Flow Augmentation Research Articles

50 years of flow augmentation bypass surgery: history, current state-of-the-art and outlook

50 years of flow augmentation bypass surgery: history, current state-of-the-art and outlook

Flow-augmentation bypass in the treatment of acute ischemic stroke.

Results of two randomized trials did not show benefit of revascularization with extracranial-intracranial (EC-IC) flow augmentation bypass in patients with symptomatic occlusion of internal carotid artery (ICA). However, patients with acute stroke were not included in these studies. Herein, we systematically analyze and discuss the literature about flow augmentation bypass for treatment of acute ischemic stroke. This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. MEDLINE, Web of Science and EMBASE were independently searched by two reviewers for published series to identify literature relating to EC-IC bypass in the surgical management of acute ischemic stroke up to June 2020. Studies were categorized according to their level of evidence. Nineteen studies met the inclusion criteria for the systematic literature review, including 16 level IV studies (ten case series and six6 case reports) and three level III studies (retrospective cohort case-control studies). Occurrence of fatal or non-fatal ischemic or hemorrhagic postoperative stroke, as well as clinical functional outcome at follow-up were considered as primary and secondary endpoints, respectively. The literature about flow augmentation bypass for treatment of acute ischemic stroke is scarce and heterogenous, with only 19 studies. The results of the present systematic review encourage further study to explore and validate the use of EC-IC bypass in the treatment of anterior circulation acute ischemic stroke in highly selected patients (symptomatic and with persistent penumbra despite best medical/endovascular treatment).

Fuzzy logic based energy balance routing algorithm in wireless sensor networks

Energy is one of the major constraints of conventional Wireless sensor network as these networks depends on battery power. Hence, the energy efficient operations are mandatory to improve the performance and life of WSN. Therefore, the energy consumption of WSN will be addressed with novel schemes of Fuzzy logic with energy metric and compare with the conventional method of Flow augmentation routing algorithm. Network Simulator2 is used for simulation and results shows that Fuzzy Logic network lifetime is most effective when compared to existing methods under various traffic load conditions.

Continuous Interrupted Double Throw Suturing Method: A Novel Suturing Technique for Extracranial-Intracranial Bypass

Despite failure of the EC/IC Bypass Study Group to demonstrate effectiveness in minimizing future stroke events, superior temporal artery-medial cerebral artery (STA-MCA) bypass remains an essential treatment for complex giant intracranial aneurysms, tumors, moyamoya disease with ischemia, and atherosclerotic steno-occlusive disease with hemodynamic cerebrovascular insufficiency. The objective of this report is to describe a novel suturing technique for STA-MCA bypass that helps reduce donor-recipient anastomosis time, allowing for a well-organized systematic workflow. Step 1 involves passing the needle of a 9-0 polypropylene suture from out-to-in on the donor vessel followed by in-to-out on the recipient vessel. Step 2: Before cutting and tying a knot as per the established method of suturing, repeat step 1 and leave the needle "parked", creating a loop that is then cut at its proximal end. Step 3: Tie knots using the jeweler's forceps. Repeat previous steps until there are enough throws to seal the bypass adequately. The STA-MCA bypass serves as a principal method for flow augmentation. The technique described here allows for more efficient and organized microsurgical movements reducing vessel tissue manipulation and clamp time. We describe a novel technique for interrupted STA-MCA bypass suturing that adds efficiency, safety, organization, and operative ease compared with the conventional method of interrupted vessel suturing.

Performance enhancement of a two-phase closed thermosyphon with a vortex generator

This study focuses on improving the heat transfer performance of a two-phase closed thermosyphon by altering the geometry of a typical straight pipe thermosyphon body. Here, a vortex generating obstacle positioned in the pipe body augments the flow path of the liquid-vapour fluid mixture. This flow augmentation induces a thermal boundary layer mixing effect, which enhances the convection heat transfer within the system under thermal loading. A multiphase numerical simulation model is developed to simulate the fluid phase change and wall temperature distribution of a two-phase closed thermosyphon. The Lee model is adapted to calculate mass and energy transfer source terms during the condensation and evaporation phase-change processes, while the Volume of Fluid method is employed to track liquid-vapour interface movement. The analysis of the new design reveals that the vortex generator has the most significant impact on average wall temperature distribution and overall thermal resistance when it is positioned in the adiabatic section and condenser section of the thermosyphon body. The reduction in thermal resistance is 3.5% and 3.3% when positioned in these two sections, respectively. This reduction corresponds to a higher velocity of the liquid-vapour mixture flow in these regions, indicating that thermal boundary layer mixing can be most enhanced in regions where the liquid-vapour mixture flow velocity has a higher magnitude.

