A Comparative Study on Environmental Flows Assessment Methods in Lower Reach of Mahanadi River

Environmental flows assessment is a process which determines the allocated water for maintaining aquatic habitats and ecological processes in a environment. The river system attains zero flow in low flow period due to construction of hydropower generating structures, water retaining structure and withdrawal of water by water users, which possesses a tremendous threat to the environment, ecology & aquatic life. Therefore a need arises to regulate the reservoirs for releasing the adequate water in the river throughout the year as well as a flushing flow once in a year. Thus environmental flows assessment is done in Lower Mahanadi sub-basin and recommended to provide the EFRs on average 26 % of MAF with a range of Low flow 56% of mean low flow & High flow 21% of mean high flow to be ensured at any circumstances to avoid any degradation of river ecosystem. In the present study the assessment of the environmental flows on the basis of Tennant method, Tessman method, VMF method, Q90_Q50 method, Smakhtin method,  low flow index (7Q10) method and FDC (EMC shifting technique) method using Global Environmental Flow Calculator (GEFC) software. Keywords: EFR, GIS, Tennant, Tessman, VMF, Q90_Q50, 7Q10, FDC method

TREND ANALYSIS OF RAINFALL, TEMPERATURE AND RUNOFF DATA: A CASE STUDY OF RANGOON WATERSHED IN NEPAL

Purpose: The study has been carried out to investigate and assess the significance of the potential trend of three variables viz. rainfall, temperature and runoff over the Rangoon watershed in Dadeldhura district of Nepal.Methodology: In this study, trend analysis has been carried out on monthly, seasonal and annual basis using the data period between 1979 to 2010 for rainfall and temperature and 1967 to 1996 for runoff. Mann-Kendall test and Sen’s slope estimate test were applied to identify the existing trend direction and Sen’s slope estimator test were used to detect the trend direction and magnitude of change over time.Main findings: The most important findings are, i) There is warming trends over the Rangoon watershed as Mann-Kendall statistic (Z-value) for most of the maximum temperature values are positive, ii) Rainfall and runoff affected by fluctuations every year though the annual rainfall showing a rising trend whereas runoff showing a falling trend. The rainfall seasonal trend analysis indicates that monsoon and post-monsoon period showed a positive rainfall trend with z statistics of +1.93, and +1.12 respectively, whereas pre-monsoon and winter seasons showed a negative trend with z statistics of -1.02, and -0.54 respectively. However, the annual rainfall in the Rangoon watershed showed a positive trend with a z value of +1.70.Importance of this study: This case study has been undertaken to investigate the trends of important climatic variables viz. rainfall, temperature which have a direct impact on the agriculture of the region.Originality / Novelty of study: This is an original research work undertaken under the M. Tech programme during 2016-17 at IIT Roorkee by the scholar Er. Amar Bahadur Pal from Nepal.

A comparative study of propofol and N2O versus sevoflurane and N2O with respect to haemodynamic response and ease of laryngeal mask airway insertion: a prospective randomized double blinded study

Background: Laryngeal mask airway (LMA) is an accepted airway device for spontaneous and modest positive pressure ventilation. Propofol is widely used Induction agent. Sevoflurane is a newer pleasant volatile anaesthetic with rapid induction and recovery with stable haemodynamics. The aim of this study was to compare propofol and sevoflurane with respect of haemodynamic changes and conditions for LMA insertion.Methods: This study was done on 60 female patients of ASA I, II grade between 20-60 years of age. Patients were randomized into two groups (n=30). All patients were preoxygenated and received inj. fentanyl 2µg/kg. Induction agent was propofol 2.5mg/kg (group P) or sevoflurane 8% with vital capacity breath (group S). Loss of eyelash reflex was the end point of induction. Induction time, conditions for LMA insertion, number of attempts, time of successful LMA insertion and haemodynamic parameters were noted.Results: time for induction and LMA insertion was significantly faster in propofol group than group S (p<0.05). Successful LMA insertion in first attempt was 100% in group P with excellent conditions (score 18) while in group S, it was 86.7% with excellent to satisfactory conditions (score 16-17). A significant fall in mean arterial pressure (p<0.05) was noted in group P while pulse rates were comparable in both groups.  Conclusions: Sevoflurane vital capacity breath inhalational induction can be used as an effective alternative to propofol though it requires greater time for LMA insertion but with better haemodynamic stability.

