Hospital-acquired pressure ulcer occurrences have declined over the past decade as reimbursement policies have changed, evidence-based practice guidelines have been implemented, and quality improvement initiatives have been launched. However, the 2006-2008 Institute for Healthcare Improvement goal of zero pressure ulcers remains difficult to achieve and even more challenging to sustain. Magnet hospitals tend to have lower hospital-acquired pressure ulcer rates than non-Magnet hospitals, yet many non-Magnet hospitals also have robust pressure ulcer prevention programs. Successful programs share commonalities in structure, processes, and outcomes. A national summit of 55 pressure ulcer experts was convened at the Virginia Commonwealth University Medical Center in March 2014. The group was divided into 3 focus groups; each was assigned a task to develop a framework describing components of a proposed Magnet-designated Center of Pressure Ulcer Prevention Excellence. Systematic literature reviews, analysis of exemplars, and nominal group process techniques were used to create the framework. This article presents a framework describing the proposed Magnet-designated Centers of Pressure Ulcer Prevention Excellence. Critical attributes of Centers of Excellence are identified and organized according to the 4 domains of the ANCC model for the Magnet Recognition Program: transformational leadership; structural empowerment; exemplary professional practice; and new knowledge innovation and improvements. The structures, processes, and outcome measures necessary to become a proposed Center of Pressure Ulcer Prevention Excellence are discussed.

The objective of this study was to examine adequacy of nutrient intake and determine the impact of multivitamin use on nutrient intake in children with autism. This was a retrospective analysis of food frequency questionnaire data collected from 54 children, ages 2-8 years, in the Autism Integrated Metabolic and Genomic Endeavor Study at Arkansas Children's Hospital Research Institute, Little Rock, AR. The average percent of Kilocalories from carbohydrate, protein and fat fell within the acceptable macronutrient distribution ranges at 56%, 14% and 33%, respectively. Mean intakes for calcium, potassium, vitamin E, vitamin D and fiber were below the dietary reference intake (DRI) levels at 75%, 57%, 77%, 25% and 41%, respectively. Mean intakes of vitamin A, thiamin, riboflavin, vitamin C, and vitamin B6 exceeded the DRI at 216%, 233%, 270%, 452% and 228%, respectively. No differences were found in vitamin D, vitamin E, calcium, total kilocalorie, carbohydrate, protein and fat intake between children who were multivitamin users and those who were non-users. These data indicate that children with autism have diets adequate in kilocalories and macronutrients, while imbalances exist in fiber and several micronutrients. Dietary interventions for children with autism should be aimed at addressing these potential nutritional imbalances.

IntroductionThe rate of overweight and obesity has drastically increased over the past two decades. Recent obesity statistics from the National Health and Nutrition Examination Survey (NHANES) captured by the Centers for Disease Control and Prevention (CDC) in [2009][2010] indicate that approximately 68.8% of American adults are either overweight or obese, with 35.7% of them being obese [1]. As the rate of overweight and obesity continues to rise steadily with no end in sight, the government is charged with the task of devising strategies to hamper the epidemic. With the passage of the Nutrition Labeling and Education Act (NLEA) in 1990, all foods purchased in stores were required to list nutrition information on the packages in a standard format-a law implemented for the purpose of creating informed consumers who make healthier choices based on their knowledge of the nutritional content of the foods on store shelves [2]. This law, however, did not have the anticipated impact on overweight and obesity rates-partially because Americans are consuming more and more meals away from home at fast-food and dine-in restaurants [3].The term "menu labeling" refers to the listing of nutrition information next to each food item on restaurant menus, menu boards, and drive-through menu boards so it can be viewed and considered by customers when making their food selections [4]. According to the Patient Protection and Affordable Care Act of 2010, Section 4205, restaurant chains with 20 or more establishments of the same name will be required to disclose nutrition information for their menu items on the menu or menu board [5]. This nutrition information, at minimum, must include calories [5] but can list further information including, but not limited to, total fat, saturated fat, carbohydrates, sodium, protein, and fiber. If not disclosed on the menu, the additional nutrition information beyond calories must be made available to customers in written form upon request [6]. In addition to the calorie labels, menus must also contain a statement specifying the recommended daily caloric intake for one day for the average American-2000 caloriesenabling customers to put the calorie labels of individual food items into context of a total daily caloric intake [5].Restaurant foods are notorious for their energy density and large portion sizes-undoubtedly contributing to the undesirable weight status of a majority of Americans. Studies show that on average, foods prepared and eaten outside the home consist of large portion sizes and have high energy density with little nutritional value and low satiating power [7,8].Some chain restaurants currently offer nutrition information in the form of tray liners, pamphlets, posters, charts, on-site computers [9,10] or on food containers or napkins, depending on the restaurant. Most restaurants offer the information online, but not necessarily at the point-of-service [11].Research has shown the difficulty of estimating the number of calories and other determinants of nutritional quality in restauran...