Salinity variation of south-western coastal region of Bangladesh in response to discharge from an upstream river

Long term variation in upstream water flow through the Ganges−Gorai river are affecting the salinity levels of south-western coastal region of Bangladesh. Salinity data for the Rupsha river was collected for several years to demonstrate the historical changes of salinity level in the south-western coastal region. Furthermore, discharge data of the Ganges and Gorai river were also collected to discuss the effect of upstream discharge on the variation of salinity level. This study also collected water and soil samples from different places of this region to measure the salinity level and compare the values with the standard ones. A decreasing trend in dry season Ganges-Gorai river flow was observed after the initiation of the Farakka barrage in 1975. Consequently, the south-western region underwent high salinity level. The Ganges sharing treaty in 1996 and dredging of the Gorai riverbed (GRRP-I and GRRP-II) in 1999 and in 2012 helped the region to recover from high salinity level for a certain period. The salinity level of the collected water samples was in alarming level but soil sample was not in so frightening condition in 2015. Results suggested that to maintain the salinity level of south-western region within the acceptable limit for drinking, fisheries, and cultivation purposes, approximately 80 m3/s Gorai river discharges required at dry season. To do that, it is necessary to ensure 1200 m3/s discharge through the Ganges river at the Hardinge Bridge point. To protect the vital south-western region, it becomes necessary to optimize flow augmentation in the Ganges-Gorai river and to continue the further phases of restoration project in the future.  Â

Left Vertebral Artery to Common Carotid Artery Transposition in a Patient With Bilateral Vertebral Insufficiency: 3-Dimensional Operative Video

Extracranial vertebral artery (VA) atherosclerosis is responsible for 14% to 32% of posterior circulation infarctions.1 In the posterior circulation, narrowing of the VA>30% is significantly associated with strokes. Subclavian artery (SCA) atherosclerosis can produce subclavian steal. Retrograde VA flow around an occluded SCA decreases blood flow to the posterior circulation and causes vertebrobasilar insufficiency (VBI). Flow augmentation to the posterior circulation can be achieved by VA endarterectomy, arterial stenting, VA-common carotid artery (CCA) transposition, or bypass using an interposition graft.2,3 This video illustrates microsurgical revascularization of the proximal VA with VA-CCA transposition. A 58-yr-old man with a prior stroke and chronic right VA occlusion presented with dysarthria and gait instability. Angiographic evaluation confirmed complete midcervical right VA occlusion and left SCA occlusion proximal to VA origin, with subclavian steal. After obtaining patient consent and a failed attempt at endovascular recanalization of the left SCA, a left VA-CCA end-to-side transposition was performed. Neck dissection exposed the left CCA. The thyrocervical trunk served as a landmark to identify the SCA, which was traced proximally to the VA origin. After proximal occlusion, the VA was transected and "fish-mouthed" for end-to-side anastomosis to CCA. An intraluminal, continuous suture technique was used to sew the back walls of this anastomosis. Postoperative computed tomography angiography confirmed bypass patency. Collateral circulation through the thyrocervical and costocervical trunks likely supplied the left arm, and no cerebral, or limb, ischemic symptoms were noted on follow-up. VA-CCA transposition is an uncommon technique for safe and effective revascularization of symptomatic, medically refractory VBI caused by VA occlusion or, as in this case, SCA occlusion with secondary subclavian steal. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

The Effect of Extracranial-to-Intracranial Bypass on Cerebral Vasoreactivity: A 4D Flow MRI Pilot Study.

