Variation in Nutritional Quality of School Lunches With Implementation of National School Lunch Program Guidelines

BACKGROUND

School lunches must meet National School Lunch Program (NSLP) requirements to receive reimbursement. In this study, we sought to determine whether there are significant differences in nutrient content and nutritional quality between 2 menus meeting NSLP requirements.

METHODS

A cross‐sectional content analysis compared 6 weeks of a typical school lunch menu (TM) from an actual school district to a best practice school lunch menu (BPM) created by a registered dietitian based on Child and Adult Care Food Program (CACFP) best practices and Dietary Guidelines for Americans (DGA) healthy meal pattern recommendations. Daily nutrient content was determined using nutrient analysis software. Nutritional quality was computed using Healthy Eating Index (HEI) 2010.

RESULTS

For nutrients required for analysis, the BPM was lower in calories, saturated fat, and sodium and higher in protein, carbohydrate, and fiber (ps < .01). For other nutrients of concern, the BPM was higher in vitamin A, vitamin D, phosphorus, and magnesium (ps < .01). The BPM had higher HEI scores for nutritional quality (p < .001).

CONCLUSIONS

Results indicate the possibility for significant variation in nutritional quality of NSLP‐qualifying lunches. Using CACFP best practices and DGA recommendations may significantly impact school lunch dietary quality.

     

Feasibility of a percutaneous technique for repairing proximal femora with simulated metastatic lesions

Fracture of the proximal femur due to metastatic disease is a significant cause of morbidity and mortality among breast cancer patients. Prophylactic surgical fixation is advised for patients at risk of fracture and typically involves placement of an orthopaedic implant. We propose that some proximal femora with metastases can be repaired by removing the lesion and filling the resulting defect with bone cement (polymethylmethacrylate), a procedure that could be performed percutaneously without the use of hardware. We studied the strengths of 12 matched pairs of cadaveric proximal femora under single-limb stance loading. One femur from each pair remained intact, while a simulated metastatic lesion, measuring approximately 75% of the neck diameter, was burred into the neck of the contralateral femur. The defects were repaired using a procedure similar to the one proposed. Femoral strength was measured via mechanical testing to failure. The strengths of the repaired femora averaged 94.7% of the strength of their respective contralateral intact femur (standard deviation, 8.7%). These findings suggest that the proposed procedure may be useful for some patients with metastases in the femoral neck. If the proximal femur could be safely repaired using the proposed technique in place of conventional surgical fixation, the patient would benefit from a shorter and less invasive surgical procedure, less pain and discomfort, greatly reduced recovery time, and a shorter hospital stay-all at a much lower cost.     

Targeted binding of PLA microparticles with lipid-PEG-tethered ligands

Solid core polymeric particles are an attractive delivery vehicle as they can efficiently encapsulate drugs of different physical and chemical characteristics. However, the effective targeting of such particles for therapeutic purposes has been somewhat elusive. Here, we report novel polymeric particles comprised of poly(lactic acid) (PLA) with incorporated poly(ethylene glycol)-lipids (PEG-lipids). Particles are characterized for morphology, surface charge, and composition with field-emission scanning electron microscopy (FESEM), zeta potential measurements, and proton nuclear magnetic resonance ((1)H NMR) spectroscopy, respectively. The surface densities of PEG lipids determined by (1)H NMR and particle size distributions are consistent with scaling theory for adsorption of chains onto a surface. We observe significant binding of liganded PEG-lipid tethers when the molecular weight is greater than the unliganded PEG-lipids for significant binding events. Importantly, the binding is not completely lost when the unliganded PEG molecular weight is greater than the liganded PEG-lipid tether. We observe a similar trend for the lower affinity ligand (thioctic acid), but the degree of binding is significantly lower than the high affinity ligand (biotin). This novel technique used to fabricate these liganded particles combined with the lipid bilayer binding studies provides a platform for systematic optimization of particle binding.     

