World’s First Aeroderivative Based LNG Liquefaction Plant – Design, Operational Experience and Debottlenecking

LectureThe Darwin LNG Facility is the world’s first liquefaction facility to utilize high efficiency aeroderivative gas turbines for its refrigeration compressors. The plant’s design, startup, successful operation for over four years, upgrade, and debottlenecking are described in this paper. The application of aeroderivative engines allows a significantly lower CO2 footprint of 20-30% compared to the use of simple cycle industrial (heavy duty) gas turbines. This paper will cover the design of all of the turbomachinery, testing of machinery, startup, operational experiences, and debottlenecking activities in which the engines were upgraded. The plant was successfully commissioned and the first LNG cargo was shipped on February 14, 2006. Debottlenecking activities were completed in 2010

Aromatase inhibitors in adjuvant therapy for hormone receptor positive breast cancer: A systematic review

A systematic review was undertaken to review the evidence for the use of third-generation aromatase inhibitors (anastrozole, letrozole and exemestane) as adjuvant therapy for post-menopausal women with early-stage, hormone receptor-positive breast cancer and to develop and support recommendations for their use, with regard to three areas: aromatase inhibitors compared to tamoxifen, aromatase inhibitors in sequence with tamoxifen for a total of five years, and aromatase inhibitors given after five years of tamoxifen therapy. MEDLINE, EMBASE, American Society of Clinical Oncology and San Antonio Breast Cancer Symposium proceedings, and the Cochrane Library were searched to May 2007 for reports of randomized controlled trials that met the inclusion criteria. Nine randomized controlled trials and one meta-analysis of three of these trials were identified that reported efficacy data. Eight of these trials reported significantly improved disease-free survival in the arms that involved aromatase inhibitors. The meta-analysis reported significantly improved overall survival among all patients, as did one individual trial. One trial of five years letrozole or placebo after five years tamoxifen found improved overall survival among node-positive patients. Aromatase inhibitors provide an alternative to tamoxifen as adjuvant therapy for post-menopausal, hormone-receptor-positive breast cancer patients. The options include anastrozole and letrozole for five years, as well as anastrozole and exemestane following two to three years oftamoxifen, for a total five years of hormonal therapy. Five years of letrozole should be considered following five years of tamoxifen. Patients receiving aromatase inhibitors should be monitored for changes in bone mineral density and for cardiovascular disease risk factors and outcomes

GT 2008-50840 AERODERIVATIVE GAS TURBINES FOR LNG LIQUEFACTION PLANTS - PART 2: WORLD'S FIRST APPLICATION AND OPERATING EXPERIENCE

ABSTRACT LNG market pressures for thermally efficient and environmentally friendly LNG plants coupled with the need for high plant availability have resulted in the world's first application of high performance aeroderivative gas turbines for a 3.7 MTPA LNG plant in Darwin. The six engines utilized are GE PGT25+ engines rated at 32 MW ISO driving propane, ethylene and methane compressors. The paper describes the design, manufacture, testing, and implementation of these units focusing on both the gas turbine and the centrifugal compressors. Power augmentation utilized on these units is also discussed. An overview of operating experience and lessons learned are provided. Part 1 of this paper provides a detailed analysis of why high thermal efficiency is important for LNG plants from an economic and greenhouse gas perspective

World’s First Aeroderivative Based LNG Liquefaction Plant – Design, Operational Experience and Debottlenecking

LectureThe Darwin LNG Facility is the world’s first liquefaction facility to utilize high efficiency aeroderivative gas turbines for its refrigeration compressors. The plant’s design, startup, successful operation for over four years, upgrade, and debottlenecking are described in this paper. The application of aeroderivative engines allows a significantly lower CO2 footprint of 20-30% compared to the use of simple cycle industrial (heavy duty) gas turbines. This paper will cover the design of all of the turbomachinery, testing of machinery, startup, operational experiences, and debottlenecking activities in which the engines were upgraded. The plant was successfully commissioned and the first LNG cargo was shipped on February 14, 2006. Debottlenecking activities were completed in 2010

ONLINE Special Article Managing central venous access devices in cancer patients: A practice guideline

In cancer care, central venous access devices (CVADs) are used to safely manage patients undergoing long-term systemic treatment. CVADs are also used to ensure the safe delivery of other agents, biotherapy and supportive therapies. Nursing practice is often driven by policies and procedures that may or may not be evidence-based. Prevention of catheter-related intraluminal thrombosis is essential for quality care. Therefore, there is a need for evidence-based standardized protocols across the system. To address the issue, our group conducted a systematic review of the existing literature, which addressed the following questions: To prevent catheter-related intraluminal thrombosis and local or systemic catheter-related infection, minimize the need to replace devices, and enhance quality of life of adults with cancer: Should CVADs be locked with heparin or saline? What volume and strength of solution should be used to lock CVADs? How frequently should CVADs be locked or flushed? What type of catheter should be used? In patients who require systemic therapy for cancer, what indicators impact the decision to insert a central venous access device (CVAD)

Therapy for Diffuse Astrocytic and Oligodendroglial Tumors in Adults: ASCO-SNO Guideline

