Critical pathways

Wildlife indicators can establish baseline conditions, act as early warning signals of environmental problems, identify the extent of contamination, define critical pathways and responses at multiple trophic levels, as well as integrate biological exposure with the physical and chemical environment (Farrington 1991). Indicator selection is based on a combination of criteria or characteristics that include (Jenkins 1981) ... 

Another related technique is the use of critical pathways. A critical pathway or clinical care plan is a detailed plan of care for a specific diagnosis, disease, or procedure [27], It describes the use and timing of all the care activities to try to optimize cost-effectiveness and improve patient outcomes. Critical pathways are much more specific than practice guidelines, which means they tend to take much more effort to produce. However, their comprehensive nature can enhance communication and coordination by different practitioners who are providing care to a particular patient. While critical pathways have been accepted within hospitals, their adoption for ambulatory care has been mixed. 

LD Jaggers. Differentiation of critical pathways from other health care management tools. Am J Health-System Pharm 53(Feb 1) 311 313, 1996. 

Voillequ , P. G. and Pelletier, C. A. (1974). Comparison of external irradiation and consumption of cows milk as critical pathways for 137Cs, MMn and 144Ce-144Pr released to the atmosphere, Health Phys. 27, 189. 

Herbes, S.E., Southworth, G.R., Shaeffer, D.L., Griest, W.H., Maskarinec, M.P (1980) Critical pathways of polycyclic aromatic hydrocarbons in aquatic environments. In The Scientific Basis of Toxicity Assessment. Witschi, H. Editor, pp. 113-128, Elsevier/North-Holland Biomedical Press, Amsterdam. 

Results show that for Cd (i) birds of prey are always more sensitive that beasts of prey and (ii) bioaccumulation is lowest in the food chain Soil —> worm —> bird/mammal. The latter food chain to birds of prey is by far the most critical pathway for Cd exposure, leading to very low critical limits for soils (approximately 0.1 ppm,... 

Teo ED, Brandon NP, Vos E, Kramer GJ (2005) A critical pathway energy efficiency analysis of the thermochemical UT-3 cycle, Int J Hydrogen Energy 30 559-564... 

Bergman, D.A. (1999) Evidence-based guidelines and critical pathways for quality improvement. Pediatrics 103(1 Suppl E) 225-232. 

Clinical pharmacology Basiliximab is a chimeric (mouse/human) interleukin-2 receptor antagonist. It is directed against the interleukin-2 receptor-alpha chain (CD25) on activated T-lymphocytes, and is a potent inhibitor of interleukin-2-mediated activation of lymphocytes, a critical pathway in the cellular immune response involved in allograft rejection. Another anti-CD25 monoclonal antibody, dacUzumab (Zenapax), has the same indication as basiliximab. 

Gordon et al. (48) recently performed a pathway-based pharmacogenomic study on rectal cancer treated with chemoradiation in which they evaluated 21 polymorphisms in 18 genes involved in the critical pathways of cancer progression (drug metabolism, tumor microenvironment, cell cycle control, and DNA repair). They applied the CART analysis and found that a classification tree with four genes (lL-8, lCAM-1, TGF-, and... 

Develop a plan, establish critical pathways and time lines, and ensure every critical step in the manufacturing process has been adequately validated. See Appendix A for a synopsis of FDA s inspection guide for assistance in performing internal audits. 

Inhibits IL-2 mediated activation of lymphocytes, a critical pathway in the cellular immune response involved with allograft rejection... 

Critical pathways, also known as clinical pathways or care maps, are tools of patient care management that are created by multidisciplinary teams, which are intended to lead to the most desirable patient outcome in the most desirable time frame. These programs prespecify what procedures, lab tests, medications, and dietary and exercise needs a patient should receive during a hospitalization for a specific time. There exists evidence that programs that focus on knee-replacement therapy and community-acquired pneumonia are... 

Kirk JK, Michael KA, Markowsky SJ, Restino MR, Zarowitz BJ. Critical pathways the time is here for pharmacist involvement. Pharmacotherapy, 1996 16 723-733. 

The World Health Organisation (WHO) established a tolerable daily intake (TDI) for U of 0.6 pg/kg body weight per day Direct ingestion or inhalation of dust particles is considered the most critical pathway of radionuclides to humans. In addition, soil-plant-man is recognised as one of the major pathways for the transfer of U to human beings. In order to estimate the intake of U through plants, it is necessary to investigate how U is taken up by food plants. 

The critical pathway is also dependent on the habits of the exposed population. If no one ever eats any fish from the river then that pathway can be crossed off Alternatively if a certain foodstuff is consumed in great quantities and the concentrations are reasonable then that foodstuff pathway can be critical. 

Because there are so many factors involved in establishing dose pathways and which may be the critical pathway, various dose assessment computer based models have been developed. These models are also used to calculate the dose per unit release of a specified radionuclide for various pathways. The Release Upper Bound, RUB can be evaluated using a dose assessment model. This is done by varying the source term used such that the resulting dose equals the dose constraint or limit. The various exposure scenarios and pathways are also chosen for importance. 

The sources of a release and the conditions at the site where it oecurs, determine one or more critical pathways in the environment between the point of discharge and man. The season of the year determines to a great extent the magnitude of contamination of different foods or environmental components. 

From the somewhat limited discussion presented in this chapter on net energy analysis, the value of conducting NBAs for energy- and synfuel-producing systems is apparent. The effort needed to complete detailed NBAs is a time-consuming task, but can provide the basic information needed to select the critical pathway to higher efficiency systems, and to help determine whether the desired results can be achieved. Without the perspective provided by an NBA, the effort to perfect a biomass energy system can easily be misdirected. 

Ng SM, Krishnaswamy P, Morissey R, Clopton P, Fitzgerald R, Maisel AS. Ninety-minute accelerated critical pathway for chest pain evaluation. Am J Cardiol 2001 88 611-7. 

Implement treatment guidelines, protocols, formulary changes, or critical pathways for therapy, as approved by an authorized health system provider or committee. 

---