Objectifs: Examiner les interrelations entre l'albumine serique basse, l'alteration du statut nutritionnel et une inflammation chronique chez les patients âges en convalescence. Projet: Etude de cohorte prospective. Cadre: Une unite de soins (TCU) au sein d'un departement des Anciens Combattants de l'unite de soins infirmiers a domicile. Participants: 275 anciens combattants âges (âge moyen = 78,9 ± 7.5y, 99% d'hommes) admis pour des soins de recuperation et de rehabilitation; Methode de mesure: Lors de leur admission et decharge (duree mediane du sejour 24j, IQR 16 a44j), chaque sujet a effectue une evaluation complete standardisee incluant une evaluation nutritionnelle, la mesure de l'albumine serique, proteine C-reactive (CRP), l'interleukine-6 (IL-6) et ses recepteur soluble, et TNF-α et ses recepteurs solubles (sTNF-RI et II). Des evaluations completes en apports nutritifs ont ete realisees chaque jour. Resultats: A la fois, la mesure de l'albumine a la sortie du malade ainsi que la modification de l'albumine pendant le sejour ont ete fortement et inversement correlee avec divers indicateurs d'inflammation, notamment la CRP et d'IL-6. Les modifications de la CRP ont ete les facteurs les plus correles a la modification de l'albumine. IL-6 est le plus correle aux taux de l'albumine lors de a sortie du malade. L'apport en nutriments est egalement correle avec l'albumine et de sa variation, mais c'st l'inflammation qui est a l'origine de la plus grosse part de cette variation dans l'analyse multivariee. Bien qu'il y ait des interactions importantes entre le temps et les apports en nutriments et l'inflammation, l'importance relative de l'inflammation comme un facteur possible de la concentration serique d'albumine semble rester inchanges avec des periodes plus longues d'observation. Conclusions: Parmi les patients âges admis dans un TCU, l'inflammation semble etre un determinant puissant de l'albumine et de son evolution durant l'hospitalisation par rapport aux apports nutritionnels. Des etudes complementaires sont necessaires pour prouver la causalite et de determiner si l'importance relative de l'inflammation sur la concentration d'albumine diminue avec plus longues periodes d'observation.

Objectives To examine the interrelationships among low serum albumin, nutritional depletion, and ongoing inflammation in older patients recovering from illness. Design A prospective cohort study Setting A transitional care unit (TCU) within a Department of Veterans Affairs hospital nursing home care unit. Participants 275 older veterans (mean age=78.9 ± 7.5y, 99% male) admitted for recuperative care and rehabilitation. Measurements At admission and discharge (median LOS 24d, IQR 16 to 44d), each subject completed a comprehensive standardized evaluation including a nutritional assessment and measurement of serum albumin, C-reactive protein (CRP), interleukin-6 (IL-6) and its soluble receptor, and tumor necrosis factoralpha (TNF-α) and its soluble receptors (sTNF-RI and II). Complete nutrient intake assessments (calorie counts) were performed daily. Results Both the discharge albumin and the change in albumin (discharge minus admission) were strongly and inversely correlated with various indicators of inflammation, particularly CRP and IL-6. Change in CRP was the strongest correlate of change in albumin (R 2 = 0.21, P<.001) and discharge IL-6 the strongest correlate of discharge albumin (R 2 = 0.21, P<.001). Nutrient intake also correlated with albumin and its change, but entered the multivariable models after inflammatory indicators and explained a smaller portion of the variance. Although there were significant interactions between time and both nutrient intake and inflammation, the relative importance of inflammation as a potential determinant of the serum albumin concentration appeared to remain unchanged with longer periods of observation. Conclusions Among elderly patients admitted to a TCU, inflammation appears to be a more powerful determinant of albumin and its change during the hospitalization than is nutrient intake. Further study is needed to prove causality and to determine whether the relative importance of inflammation on the albumin concentration diminishes with more prolonged periods of observation.

OBJECTIVES:To determine the relationship between prealbumin, nutrient intake, and indicators of inflammation for recuperative and rehabilitative care patients. DESIGN:Prospective cohort. SETTING:Recuperative Care Unit within a Veterans Administration Nursing Home Care Unit. PARTICIPANTS:One hundred eleven men (100 white; mean age 80, range 64-93). MEASUREMENTS:Prealbumin and seven markers of inflammation (C-reactive protein (CRP), tumor necrosis factor, and interleukin-6 (IL-6) and their soluble receptors) were measured at admission and discharge (median length of stay 23 days, interquartile range 15-40 days). Detailed calorie counts were performed daily, and intake was expressed as a percentage of estimated requirements for protein (1.5 g/kg body weight per day) and energy (Harris-Benedict equation). The study objective was examined using least-squares regression analysis. RESULTS:Discharge prealbumin and the change in prealbumin were positively correlated with protein and energy intake and inversely correlated with markers of inflammation, particularly CRP and IL-6. When all covariates were included in a multivariable regression analysis, the markers of inflammation predominantly accounted for the variance in prealbumin change (56%), whereas discharge protein intake accounted for 6%. CONCLUSION:For older recuperative care patients, prealbumin and its change during hospitalization are positively associated with protein intake, but inflammation or changes in inflammation appear to exert a much more-powerful influence on prealbumin concentration. Given the potential confounding effects of inflammation, monitoring the change in prealbumin is not an adequate substitute for a more-detailed nutritional assessment in this population.

The Savannah River Site's Defense Waste Processing Facility (DWPF) near Aiken, SC is the world's largest radioactive waste vitrification facility. Radioactive operations began in March 1996 and over 1,000 canisters have been produced. This paper presents an overview of the DWPF process and a summary of recent facility operations and process improvements. These process improvements include efforts to extend the life of the DWPF melter, projects to increase facility throughput, initiatives to reduce the quantity of wastewater generated, improved remote decontamination capabilities, and improvements to remote canyon equipment to extend equipment life span. This paper also includes a review of a melt rate improvement program conducted by Savannah River Technology Center personnel. This program involved identifying the factors that impacted melt rate, conducting small scale testing of proposed process changes and developing a cost effective implementation plan.