79 research outputs found
Comparative evaluation of analgesic efficacy of tramadol and diclofenac-sodium in post-operative orthopedic patients
Background: Post-operative pain management is an important consideration in the orthopedic department. The purpose of this study was to compare the analgesic efficacy of tramadol with diclofenac sodium in patients with postoperative orthopedic pain.Methods: A hospital based, prospective, observational study was undertaken in Department of Orthopedics for a period of one year. A group of 60 patients having post-operative pain intensity assessed as 6cm or more on a 10cm visual analogue scale (VAS) were assigned to receive either tramadol thrice a day (n=30) or diclofenac sodium thrice a day (n=30). Both drugs were administered parenterally for initial 24hr, then orally for next 96 hr. The primary efficacy outcome measures were pain intensity difference assessed at 2hr, 4hr, 8hr, 16hr, 24hr, 32hr, 40hr, 48hr, 56hr, 64hr, 72hr, 80hr, 96hr, 104hr, 112hr and 120hr using a VAS and sum of pain intensity differences assessed at 8hr, 24hr, 48hr, 72hr, 96hr and 120hr whereas secondary efficacy measures included maximum fall in pain intensity, number of patients who required rescue medication and their quality of sleep in the night.Results: Mean pain intensity differences assessed on 10cm VAS were significantly better for tramadol group compared to diclofenac group at all the time points except 88 hr. Sum of pain intensity differences over 8hr, 24hr, 48hr, 72hr, 96hr and 120 hr for the tramadol group was significantly superior than diclofenac group. Maximum fall in pain intensity score was also significantly superior in the tramadol group as compared to the diclofenac group. However, no patients required rescue medication in either of the groups. Patient’s quality of sleep improved with both drugs but tramadol produced significantly better quality of sleep every night than did diclofenac. Both the study medications produced effective analgesia and were well tolerated with no incidence of serious adverse effects throughout the study.Conclusions: Tramadol has a more pronounced analgesic effect than diclofenac. Thus, tramadol can be considered as an effective alternative to traditional NSAIDs in the treatment of post-operative pain
Transforming environmental governance: critical action intellectuals and their praxis in the field
Over the past decade, widespread concern has emerged over how environmental governance can be transformed to avoid impending catastrophes such as climate change, biodiversity loss, and livelihood insecurity. A variety of approaches have emerged, focusing on either politics, technological breakthrough, social movements, or macro-economic processes as the main drivers of change. In contrast, this paper presents theoretical insights about how systemic change in environmental governance can be triggered by critical and intellectually grounded social actors in specific contexts of environment and development. Conceptualising such actors as critical action intellectuals (CAI), we analyze how CAI emerge in specific socio-environmental contexts and contribute to systemic change in governance. CAI trigger transformative change by shifting policy discourse, generating alternative evidence, and challenging dominant policy assumptions, whilst aiming to empower marginalized groups. While CAI do not work in a vacuum, nor are the sole force in transformation, we nevertheless show that the praxis of CAI within fields of environmental governance has the potential to trigger transformation. We illustrate this through three cases of natural resource governance in Nepal, Nicaragua and Guatemala, and Kenya, where the authors themselves have engaged as CAI. We contribute to theorising the 'how' of transformation by showing the ways CAI praxis reshape fields of governance and catalyze transformation, distinct from, and at times complementary to, other dominant drivers such as social movements, macroeconomic processes or technological breakthroughs
Turning conflicts into cooperation? The role of adaptive learning and deliberation in managing natural resources conflicts in Nepal
Conflicts over natural resources are likely to escalate under changing socio-economic contexts and climate change. This paper tests the effectiveness of what we term Adaptive Learning and Deliberation (ALD) in understanding and addressing conflicts over the local management of forests and water, drawing on the experimental works in Nepal. Based on a three-year action research, the paper offers policy and practical insights on how complex and protracted conflicts can be addressed through researcher-facilitated inquiry and deliberative process which forms the core of ALD approach. The conflicts included in the study are not solely triggered by climate change but are a result of diverse environmental changes, diverse policy responses to local issues of resource governance, and wider political and economic factors. We analyze experimental practices of ALD implemented in two sites, where our research team facilitated the ALD process, gathering evidence in relation to conflicting institutional issues, all of which was then fed into researcher-mediated and evidence informed deliberations on conflict management. The analysis shows that the ALD process was helpful in rearranging local institutions to accommodate the interests of the conflicting groups and, to some extent, challenge some of the underlying exclusionary provisions of forest and water institutions which have deep social roots in the Nepalese society. We also identify three key limitations of this approach – transaction costs, the need for strong research and facilitative capacity within the research team, and the acceptance of researchers' involvement among the conflicting stakeholders. Finally, we discuss some policy implications of the findings, including potential implications for building climate resilience
Imposing indicators or co-creating meanings in Nepal
Over the past two decades, the government of Nepal has handed over patches of forest to local communities. These communities form forest user groups as part of the nationwide community forestry program supported by the Master Plan for the Forestry Sector (1988), the Forest Act (1993), and the Forest Rules (1995). The main aim of this program is to provide a legal basis for access to forests by local communities as a means to improving livelihoods, as well as to reverse the trends of forest degradation and deforestation, particularly in the middle hills of the country
Renaturation of Phosphorylase Kinase Activity From Sodium Dodecyl Sulfate-Polyacrylamide Gels
Phosphorylase kinase activity is renatured and detected in situ following electrophoresis of the denatured holoenzyme in a sodium dodecyl sulfate-polyacrylamide gel containing phosphorylase b that has been included in the gel polymerization according to the method of R. L. Geahlen et al [(1986) Anal. Biochem. 153, 151-158]. Among the enzyme\u27s four subunits, only γ is catalytically active. When extract of rabbit muscle is electrophoresed and renatured in a similar manner, the phosphorylase-conversion activity is also associated only with a protein band that comigrates with the γ subunit of phosphorylase kinase. This suggests that the γ subunit of phosphorylase kinase may be the sole activity in rabbit muscle responsible for the phosphorylation of phosphorylase b. In an alternative method for the renaturation of activity from conventional sodium dodecyl sulfate-polyacrylamide gels, the subunits of the enzyme are visualized using 2.5 m KCl, excised from the gel, and eluted by diffusion into buffer containing sodium dodecyl sulfate, which is subsequently removed by acetone precipitation of the eluted subunits. Catalytic activity is recovered when the acetone precipitate of the extracted γ subunit is dissolved in 6 m guanidine hydrochloride and diluted 50-fold into an activity assay. Inclusion of eluted α and β subunits in the assay inhibits the activity of the γ subunit, which supports our previous finding that the α and/or β subunits suppress the activity of the catalytic γ subunit [H. K. Paudel and G. M. Carlson (1987) J. Biol. Chem. 262, 11912-11915]
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