PURPOSE: To provide guidance to clinicians regarding therapy for diffuse astrocytic and oligodendroglial tumors in adults. METHODS: ASCO and the Society for Neuro-Oncology convened an Expert Panel and conducted a systematic review of the literature. RESULTS: Fifty-nine randomized trials focusing on therapeutic management were identified. RECOMMENDATIONS: Adults with newly diagnosed oligodendroglioma, isocitrate dehydrogenase (IDH)-mutant, 1p19q codeleted CNS WHO grade 2 and 3 should be offered radiation therapy (RT) and procarbazine, lomustine, and vincristine (PCV). Temozolomide (TMZ) is a reasonable alternative for patients who may not tolerate PCV, but no high-level evidence supports upfront TMZ in this setting. People with newly diagnosed astrocytoma, IDH-mutant, 1p19q non-codeleted CNS WHO grade 2 should be offered RT with adjuvant chemotherapy (TMZ or PCV). People with astrocytoma, IDH-mutant, 1p19q non-codeleted CNS WHO grade 3 should be offered RT and adjuvant TMZ. People with astrocytoma, IDH-mutant, CNS WHO grade 4 may follow recommendations for either astrocytoma, IDH-mutant, 1p19q non-codeleted CNS WHO grade 3 or glioblastoma, IDH-wildtype, CNS WHO grade 4. Concurrent TMZ and RT should be offered to patients with newly diagnosed glioblastoma, IDH-wildtype, CNS WHO grade 4 followed by 6 months of adjuvant TMZ. Alternating electric field therapy, approved by the US Food and Drug Administration, should be considered for these patients. Bevacizumab is not recommended. In situations in which the benefits of 6-week RT plus TMZ may not outweigh the harms, hypofractionated RT plus TMZ is reasonable. In patients age ≥ 60 to ≥ 70 years, with poor performance status or for whom toxicity or prognosis are concerns, best supportive care alone, RT alone (for MGMT promoter unmethylated tumors), or TMZ alone (for MGMT promoter methylated tumors) are reasonable treatment options. Additional information is available at www.asco.org/neurooncology-guidelines

Anticonvulsant prophylaxis and steroid use in adults with metastatic brain tumors: summary of SNO and ASCO endorsement of the Congress of Neurological Surgeons guidelines

BACKGROUND: The Congress of Neurological Surgeons (CNS) has developed a series of guidelines on the treatment of adults with metastatic brain tumors, including systemic therapy and supportive care topics. ASCO has a policy and set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations. METHODS: Two CNS Guidelines were reviewed for developmental rigor by methodologists and an independent multi-disciplinary Expert Panel was formed to review the content and assess agreement with the recommendations. The expert panel voted to endorse the two guidelines and ASCO and SNO independently reviewed and approved the ASCO/SNO guideline endorsement. RESULTS: The ASCO/SNO Expert Panel determined that the recommendations from the CNS anticonvulsants and steroids guidelines, published January 9, 2019, are clear, thorough, and based upon the most relevant scientific evidence. ASCO/SNO endorsed these two CNS guidelines, with minor alterations. CONCLUSIONS: Key recommendations include: prophylactic anti-epileptic drugs were not recommended for routine use; corticosteroids (specifically dexamethasone) were recommended for temporary symptomatic relief in patients with neurologic symptoms and signs related to mass effect from brain metastases

Radiation Therapy for Brain Metastases: ASCO Guideline Endorsement of ASTRO Guideline

PURPOSEAmerican Society of Radiation Oncology (ASTRO) has developed a guideline on appropriate radiation therapy for brain metastases. ASCO has a policy and set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations.METHODS"Radiation Therapy for Brain Metastases: An ASTRO Clinical Practice Guideline"2 was reviewed for developmental rigor by methodologists. An ASCO Endorsement Panel subsequently reviewed the content and the recommendations.RESULTSThe ASCO Endorsement Panel determined that the recommendations from the ASTRO guideline, published May 6, 2022, are clear, thorough, and based upon the most relevant scientific evidence. ASCO endorses "Radiation Therapy for Brain Metastases: An ASTRO Clinical Practice Guideline."2RECOMMENDATIONSWithin the guideline, stereotactic radiosurgery (SRS) is recommended for patients with Eastern Cooperative Oncology Group performance status of 0-2 and up to four intact brain metastases, and conditionally recommended for patients with up to 10 intact brain metastases. The guideline provides detailed dosing and fractionation recommendations on the basis of the size of the metastases. For patients with resected brain metastases, radiation therapy (SRS or whole-brain radiation therapy [WBRT]) is recommended to improve intracranial disease control; if there are limited additional brain metastases, SRS is recommended over WBRT. For patients with favorable prognosis and brain metastases ineligible for surgery and/or SRS, WBRT is recommended with hippocampal avoidance where possible and the addition of memantine is recommended. For patients with brain metastases, limiting the single-fraction V12Gy to brain tissue to ≤ 10 cm3 is conditionally recommended.Additional information is available at www.asco.org/neurooncology-guidelines