in clinical trials with variable results. This meta-analysis evaluates whether tranexamic acid and aprotinin significantly reduces blood loss and transfusion requirements in total hip arthroplasty. Thirteen clinical trials were identified. Combined, these agents were significant across all outcome measures in reducing blood loss and transfusions. Separately, only aprotinin was found to be significant. The data also showed that aprotinin (tranexamic acid is inconclusive) is only beneficial in revision total hip arthroplasty. Therefore, only aprotinin is effective in reducing both blood loss and transfusion requirements without an increase in thromboembolic complications in patients undergoing revision total hip arthroplasty.

I. INTRODUCTION Currently, there is a large theoretical and empirical literature that has examined the demand and supply of publicly provided goods and services (Bergstrom and Goodman, 1973; Inman, 1978; Bergstrom et al., 1982; Rubinfield and Shapiro, 1989). This literature has formed the foundation for an understanding of the mechanisms of publicly provided goods and services. Intertwined in this literature are evolving theories of intergovernmental relationships and the effect these relationship has on the provision of publicly provided goods and services. Collectively, this research has helped articulate broad themes on the appropriate roles of governments and the efficient provision of publicly provided goods and services. However, this research has been underutilized in determining the appropriate provision of specific services. In this current research, the authors examine a specific federal program, the Department of Education's Impact Aid program, and draw on the existing literature of the provision public services to estimate the adequacy of funding. The results have direct implications for the Impact Aid program, but the analysis also has implications for the provision of other government services and as an empirical example of the effect of intergovernmental aid programs. Overview of Impact Aid Program The Impact Aid, originally created in 1950, (1) is a nearly $1 billion program constructed to reimburse local school districts for federal activity within the districts. These activities could include the placement of federal employees and their families on or near nontaxable federal property, which could create two adverse effects for the school district. First, federally connected students may create an additional cost burden for a local school district, and second, the school district may have a reduced tax base. On this premise, the federal government reimburses the school district through Impact Aid for the additional burden federal activities create within the district. Currently, the program provides funds for 1.2 million children in over 1400 school districts nationwide; as a result, the program not only affects students directly associated with these federal activities, such as children that live on Indian reservations and military bases, but also all other students who attend schools within these districts. Of the various activities, military bases plays an important role of the Impact Aid program. Impact Aid supports a portion of the education expenditures for 416,000 military-related students attending public schools operated by the local school district. About 37% of these students reside on military bases that are not subject to local property taxes. The remainder resides in local communities and support local schools explicitly through property taxes (if homeowners) or implicitly through rental payments (if renters). Both on- and off-base military residents work on federal facilities and do not contribute directly to the local tax bases through levies on their employment site. Finally, all military members have access to on-base shopping facilities that do not collect local sales taxes. The premise of Impact Aid payments is that military families are not paying their fair share of local school revenues because they are insulated from a portion of the local tax liability. The primary schooling option for military families assigned in the United States is the local public school system. (2) Most military-related children live in civilian communities and attend nearby schools like their civilian counterparts. Children in on-base residences generally attend an on-base school that is operated by the school district for the nearby community. The Impact Aid law has received bipartisan support, but there has been continuing debate over whether the program reimburses local school districts adequately. In this current research, the authors draw on the existing literature of publicly provided goods and services to estimate the adequacy of funding for the publicly provided Impact Aid program. …