ObjectiveTo determine if post liver transplant weight gain results in increased cardiovascular disease risk by increasing risk factors such as blood pressure and lipid levels after transplant.MethodsData on 69 patients who received a liver transplant from 2006–2008 at the University of Arkansas for Medical Sciences Liver Transplant Program was collected by electronic medical record review. Descriptive statistics were calculated to describe differences between groups. BMI, blood pressure and lipid levels were evaluated to examine a correlation between the groups.ResultsOverweight and obesity were common after liver transplant with 72% of the population overweight or obese at 1 year post transplant and 75.6% overweight or obese at the most recent time point analyzed. Blood pressure, total cholesterol, LDL and triglycerides all increased after transplant, while HDL‐cholesterol decreased. A significant relationship exists between blood pressure, HDL‐cholesterol and BMI after liver transplant.ConclusionIncrease in blood pressure, lipid levels, BMI and overweight/obesity after liver transplant is common. Pre‐transplant patient education on the risk of weight gain, overweight and obesity, HTN, and dyslipidemia after transplant as well as ongoing follow up post transplant for weight management is warranted. Supported by: Department of Dietetics and Nutrition.

Alterations in nutrient metabolism may exist in children with autism spectrum disorders (ASD’s), especially the pathways involving folate‐dependent one‐carbon metabolism. Few studies have investigated intake and plasma levels of choline and betaine in children with ASD, although they play a role in these metabolic pathways. This study examined 1) differences in plasma levels of choline and betaine in children with and without ASD and 2) relationships between dietary intake and plasma levels of choline and betaine in children with ASD. Secondary data analyses on 63 children were conducted. Significantly lower choline levels were found in children with ASD (M=8.00, SD=2.42) compared to children without ASD, M=10.03, SD=2.84; t (61) =‐3.04, p= 0.004, (two‐tailed). Similarly, betaine levels were significantly lower in children with ASD (M=24.1, SD=6.49) compared to children without ASD, M=36.70, SD= 6.73; t (60)= ‐7.5, p < 0.001, (two‐tailed). Strong, positive correlations were found between dietary intake and plasma levels of choline (r= 0.657, n=33, p<0.0005) and betaine (r=0.688, n=33, p<0.0005) in children with ASD. These results suggest that children with ASD may have diets inadequate in choline. Grant Funding Source: HRSA; NICHD and Rochester University

Questions remain about potential nutrition deficits associated with autism. The purpose of this study was to determine if children with autistic disorder have adequate nutrient intake and if multivitamin use (MVIU) impacts intake. Participants (n=54) in the Autism IMAGE (Integrated Metabolic and Genomic Endeavor) Study at a local children's hospital completed Block Food Frequency Questionnaires (FFQ) for children ages 2 to 7. FFQ results were compared to Dietary Reference Intake (DRI) and Acceptable Macronutrient Distribution Ranges (AMDR). Mean intakes for % kcals from carbohydrate, protein and fat were within AMDR at 55% (SD=7), 14% (SD=3) and 33% (SD=5), respectively. However, intakes were below DRI for calcium (75% DRI ±45) and vitamins E (77% DRI ±26) and D (25% DRI ±19). A significant, positive relationship was found between MVIU and carbohydrate (p<.05); however, no significant relationships were found between MVIU and calcium, vitamins E or D, calories, protein or fat. Our results show that diets of children with autism are lacking in some micronutrients while macronutrient intake falls within recommended ranges.Supported by 1Dept of Dietetics & Nutrition and 2LEND to JJ

Vitamin D deficiency is a significant problem in the United States, especially among older adults. The objectives of this studywere to determine if age, gender, and race influence vitamin D intake and to determine if varying degrees of vitamin D inadequacy exist in adults. Secondary data analyses were performed on 1,065 adults (>41 years) in the 2009‐2010 NHANES data set. We found that Mexican Hispanics had significantly higher vitamin D intake levels compared to Non‐Hispanic Whites (p=.003, 2‐tailed). Analysis also showed that there was a significant difference in the vitamin D intake levels among males (0.6 ‐ 38.6 mcg/d) and females (5.6 ‐ 43.2 mcg/d), p<.001. There was no relationship between vitamin D intake and age. The findings suggest that the mean intake of vitamin D for age, race, and gender where all above the RDA (15 mcg/d), but the min ‐ max ranges for all participants in the study suggest some individuals were well above the RDA for vitamin D while others were well below that threshold. Much of the current research on vitamin D is showing a correlation between deficiency and all‐cause mortality. Further research is needed to confirm this correlation.

Recent studies have noted a decrease in dairy intake and an increase in soda intake within the adolescent age group. Such studies have indicated trends in adolescent beverage intake may be detrimental to bone health. The purpose of this research was to examine relationships among dietary factors and bone mineral density (BMD) in adolescents using National Health and Nutrition Examination Survey (NHANES) 2009‐2010 data for 1176 participants aged 12‐19 years of age. Adolescent mean dairy intake had a statistically significant positive correlation (small effect size) to mean femur BMD (rs= 0.076, p<0.01). Adolescent mean dairy intake had a statistically significant positive correlation (large effect size) to mean calcium intake (rs= 0.888, p<0.01). There was a statistically significant difference in mean calcium intake between genders, t(1171.26) =5.82, p<0.01, with males having a higher mean intake (942±5.63 mg) than females (650±3.32 mg). There was a statistically significant difference in mean dairy intake between genders, t(1173.71)= 8.92, p<0.01, with males having a higher intake (2.07±0.27 cps) than females (1.42±0.19 cps). The analyses suggest dairy consumption should be encouraged within the adolescent population to promote optimal bone health.