Eliminating health disparities: understanding this important phenomenon

Since the formation of the United States in early times, diversity has always been a reality. With the immigration of diverse whites from Europe, the importation of black slaves from Africa, and the presence of the preexisting Native American populations, diversity has long been a fact of life in this country. However, one of the long-standing priorities of the United States has been "good health" for all the people. The broad diversity of the population has presented a tremendous challenge to health care. This article addresses this important topic by looking at the concept of health disparity from a biopsychosocial perspective and further by describing disparities that are present in the United States among the 2 major ethnic minority groups, African Americans and Mexican Americans. Many other health disparities could be considered in other groups, but space limits of article allow only the 2 major ethnic minority groups to be addressed.     

Inside the Premier/CMS Pay-for-Performance Project

In an H&HN exclusive roundtable discussion, representatives from the five top-performing hospitals describe what they've learned so far from the Premier/CMS Pay-for-Performance Project. For hospitals around the country, so-called value-based ent will soon be the primary way they get paid by both public and commercial insurers. The Premier/CMS participants offer valuable insights--and warnings--about the challenges ahead.     

Catholic Health Initiatives at 10

The summer of 2006 marked the 10th anniversary of the formation of Denver-based Catholic Health Initiatives (CHI). Formed in 1996 as the result of the merger of three Catholic health care systems, and soon joined by a fourth, the system integrated a diverse collection of health care facilities previously sponsored by 12 different religious congregations. It was the first Catholic health system to give laity a sponsorship role in its facilities. CHI's facilities are sponsored by a public juridic person (PJP), the Catholic Health Care Federation (CHCF). The same people who sit on the system's board also constitute CHCF. They are thus responsible for both governance and sponsorship. CHI was the first Catholic health care system to give laypersons a sponsorship role in its facilities. Establishing the PJP was a long and complex task. Eventually, the church determined that CHI's PJP should be pontifical, accountable to the Congregation for Institutes of Consecrated Life and Societies of Apostolic Life in Rome. CHCF in 1991 became the first PJP in health care in the United States. CHI's staff, led by its first president and chief executive officer, Patricia Cahill, quickly took steps to help the new system begin to coalesce, establishing a single, systemwide pension plan, debt policy, and so forth. Also challenging was the creation of a systemwide new culture. An essential step in the development of CHI's culture was the involvement of employees in the identification of its core values: reverence, integrity, compassion, and excellence, The creation of CHI's Mission and Ministry Fund also helped give the system an identity. This fund provides grants to programs that take an innovative approach to building healthy communities, a goal expressed in CHI's mission and vision statements. The people who created CHI and nurtured it during its first decade give it high marks for faithful adherence to its mission. Even so, they acknowledge that there is always more work to be done.     

Human Salmonella and concurrent decreased susceptibility to quinolones and extended-spectrum cephalosporins

The National Antimicrobial Resistance Monitoring System monitors susceptibility among Enterobacteriaceae in humans in the United States. We studied isolates exhibiting decreased susceptibility to quinolones (nalidixic acid MIC >32 microg/mL or ciprofloxacin MIC > or =0.12 microg/mL) and extended-spectrum cephalosporins (ceftiofur or ceftriaxone MIC > or =2 microg/mL) during 1996-2004. Of non-Typhi Salmonella, 0.19% (27/14,043) met these criteria: 11 Senftenberg; 6 Typhimurium; 3 Newport; 2 Enteridis; and 1 each Agona, Haifa, Mbandaka, Saintpaul, and Uganda. Twenty-six isolates had gyrA mutations (11 at codon 83 only, 3 at codon 87 only, 12 at both). All Senftenberg isolates had parC mutations (S801 and T57S); 6 others had the T57S mutation. The Mbandaka isolate contained qnrB2. Eight isolates contained bla(CMY-2); 1 Senftenberg contained bla(CMY-23). One Senftenberg and 1 Typhimurium isolate contained bla(SHV-12); the Mbandaka isolate contained bla(SHV-30). Nine Senftenberg isolates contained bla(OXA-1) contained bla(OXA-9). Further studies should address patient outcomes, risk factors, and resistance dissemination prevention strategies.