Assessing Laws and Legal Authorities for Obesity Prevention and Control

This is the first paper in a two part series on the laws and legal authorities for obesity prevention and control, which resulted from the National Summit on Legal Preparedness for Obesity Prevention and Control in 2008. In this paper, the authors apply the “laws and legal authorities” component of the Centers for Disease Control and Prevention (CDC) legal framework on public health legal preparedness to demonstrate the essential role that law can play in the fight against obesity. Their analysis identified numerous laws and policies in the three vital domains of healthy lifestyles, healthy places, and healthy societies. For example, in terms of healthy lifestyles, governments can impact nutrition through: food subsidies, taxation, and bans; food marketing strategies; and nutritional labeling and education. With regard to healthy places, state and local governments can apply zoning laws and policy decisions to change the environment to encourage healthy eating and physical activity. Governments can promote healthy societies through laws and legal authorities that affect the ability to address obesity from a social perspective (such as antidiscrimination law, health care insurance and benefit design, school and day care for children, and surveillance). This paper describes instances of how current laws and legal authorities affect the public health goal of preventing obesity in both positive and negative ways. It also highlights the progressive use of laws at every level of government (i.e., federal, state, and local) and the interaction of these laws as they relate to obesity prevention and control. In addition, general gaps in the use of law for obesity prevention and control are identified for attention and action. (These gaps serve as the basis for the companion paper, which delineates options for policymakers, practitioners, and other key stakeholders in the improvement of laws and legal authorities for obesity prevention and control.

Resonator/zero-Qubit architecture for superconducting qubits

We analyze the performance of the Resonator/zero-Qubit (RezQu) architecture in which the qubits are complemented with memory resonators and coupled via a resonator bus. Separating the stored information from the rest of the processing circuit by at least two coupling steps and the zero qubit state results in a significant increase of the ON/OFF ratio and the reduction of the idling error. Assuming no decoherence, we calculate such idling error, as well as the errors for the MOVE operation and tunneling measurement, and show that the RezQu architecture can provide high fidelity performance required for medium-scale quantum information processing.Comment: 11 pages, 5 figure

Embolization of sacral tumors

Journal ArticleThe management of sacral tumors is challenging because of difficulties in accessing the lesion, the high rate of local recurrence, extensive vascularity causing significant intraoperative blood loss, resistance to radiation therapy, and risk of malignant transformation. Although surgery is the main treatment for many sacral tumors, embolization is a valuable primary and adjunctive therapy. Patients with benign lesions, including aneurysmal bone cysts and giant cell tumors, have responded to embolization with resolution of their symptoms and with ossification of their lesions. Embolization is used as a primary therapy for metastatic lesions and results in neurological improvement, reduced tumor size, and decreased spinal canal compromise. It is also used as an adjuvant therapy to reduce intraoperative blood loss and to aid in the resection of benign, malignant, and metastatic sacral lesions. It is important to note that embolization techniques are a valuable resource in the treatment of sacral tumors, and, overall, embolization should always be considered in patients with sacral tumors

Comparison of radiosurgery and conventional surgery for the treatment of glomus jugulare tumors

Journal ArticleObject. The optimal management of glomus jugulare tumors remains controversial. Available treatments were once associated with poor outcomes and significant complication rates. Advances in skull base surgery and the delivery of radiation therapy by stereotactic radiosurgery have improved the results obtained using these treatment options. The authors summarize and compare the contemporary outcomes and complications for these therapies. Methods. Papers published between 1994 and 2004 that detailed the use of radiosurgery or surgery to treat glomus jugulare tumors were reviewed. Eight radiosurgery series including 142 patients and seven surgical studies including 374 patients were evaluated for neurological outcome, change in tumor size (radiosurgery) or percent of total resection (surgery), recurrences, tumor control, need for further treatment, and complications. The mean age at treatment for patients who underwent surgery and radiosurgery was 47.3 and 56.7 years, respectively. The mean follow-up duration was 49.2 and 39.4 months, respectively. The surgical control rate was 92.1%, with 88.2% of tumors totally resected in the initial surgery. A cerebrospinal fluid leak occurred in 8.3% of patients who underwent surgery and recurrences were found in 3.1%; the mortality rate was 1.3%. Among patients who underwent radiosurgery, tumors diminished in 36.5%, whereas 61.3% had no change in tumor size, and subjective or objective improvements occurred in 39%. Despite the presence of residual tumor in 100% of radiosurgically treated patients, recurrences were found in only 2.1%, the morbidity rate was 8.5%, and there were no deaths. Conclusions. Death and recurrences after these treatments are infrequent, and therefore both treatments are considered to be safe and efficacious. Although surgery is associated with higher morbidity rates, it immediately and totally eliminates the tumor. The radiosurgery results are very promising, although the incidence of late recurrence (after 10-20 years) is unknown

Trigeminal amyloidoma: case report and review of the literature

ManuscriptThe authors present a case of amyloid infiltration involving the trigeminal nerve that mimicked a malignant cavernous sinus tumor with perineural tumor infiltration. A 64-year-old man presented with trigeminal nerve numbness. Imaging revealed a plaque-like enhancing lesion along the right lateral cavernous sinus extending anteriorly into Meckel's cave and involving the proximal V2 and V3 trigeminal nerves. The patient underwent extradural frontotemporal craniotomy with middle fossa exposure of the cavernous sinus to diagnose and treat the presumed malignant cavernous sinus tumor. A reddish mass involving the lateral dural wall of the cavernous sinus was resected. There was also enlargement of the gasserian ganglion and second and third divisions of the trigeminal nerve, the latter of which was biopsied. Permanent histopathological studies demonstrated microscopic eosinophilic, amorphous material, which stained positive for Congo red, and absence of neoplastic cells. The final diagnosis was amyloidoma. Thus, amyloidomas may occur from the trigeminal nerve or ganglia and should be considered in the differential diagnosis of a cavernous sinus lesion mimicking a tumor. The few reports of trigeminal amyloidomas are reviewed and the presentation, imaging, and management of this skull base lesion are discussed. Overall, patients may have symptomatic improvement of trigeminal neuropathy with resection of the amyloidoma outside of the nerve capsule that is compressing the nerve, while resection of the lesion from within the capsule may result in permanent trigeminal nerve dysfunction