Extracranial-to-intracranial (EC-IC) surgical bypass improves cerebral blood flow (CBF) and cerebrovascular vasoreactivity (CVR) for patients with carotid occlusion. Bypass graft patency and contribution of the graft to the postoperative increase in CVR are challenging to assess. To assess the effectiveness of 4D flow magnetic resonance imaging (MRI) to evaluate bypass graft patency and flow augmentation through the superficial temporal artery (STA) before and after EC-IC bypass. Three consecutive patients undergoing EC-IC bypass for carotid occlusion were evaluated pre- and postoperatively using CVR testing with pre- and poststimulus 4D flow-MRI for assessment of the bypass graft and intracranial vasculature. Preoperatively, 2 patients (patients 1 and 3) did not augment flow through either native STA. The third, who had evidence of extensive native EC-IC collateralization on digital subtraction angiography (DSA), did augment flow through the STA preoperatively (CVR = 1). Postoperatively, all patients demonstrated CVR > 1 on the side of bypass. The patient who had CVR > 1 preoperatively demonstrated the greatest increase in resting postoperative graft flow (from 40 to 130 mL/minute), but the smallest CVR, with a poststimulus graft flow of 160 mL/minute (CVR = 1.2). The 2 patients who did not demonstrate augmentation of graft flow preoperatively augmented postoperatively from 10 to 20 mL/minute (CVR = 2.0) and 10-80 mL/minute (CVR = 8.0), respectively. Intracranial flow was simultaneously interrogated. Two patients demonstrated mild reductions in resting flow velocities in all interrogated vessels immediately following bypass. The patient who underwent CVR testing on postoperative day 48 demonstrated a stable or increased flow rate in most intracranial vessels. Four-dimensional flow MRI allows for noninvasive, simultaneous interrogation of the intra- and extracranial arterial vasculature during CVR testing, and reveals unique paradigms in cerebrovascular physiology. Observing these flow patterns may aid in improved patient selection and more detailed postoperative evaluation for patients undergoing EC-IC bypass.

Ultrasound Use in Diagnosis and Management of Venous Leg Ulcer.

Leg ulcers caused by venous diseases are effectively assessed by Doppler ultrasonography. The examination provides clear anatomical and physiological information for the diagnosis, treatment planning, and real-time guiding during the surgical treatment. Diagnostic Doppler ultrasonography assesses deep, superficial, and perforator veins, starting from patency assessment by direct visualization and simply compression test. The internal flow can be assessed by pulse wave analysis, which is used for rule out downstream flow obstruction and valvular incompetence. The venous valve function of deep, superficial, and perforator systems can be evaluated by measuring the time of the retrograde flow after flow augmentation performing in the upright position. At the end of the study, the venous map will be obtained and this map will guide clinicians to target treatment where the culprit is. The ultrasound technology has made a big shift in the treatment in the venous disease. In recent years, after the evolution and wide availability of ultrasound, newer treatment modalities have emerged for venous treatment. These include endovenous thermal ablation, endovenous adhesive closure, and ultrasound-guided foam sclerotherapy. Patients no longer require general anesthesia or hospitalization. Therefore utilization of duplex ultrasound has also surged and played an essential role in both diagnosis and therapy in venous ulcer. This article has dedicated to reviewing basic anatomy, the technique in diagnosis, and treatment.

Proximal hyper-intense vessel sign on initial FLAIR MRI in hyper-acute middle cerebral artery ischemic stroke: a retrospective observational study.

A hyper-intense vessel sign on fluid attenuated inversion recovery magnetic resonance imaging (FHV) represents slow blood flow in the cerebral arteries. To investigate the relationship between the proximal FHV (pFHV) on initial magnetic resonance imaging (MRI) and the status of the culprit vessel (stenosis, obstruction) in hyper-acute strokes affecting the territory of the middle cerebral artery (MCA). The study participants consisted of 105 patients presenting to the emergency department (ED) with acute MCA infarction within 4.5 h of onset of symptoms. Patients underwent brain MRI within 45 min of arrival at the ED and angiography within 2 h of arrival. Culprit vessel status and presence of a pFHV on initial MRI were investigated retrospectively. The pFHV was observed in 71/105 (67.6%) patients who presented with a hyper-acute MCA infarction. All patients with hyper-acute MCA infarction caused by internal carotid artery (90.6% caused by M1 occlusion, 92.9% caused by M2 occlusion) showed a pFHV on initial MRI. After logistic regression analysis, the presence of a pFHV showed significant positive correlation with large vessel occlusion (adjusted odds ratio [OR] 34.533, 95% confidence interval [CI] 9.781-121.926; P < 0.001). A pFHV was not associated with severe large vessel stenosis. A pFHV is independently representative of the acute occlusion of intervention-eligible proximal arteries within the territory of the MCA. If a patient with a hyper-acute MCA infarction shows a pFHV, aggressive flow augmentation strategies and early activation of intervention team should be warranted for best patient outcome.