A prospective randomized study for comparison of haemodynamic changes and recovery characteristics with propofol and sevoflurane anaesthesia during laparoscopic cholecystectomies

Background: Day care laparoscopic surgical procedures are rapidly increasing nowadays. Rapid emergence and early recovery from anaesthesia with minimal complications are desired. Both propofol and sevoflurane meet above criteria and established as agents of choice in laparoscopic surgeries for induction and maintenance of anaesthesia. So this study aimed to compare sevoflurane with propofol for intraoperative haemodynamic changes with postoperative recovery profile in patient’s undergone laparoscopic cholecystectomies under general anaesthesia.Methods: In this prospective randomized study, sixty patients of either sex, 18-60 years with ASA grade 1 and 2 scheduled for laparoscopic cholecystectomies under general anaesthesia were randomly allocated into two groups. In Group S, patients were maintained on sevoflurane anaesthesia (0.5-2.5%) while in Group P, patients were maintained with propofol infusion (75-125 µg/kg/min) along with O2 (50%) and N2O (50%).The intraoperative haemodynamic parameters, recovery characteristics and postoperative nausea and vomiting (PONV) were observed in both groups.Results: The mean baseline haemodynamic parameters (HR, SBP, DBP, MBP, SpO2 and EtCO2) were comparable in both groups, (P>0.05). No significant difference in HR was at observed any time interval, P>0.05, however, SBP, DBP and MBP were significantly lower in propofol group at different time intervals, P<0.05, but clinically not significant and patients remained haemodynamically stable in both groups. The mean time for all recovery characteristics were significantly shorter in sevoflurane group as compared to propofol group, (P<0.01). However the incidence of PONV was significantly more in sevoflurane group.Conclusions: Sevoflurane can be used as an effective alternative to propofol for maintenance of anaesthesia in day care laparoscopic procedures as it has better recovery profile with stable haemodynamic parameters

Projecting Climate and Land Use Change Impacts on Actual Evapotranspiration for the Narmada River Basin in Central India in the Future

Assessment of actual evapotranspiration (ET) is essential as it controls the exchange of water and heat energy between the atmosphere and land surface. ET also influences the available water resources and assists in the crop water assessment in agricultural areas. This study involves the assessment of spatial distribution of seasonal and annual ET using Surface Energy Balance Algorithm for Land (SEBAL) and provides an estimation of future changes in ET due to land use and climate change for a portion of the Narmada river basin in Central India. Climate change effects on future ET are assessed using the ACCESS1-0 model of CMIP5. A Markov Chain model estimated future land use based on the probability of changes in the past. The ET analysis is carried out for the years 2009-2011. The results indicate variation in the seasonal ET with the changed land use. High ET is observed over forest areas and crop lands, but ET decreases over crop lands after harvest. The overall annual ET is high over water bodies and forest areas. ET is high in the premonsoon season over the water bodies and decreases in the winter. Future ET in the 2020s, 2030s, 2040s, and 2050s is shown with respect to land use and climate changes that project a gradual decrease due to the constant removal of the forest areas. The lowest ET is projected in 2050. Individual impact of land use change projects decreases in ET from 1990 to 2050, while climate change effect projects increases in ET in the future due to rises in temperature. However, the combined impacts of land use and climate changes indicate a decrease in ET in the future

An evaluation of a price transparency intervention for two commonly prescribed medications on total institutional expenditure: a prospective study

