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Summary Background We previously reported the 5-year results of the phase 3 IBCSG 23-01 trial comparing disease-free survival in patients with breast cancer with one or more micrometastatic (≤2 mm) sentinel nodes randomly assigned to either axillary dissection or no axillary dissection. The results showed no difference in disease-free survival between the groups and showed non-inferiority of no axillary dissection relative to axillary dissection. The current analysis presents the results of the study after a median follow-up of 9·7 years (IQR 7·8–12·7). Methods In this multicentre, randomised, controlled, open-label, non-inferiority, phase 3 trial, participants were recruited from 27 hospitals and cancer centres in nine countries. Eligible women could be of any age with clinical, mammographic, ultrasonographic, or pathological diagnosis of breast cancer with largest lesion diameter of 5 cm or smaller, and one or more metastatic sentinel nodes, all of which were 2 mm or smaller and with no extracapsular extension. Patients were randomly assigned (1:1) before surgery (mastectomy or breast-conserving surgery) to no axillary dissection or axillary dissection using permuted blocks generated by a web-based congruence algorithm, with stratification by centre and menopausal status. The protocol-specified primary endpoint was disease-free survival, analysed in the intention-to-treat population (as randomly assigned). Safety was assessed in all randomly assigned patients who received their allocated treatment (as treated). We did a one-sided test for non-inferiority of no axillary dissection by comparing the observed hazard ratios (HRs) for disease-free survival with a margin of 1·25. This 10-year follow-up analysis was not prespecified in the trial's protocol and thus was not adjusted for multiple, sequential testing. This trial is registered with ClinicalTrials.gov, number NCT00072293. Findings Between April 1, 2001, and Feb 8, 2010, 6681 patients were screened and 934 randomly assigned to no axillary dissection (n=469) or axillary dissection (n=465). Three patients were ineligible and were excluded from the trial after randomisation. Disease-free survival at 10 years was 76·8% (95% CI 72·5–81·0) in the no axillary dissection group, compared with 74·9% (70·5–79·3) in the axillary dissection group (HR 0·85, 95% CI 0·65–1·11; log-rank p=0·24; p=0·0024 for non-inferiority). Long-term surgical complications included lymphoedema of any grade in 16 (4%) of 453 patients in the no axillary dissection group and 60 (13%) of 447 in the axillary dissection group, sensory neuropathy of any grade in 57 (13%) in the no axillary dissection group versus 85 (19%) in the axillary dissection group, and motor neuropathy of any grade (14 [3%] in the no axillary dissection group vs 40 [9%] in the axillary dissection group). One serious adverse event (postoperative infection and inflamed axilla requiring hospital admission) was attributed to axillary dissection; the event resolved without sequelae. Interpretation The findings of the IBCSG 23-01 trial after a median follow-up of 9·7 years (IQR 7·8–12·7) corroborate those obtained at 5 years and are consistent with those of the 10-year follow-up analysis of the Z0011 trial. Together, these findings support the current practice of not doing an axillary dissection when the tumour burden in the sentinel nodes is minimal or moderate in patients with early breast cancer. Funding International Breast Cancer Study Group.

This work analyzes the impact of weather forecast uncertainty on the annual performance of a Concentrated Solar Power (CSP) plant. Forecast time series has been produced by a commercial forecast provider using the technique of hindcasting for the full year 2011 in hourly resolution for Ouarzazate, Morocco. Impact of forecast uncertainty has been measured on three case studies, representing typical tariff schemes observed in recent CSP projects plus a spot market price scenario. The analysis has been carried out using an annual performance model and a standard dispatch optimization algorithm based on dynamic programming. The dispatch optimizer has been demonstrated to be a key requisite to maximize the annual revenues depending on the price scenario, harvesting the maximum potential out of the CSP plant. Forecasting uncertainty affects the revenue enhancement outcome of a dispatch optimizer depending on the error level and the price function. Results show that forecasting accuracy of direct solar irradianc...

The steam turbine cooldown has a significant impact on the cyclic fatigue life. A lower initial metal temperature after standstill results in a higher temperature difference to be overcome during the next start-up. Generally, lower initial metal temperatures result in higher start-up stress. In order to optimize steam turbines for cyclic operation, it is essential to fully understand natural cooling, which is especially challenging for rotors. This paper presents a first-in-time application of a 2D numerical procedure for the assessment of the thermal regime during natural cooling, including the rotors, casings, valves, and main pipes. The concept of the cooling calculation is to replace the fluid gross buoyancy during natural cooling by an equivalent fluid conductivity that gives the same thermal effect on the metal parts. The fluid equivalent conductivity is calculated based on experimental data. The turbine temperature was measured with pyrometric probes on the rotor and with standard thermocouples on inner and outer casings. The pyrometric probes were calibrated with standard temperature measurements on a thermo well, where the steam transmittance and the rotor metal transmissivity were measured.

Steam turbine start-up has a significant impact on the cyclic fatigue life. Modern steam turbines are operated at high temperatures for optimal efficiency, which results in high temperature differences relative to the condition before start-up. To achieve the fastest possible start-up time without reducing the lifetime of the turbine components due to excessive thermal stress, the start-up procedure of cyclic turbines is optimized to follow the specific material low cycle fatigue limit. For such optimization and to ensure reliable operation, it is essential to fully understand the thermal behavior of the components during start-up. This is especially challenging in low flow conditions, i.e. during pre-warming and early loading phase. A two-dimensional numerical procedure is described for the assessment of the thermal regime during start-up. The calculation procedure includes the rotor, casings, valves and main pipes. The concept of the start-up calculation is to replace the convective effect of the steam in the turbine cavity by an equivalent fluid over-conductivity that gives the same thermal effect on metallic parts. This approach allows simulating accurately the effect of steam ingestion during pre-warming phase. The fluid equivalent over-conductivity is calibrated with experimental data. At the end of the paper the impact of ingested steam temperature and mass-flow on the rotor cyclic lifetime is demonstrated. This paper is a continuation of papers [1] and [2].Copyright © 2013 by Alstom Technology

Steam turbine cool-down has a significant impact on the cyclic fatigue life. A lower initial metal temperature after standstill results in a higher temperature difference to be overcome during the next start-up. Generally, lower initial metal temperatures result in higher start-up stress. In order to optimize steam turbines for cyclic operation, it is essential to fully understand natural cooling, which is especially challenging for rotors. A two-dimensional numerical procedure is described for the assessment of the thermal regime during natural cooling including the rotors, casings, valves and main pipes. The concept of the cooling calculation is to replace the steam gross buoyancy during the gland steam ingestion phase by an equivalent fluid conductivity, that gives the same thermal effect on the metal parts. The fluid equivalent conductivity is calculated based on measurements. The approach is calibrated with experimental data. Finally, the highly sensitive nature of the cyclic lifetime to the predicted cooling evolution is demonstrated. This paper is complementary with the paper [1].