A Single-Center Experience in Portal Flow Augmentation in Liver Transplantation With Prior Large Spontaneous Splenorenal Shunt

Large portosystemic shunts may cause portal steal syndrome in liver transplantation (LT). Because of the possible devastating consequences of the syndrome, the authors recommend perioperative management of these large shunts. Fourteen adult recipients who underwent portal flow augmentation, including left renal vein ligation (LRVL), renoportal anastomosis (RPA), shunt ligation (SL), and splenic vein ligation (SVL) for large spontaneous splenorenal shunt (SSRS), are included in this study, and the results were analyzed. A total of 13 patients had a large SSRS, and in 1 patient, the large shunt was placed between the superior mesenteric vein and the right renal vein. LDLT was performed in 13 patients. LRVL (n = 5), SVL (n = 6), RPA (n = 2), SL (n = 1) were performed to the patients as graft inflow augmentation. The graft-recipient weight ratios (GRWR) were less than 0.8% in 5 patients (35.7%): 2 had LRVL, and 3 had SVL. Small-for-size syndrome (SFSS) occurred only in these 2 patients with LRVL (GRWR ≤0.8%) and, splenic artery ligation was performed for graft inflow modulation. No mortality or serious complications were reported during follow-up. We consider that in patients with large SSRS and small-for-size grafts, SVL can be performed safely and with satisfactory outcomes.

A mathematical framework on Cattaneo–Christov model over an incessant moving needle

PurposeThe main theme of this paper is the effect of viscous dissipation Darcy–Forchheimer flow and heat transfer augmentation of a viscoelastic fluid over an incessant moving needle.Design/methodology/approachThe governing partial differential equations of the current problem are diminished into a set of ordinary differential equations using requisite similarity transformations. Energy equation is extended by using Cattaneo–Christov heat flux model with variable thermal conductivity. By applying boundary layer approximation system of equations is framed.FindingsConvective condition is also introduced in this analysis. Obtained set of similarity equations are then solved with the help of efficient numerical method four–fifth-order RKF-45.Originality/valueThe outcomes of various pertinent parameters on the velocity, temperature distributions are analysed by using portraits.

Flow Augmentation in the Myocardium by Ultrasound Cavitation of Microbubbles: Role of Shear-Mediated Purinergic Signaling

Ultrasound-mediated cavitation of microbubble contrast agents produces high intravascular shear. We hypothesized that microbubble cavitation increases myocardial microvascular perfusion through shear-dependent purinergic pathways downstream from ATP release that is immediate and sustained through cellular ATP channels such as Pannexin-1. Quantitative myocardial contrast echocardiography perfusion imaging and invivo optical imaging of ATP was performed in wild-type and Pannexin-1-deficient (Panx1-/-) mice before and 5 and 30minutes after 10minutes of ultrasound-mediated (1.3MHz, mechanical index 1.3) myocardial microbubble cavitation. Flow augmentation in a preclinical model closer to humans was evaluated in rhesus macaques undergoing myocardial contrast echocardiography perfusion imaging after high-power cavitation in the apical four-chamber plane for 10minutes. Microbubble cavitation in wild-type mice (n=7) increased myocardial perfusion by 64%±25% at 5minutes and 95%±55% at 30minutes compared with baseline (P<.05). In Panx1-/- mice (n=5), perfusion increased by 28%±26% at 5minutes (P=.04) but returned to baseline at 30minutes. Myocardial ATP signal in wild-type (n=7) mice undergoing cavitation compared with sham-treated controls (n=3) was 450-fold higher at 5minutes and 90-fold higher at 30minutes after cavitation (P<.001). The ATP signal in Panx1-/- mice (n=4) was consistently 10-fold lower than that in wild-type mice and was similar to sham controls at 30minutes. In macaques (n=8), myocardial perfusion increased twofold in the cavitation-exposed four-chamber plane, similar in degree to that produced by adenosine, but did not increase in the control two-chamber plane. Cavitation of microbubbles in the myocardial microcirculation produces an immediate release of ATP, likely from cell microporation, as well as sustained release, which is channel dependent and responsible for persistent flow augmentation. These findings provide mechanistic insight by which cavitation improves perfusion and reduces infarct size in patients with myocardial infarction.

How I do it: superficial temporal artery-middle cerebral artery bypass for flow augmentation and replacement.

The superficial temporal artery-middle cerebral artery (STA-MCA) bypass augments blood flow in patients with cerebral ischemia or replaces flow in patients with complex aneurysms or skull base tumors requiring vessel sacrifice. We provide a description of the STA-MCA bypass with figures and video to illustrate the procedure. The STA-MCA end-to-side anastomosis is a foundational skill for the cerebrovascular surgeon and a building block for more complex bypasses.

