Critical pathway development: an integrative literature review.

OBJECTIVE: The purpose of this integrative literature review was to summarize and analyze the methods used to develop critical pathways. METHOD: Relevant articles published in occupational therapy, physical therapy, nursing, and medical journals between 1992 and 1997 were reviewed to extract various methods and the steps or criteria used for each method. RESULTS: Nine approaches to critical pathway development and the steps or criteria involved in each method are presented in tabular format. The most detailed approach was used as a gold standard, and the other approaches were compared to it. CONCLUSION: This review should assist occupational therapy practitioners working with various diagnostic populations to understand the methods used, and steps involved, in the development of critical pathways. It should also serve as a resource for practitioners who have the opportunity to participate in critical pathway development.

Comparative development of Brugia pahangi and variation in acid hydrolase enzyme titers in.

The development of the filarial nematode Brugia pahangi was monitored and compared in susceptible (BLACK EYE) and refractory (ROCK) strains of Aedes aegypti. Simultaneously, the activities of acid phosphatase, beta-glucuronidase, alpha-glucosidase, and N-acetyl-beta-glucosaminidase were measured. Three- to five-day-old females of both strains were fed on infected and uninfected clawed jirds (Meriones unguiculatus) then dissected or homogenized at 2 h, at 24-h intervals for 5 days, and at 8 and 10 days after treatment. Enzyme activities were assayed by a fluorometric procedure. The susceptible strain maintained an 80% infection and 18.6 larvae/mosquito over the 10-day period. In contrast, the refractory strain was initially 33% infected and had a mean of 4.9 larvae/mosquito and this decreased to 20% by 3 days, and to 3% with a mean of 0.33 larvae/mosquito at 10 days. Significantly higher acid phosphatase and beta-glucuronidase activities were observed in the refractory strain at specific time intervals after infection. Alpha-glucosidase and N-acetyl-beta-glucosaminidase were highly variable among strains and according to infection status. Analysis of the results of this study suggests that certain acid hydrolase enzymes could be involved in the elimination of B. pahangi in refractory strains of Ae. aegypti and could be used to monitor biochemical changes in response to filarial nematode infections in certain mosquito populations.

Reduction in susceptibility to Brugia malayi of F2 progeny of Aedes togoi treated with ethyl methanesulfonate.

The susceptibility to Brugia malayi infection was tested in F2 female progeny derived from male and female Aedes togoi treated with ethyl methanesulfonate (EMS). Three-day-old males and females were treated with 0.025, 0.050, and 0.075, 0.10, 0.15, or 0.20% EMS by allowing them to feed for 5 days on sugar cubes containing EMS and then mated at random. Percentage of susceptibility and mean number of infective larvae (L3) in F2 females were analyzed over a 2-wk period. Reductions in susceptibility were significant in the F2 populations arising from the 3 highest EMS concentrations. F2 infections were reduced by 80%, indicating that EMS-induced mutations affect loci associated with filarial nematode susceptibility.

Variation in acid hydrolase enzyme titers in different developmental stages of Aedes togoi.

Genetic mechanisms of filarial nematode susceptibility were studied in Aedes togoi. Acid hydrolases may play an important role in this process, including humoral or cell-mediated defenses. Levels of acid phosphatase, alpha-glucosidase, beta-glucuronidase, and N-acetyl-beta-glucosaminidase were determined for 1st- and 4th-instar larvae, male and female pupae, and 1- and 7-day-old adults using fluorometric and colorimetric assays. Acid phosphatase activity was highest in 1-day-old adults, moderate in larvae and pupae, and lowest in 7-day-old adults. Female 7-day-old adults had significantly higher levels than males of the same age. Moderate levels of alpha-glucosidase were found in larvae, with progressive increases in activity from pupae to 7-day-old adults. Levels in male pupae and 1-day-old males were higher than in females, but activity was twice as high in 7-day-old females. Activity of beta-glucuronidase was greater in adults, with females showing a 2-fold higher level than males at 7 days. In contrast, N-acetyl-beta-glucosaminidase activity was highest in 1st- and 4th-instar larvae and 1-day-old males and females. Activity also was significantly higher in male pupae, slightly greater in 1-day-old males, but twice as high in 7-day-old females when compared to males of the same age. Results showed significant changes and variation in acid hydrolase enzyme titers in the different life stages of Ae. togoi. These and other specific acid hydrolases could prove effective in monitoring biochemical and genetic changes in mosquito populations.