Importance: Providing cost feedback has been demonstrated to decrease demand from clinicians. Objective: We tested the hypothesis that providing the cost of drugs to clinicians would modify total expenditure. Design: A prospective study design with a step-wise intervention. Setting/Participants: Individuals who were admitted to the XXX from November 2013 to November 2015 under the physicians. Intervention: The cost of all antibiotics and inhaled corticosteroids was added to the electronic prescribing system. Main outcomes: The weekly cost for antibiotics and inhaled corticosteroids in the intervention period compared to baseline. Results: Mean weekly expenditure on antibiotics per patient decreased by £3.75 (95% confidence intervals CI: -6.52 to -0.98) after the intervention from a pre-intervention mean of £26.44, and then slowly increased subsequently by £0.10/week (95%CI: +0.02 to +0.18). Mean weekly expenditure on inhaled corticosteroids per patient did not substantially change after the intervention (-£0.03, 95%CI: -0.06 to -0.01 after the intervention from a pre-intervention mean of £5.29 per person). New clinical guidelines for inhaled corticosteroids were associated with a decrease in weekly expenditure. Conclusions and relevance: Provision of cost feedback resulted in no sustained change in institutional expenditure. However, clinical guidelines have potential for modifying clinical prescribing behaviour

Conjoint bicondylar Hoffa fracture in a child: a rare variant treated by minimally invasive approach

A case of conjoint Hoffa-type fracture in a child is presented. Hoffa fracture, i.e., coronal slice fracture of the condyles of the femur, is rare in adults and even rarer in the pediatric population. To date, no case of conjoint bicondylar Hoffa fracture has been reported in the literature. The presented case was successfully treated by arthroscopically assisted internal fixation

An evaluation of a price transparency intervention for two commonly prescribed medications on total institutional expenditure: a prospective study

Importance: Providing cost feedback has been demonstrated to decrease demand from clinicians.Objective: We tested the hypothesis that providing the cost of drugs to clinicians would modify total expenditure.Design: A prospective study design with a step-wise intervention.Setting/Participants: Individuals who were admitted to the XXX from November 2013 to November 2015 under the physicians.Intervention: The cost of all antibiotics and inhaled corticosteroids was added to the electronic prescribing system.Main outcomes: The weekly cost for antibiotics and inhaled corticosteroids in the intervention period compared to baseline.Results: Mean weekly expenditure on antibiotics per patient decreased by £3.75 (95% confidence intervals CI: -6.52 to -0.98) after the intervention from a pre-intervention mean of £26.44, and then slowly increased subsequently by £0.10/week (95%CI: +0.02 to +0.18). Mean weekly expenditure on inhaled corticosteroids per patient did not substantially change after the intervention (-£0.03, 95%CI: -0.06 to -0.01 after the intervention from a pre-intervention mean of £5.29 per person).New clinical guidelines for inhaled corticosteroids were associated with a decrease in weekly expenditure.Conclusions and relevance: Provision of cost feedback resulted in no sustained change in institutional expenditure. However, clinical guidelines have potential for modifying clinical prescribing behaviour

Successfully treated synchronous double malignancy of the breast and esophagus: a case report

<p>Abstract</p> <p>Introduction</p> <p>The incidence of multiple primary cancers is reported to be between 0.3% and 4.3%. The second primary lesion is identified either simultaneously with the primary lesion (synchronous) or after a period of time (metachronous). Few cases of metastasis of breast carcinoma to the esophagus and vice versa have been reported in the past.</p> <p>Case presentation</p> <p>We report an extremely rare case of a 55-year-old Indian woman who had carcinomas in both the esophagus and the breast simultaneously. She was treated successfully using combined modalities of surgery, chemotherapy and radiation therapy.</p> <p>Conclusion</p> <p>Cases of synchronous double malignancies can be treated by dealing with the malignancy in the two sites as independent carcinomas. We have to take into consideration the total dose of radiation to a critical organ as well as the effect of the total dose of toxic chemotherapeutic drugs on our patient.</p