A Systems Approach to Municipal Water Portfolio Security: A Case Study of the Phoenix Metropolitan Area

We present a rigorous quantitative, systems-based model to measure a municipality’s water portfolio security using four objectives: Sustainability, Resilience, Vulnerability, and Cost (SRVC). Water engineers and planners can operationalize this simple model using readily available data to capture dimensions of water security that go far beyond typical reliability and cost analysis. We implement this model for the Phoenix Metropolitan Area under several scenarios to assess multi-objective water security outcomes at the municipal-level and metropolitan area-level to water shocks and drought. We find the benefits of adaptive water security policies are dependent on a municipality’s predominant water source, calling for a variegated approach to water security planning across a tightly interrelated metropolitan area. Additionally, we find little correlation between sustainability, resilience, and vulnerability versus cost. Therefore, municipalities can enhance water security along cost-neutral, adaptive policy pathways. Residential water conservation and upstream flow augmentation are cost-effective policies to improve water security that also improve sustainability, resilience, and vulnerability and are adequate adaptations to a short-term Colorado River shortage. The Phoenix Metropolitan Area’s resilience to drought is higher than that of any of its constituent municipalities, underscoring the benefits of coordinated water planning at the metropolitan area-level.

Experimental study on performance improvement of a Savonius turbine by equipping with a cylindrical cowling

ABSTRACT Savonius turbine is a drag-type vertical axis wind turbine. Negative torque reduction and flow augmentation are common methods which consequently improve its performance. The present research is to develop, test, and compare two types of modified Savonius. The two turbines are equipped with different self-adjusting cylindrical cowlings, i.e., CC1 and CC2. The experiment was conducted by facing the rotors with the wind of Reynolds number range 1.06 × 105–1.80 × 105. It was found that both the cowlings were capable of improving the performance of the turbine by wind-flow improvement, however the rotor equipped with CC2 showed the best performance. The maximum Cp of rotor with CC2 was found at Re – 1.46 × 105 with magnitude 0.22, while for unmodified rotor, it was 0.16. The Ca (Reynolds number average of – TSR-averaged Cp) for the rotor with CC2 was found 80% more than that of unmodified rotor. For the rotor with CC1, the Ca was found 53.3% more than that of unmodified rotor. Abbreviations HAWT: Horizontal axis wind turbine; VAWT: Vertical axis wind turbine; M: Torque (N-m); M+: Positive Torque (N-m); M-: Negative Torque (N-m); Pi: Input power of wind; Po: Output power of rotor; Cp: Coefficient of power; Cm: Coefficient of torque; ω: Angular velocity of rotor (rad/s); U: Tip speed of rotor (m/s); TSR: Tip speed ratio; T1, T2: Tensions over dynamometer pulley (N); V: Wind velocity (m/s); ρ: Density of wind (m3/kg); H: Height of rotor (m); D: Diameter of rotor (m); d: Diameter of dynamometer pulley (m); Re: Reynolds number; CC: Cylindrical cowling; CC1: Cylindrical cowling with covering angle 180°; CC2: Cylindrical cowling with covering angle 270°; Cpa: TSR-averaged Cp of the rotor at constant Reynolds number; Cma: TSR-averaged Cm of the rotor at constant Reynolds number; Ca: Reynolds number averaged Cpa of the rotor; Ma: Reynolds number averaged Cma of the rotor.

Mechanisms of exertional angina in patients with normal coronary arteries

Forty per cent of patients undergoing angiography to investigate exertional chest pain have normal coronary arteries. While described for nearly half a century, this condition has remained a mechanistic enigma.[1–2][1] Diminished coronary blood flow augmentation to a pharmacological vasodilator,

Unsteady Self-similar Flow over an Impulsively Started Shrinking Sheet: Flow Augmentation with No Separation