Distal ventriculoperitoneal shunt failure secondary to Clostridium Difficile Colitis

Journal ArticleDistal ventriculoperitoneal shunt obstruction is typically associated with cerebrospinal fluid (CSF) infection, fluid pseudocysts, bowel obstruction, bowel perforation, or improper shunt placement in the abdomen. We describe a unique etiology for distal shunt obstruction secondary to Clostridium difficile pancolitis that occurred because of inflammation and ascites, which led to incomplete drainage and absorption of CSF. This case illustrates the importance of considering distal shunt obstruction in a patient with signs of abdominal pathology in the setting of mental status changes, and the effective treatment of this patient initially with distal catheter externalization followed by internalization of a new distal catheter after resolution of the pancoliti

Molecular, genetic, and cellular pathogenesis of neurofibromas and surgical implications

Journal ArticleNEUROFIBROMATOSIS 1 (NF1) IS A common autosomal dominant disease characterized by complex and multicellular neurofibroma tumors. Significant advances have been made in the research of the cellular, genetic, and molecular biology of NF1. The NF1 gene was identified by positional cloning. The functions of its protein product, neurofibromin, in RAS signaling and in other signal transduction pathways are being elucidated, and the important roles of loss of heterozygosity and haploinsufficiency in tumorigenesis are better understood. The Schwann cell was discovered to be the cell of origin for neurofibromas, but understanding of a more complicated interplay of multiple cell types in tumorigenesis, specifically recruited heterogenous cell types such as mast cells and fibroblasts, has important implications for surgical therapy of these tumors. This review summarizes the most recent NF1 and neurofibroma literature describing the pathogenesis and treatment of nerve sheath tumors. Understanding the biological underpinnings of tumorigenesis in NF1 has implications for future surgical and medical management of neurofibromas

Cavernous hemangioma of the skull presenting with subdural hematoma

Journal ArticleCavernous hemangioma of the calvaria is a very rare disease, and patients usually present with headaches or a visible skull deformity. Few reports of patients presenting with intradiploic or epidural hemorrhages are found in the literature. No case of an intradural hemorrhage from a cavernous hemangioma of the skull has been reported to date. The authors present the case of a 50-year-old man in whom a symptomatic subdural hematoma (SDH) resulting from a cavernous hemangioma of the calvaria had hemorrhaged and eroded through the inner table of the skull and dura mater. The patient underwent surgery for evacuation of the SDH and resection of the calvarial lesion. Postoperatively, the patient experienced immediate relief of his symptoms and had no clinical or radiological recurrence. Calvarial cavernous hemangiomas should be considered in the differential diagnosis of nontraumatic SDHs. Additionally, skull lesions that present with intracranial hemorrhages must be identified and resected at the time of hematoma evacuation to prevent recurrences

Spinal meningiomas: surgical management and outcome

Journal ArticleAdvances in imaging and surgical technique have improved the treatment of spinal meningiomas; these include magnetic resonance imaging, intraoperative ultrasonography, neuromonitoring, the operative microscope, and ultrasonic cavitation aspirators. This study is a retrospective review of all patients treated at a single institution and with a pathologically confirmed diagnosis of spinal meningioma. Additionally the authors analyze data obtained in 556 patients reported in six large series in the literature, evaluating surgical techniques, results, and functional outcomes. Overall, surgical treatment of spinal meningiomas is associated with favorable outcomes. Spinal meningiomas can be completely resected, are associated with postoperative functional improvement, and the rate of recurrence is low

Neurosurgical workforce trends in the United States

Journal ArticleObject. The purpose of this study was to evaluate the US neurosurgery workforce by reviewing journal recruitment advertisements published during the past 10 years. Methods. The number of available academic and private neurosurgical staff positions was determined based on recruitment advertisements in the Journal of Neurosurgery and Neurosurgery for the 10-year period from 1994 to 2003. Advertisements were evaluated for practice venue, subspecialization, and location. The numbers of active neurosurgeons and graduating residents also were reviewed. The number of advertised neurosurgical positions increased from 141.6 ± 38.2 per year from 1994 through 1998 to 282.4 ± 13.6 per year from 1999 through 2003 (mean 6 standard deviation, p < 0.05). The mean number of academic positions increased from 50.6 ± 11.1 to 95 ± 17.5 (p < 0.05), and the mean number of private positions rose from 91 ± 30.4 to 187.4 ± 6.8 (p < 0.05). Subspecialty positions represented a mean of only 15.6 ± 5% per year during the first time period and 18.8 ± 3% per year in the second period (p = 0.22), and therefore the majority of positions advertised continued to be those for generalists. The number of practicing neurosurgeons declined after 1998, and by 2002 it was less than it had been in 1991. The numbers of incoming and matriculating residents during the study period were static. Conclusions. The number of recruitment advertisements for neurosurgeons during the last 5 years has increased significantly, concomitant with a severe decline in the number of active neurosurgeons and a static supply of residents