Abstract The unsteady self-similar flow due to a permeable shrinking sheet is analyzed in this investigation. The current theoretical study is enacted in the light of correct self-similar formulation proposed by (Mehmood. A. Viscous flows: Stretching and shrinking of surfaces, Springer, 2017). For the existence of a meaningful solution the retarded boundary-layer developed due to retarded shrinking wall velocity u w x = ± x t \left( {{u_w}\left( x \right) = {{ \pm x} \over t}} \right) is supported by the sufficient mass suction introduced at the shrinking surface. Main theme of this paper is to utilize the correct mathematical formulation for the shrinking sheet flow in order to investigate the existence of dual solutions of the considered problem. By using suitable self-similar transformations, the nonlinear Navier–Stokes equations are converted to corresponding non-linear ordinary differential equations. A reliable numerical technique (shooting method) is applied to solve the resulting ODEs for the involved physical parameters. Particular to this problem, it is observed that a sufficient amount of wall suction is mandatory S &lt; S c ; S c ≤ 0 \left( {S \lt {S_c}; {S_c} \le 0} \right) for the existence of meaningful solutions; and also the solutions are non-unique. As the magnitude of wall suction is reduced (i. e. S → S c S \to {S_c} ) the solution seizes to exist by having non-zero coefficient of wall skin-friction, reflecting the absence of any flow separation. On the other hand, a stronger flow augmentation is noted for the increasing values of the wall suction parameter S S . The results are presented through graphs as well as in tabulated form. It is noticed that dual solutions exist for sufficiently large magnitude of the suction parameter S &gt; S c \left( { \left| S \right| \gt \left| {{S_c}} \right| } \right) .

Abstract 114: Diverse Patients Show Physiologic Benefit From Refined Sphenopalatine Ganglion Electrode Placement and Stimulation Level Selection to Augment Blood Flow and Neurologic Function in Acute Ischemic Stroke (The IMPACT-24M Trial)

Background: Two large RCTs have indicated sphenopalatine ganglion (SPG) stimulation reduces 3m disability in acute ischemic stroke patients with confirmed cortical involvement. The current trial evaluated two refinements in SPG stimulation technique: 1) SPG electrode placement with real-time optical tracking guidance; and 2) stimulation intensity comfortable tolerance level (CTL) selection using non-noxious facial physiologic markers. Methods: Single, active arm trial at 4 centers, enrolling patients with anterior circulation ischemic stroke &lt;24h, NIHSS 1-6, not receiving recanalization therapies. Stimulation level was based on ipsilateral facial tingling sensation or lacrimation. SPG stimulation effects were assessed by volumetric blood flow in the ipsilateral common carotid artery (ultrasound) and affected hand grasp and pinch strength before and during stimulation, and by NIHSS change by day 7. Results: Among 50 enrolled patients, age was median 66y (IQR 60-74), 44% female, NIHSS median 5 (IQR 4-5), and median onset-to-screening time 18h (IQR 9-20). Median implantation skin-to-skin time was 4 minutes (IQR 3-7) and all 50 implants were placed correctly. CTL was found based on physiological biomarkers in 96% of patients, including 86% in the optimal, low-medium intensity range. SPG stimulation significantly increased common carotid artery peak systolic and end diastolic blood flow (up 44%, p&lt;0.0001; and up 52%, p&lt;0.0001) and improved pinch strength (up 42%, p&lt;0.0001) and grasp strength (up 26%, p&lt;0.0001). Degree of NIHSS recovery by day 7 was greater than in matched historic controls, median 75% vs 50%, p=0.0003. Forest plot analysis showed benefits were homogenous across the subgroups of: sex, age, time from onset, stroke side, NIHSS, and ASPECTS score. Conclusion: SPG stimulator placement with real-time optical tracking guidance was fast and accurate, and selection of optimal stimulation intensity levels based on non-noxious facial tingling and lacrimation was feasible in nearly all patients. SPG activation led to cranial blood flow augmentation and improved hand motor function during stimulation, and neurologic deficit reduction at 1 week, consistently across broad patient subsets of age, sex, side, severity, and time to treatment.

Restoration scenario analysis of Hindon River in India using water quality model, WASP8

The river restoration scenario analysis was carried out using steady state US-EPA Water Quality Analysis Simulation Program (WASP8) for Hindon River in India which has been classified as Class ‘E’ by Central Pollution Control Board (CPCB). Restoration scenarios for load reduction, flow augmentation, reaeration and dredging were generated after fairly calibrating and validating the model. The scenario analysis indicated that reductions in municipal waste load and reduction in sediment oxygen demand would significantly improve the water quality along the river. Flow augmentation scenario also seemed to improve the water quality to some extent however it does not fulfil the criteria set by CPCB for the propagation of wildlife and fisheries. However, it may prevent stagnation of water along the river stretch. Therefore, high levels of sewage treatment work are required to strengthen the restoration activities and render the water quality better.