ABSTRACT. Transforming growth factor-a (TGF-a) is a structural homologue of epidermal growth factor and competes for binding on a common transmembrane protein receptor/kinase. Although TGF-a appears to be more important than epidermal growth factor in embryogenesis and mammalian organogenesis, there is little information regarding its expression in developing lung. Accordingly, we measured levels of immunoreactive TGF-a and its gene expression in late-term fetal rat lung during the transition from the canalicular (19-20 d) to the saccular (21 d) stage. We report that at 19 d gestation intrapulmonary levels of TGF-a were 1.4 f 0.3 pmol/mg protein as determined by RIA, but had decreased by 50% at 21 d. To determine if the TGF-a gene is expressed in lung, RNA isolated from fetal rat lung was reverse transcribed, and a 302-bp fragment corresponding to a portion of the TGF-a gene was amplified by polymerase chain reaction. Southern blot hybridization with a 32P-labeled 2.3-kb EcoRI fragment of rat TGF-a cDNA clone showed a pattern of declining expression during late gestation. Therefore, fetal rat lung expresses TGF-a, as is evidenced by the synthesis of both the message and the protein. Because levels of protein were highest in the period of canalicular lung development when the respiratory acinus is formed and vascularized, a potential role for this intrapulmonary growth factor in pulmonary remodeling is suggested. (Pediatr Res 31: 286-290,1992) Abbreviations TGF-a, transforming growth factor-a EGF, epidermal growth factor EGF-R, epidermal growth factor receptor IR-TGF-a, immuno reactive TGF-a PCR, polymerase chain reaction SSC, sodium chloride, sodium citrate sus has grown that TGF-a, and not EGF, is the more abundant, and perhaps critical, fetal growth factor of the two (4-7).It seems likely that the above growth factors play an important role in fetal lung development as well. EGF receptors are abundant in fetal lung tissue (8-lo), and exogenous EGF can 1 ) stimulate proliferation of epithelial cells in conducting airways of fetal lambs in vivo (1 1) and fetal human epithelial type I1 cells in vitro (12), 2 ) accelerate lung maturation of fetal rabbits in vivo (8) and rat alveolar epithelial cells in vitro (13,14), and 3 ) accelerate differentiation of tracheal mucous secretory cells in fetal rhesus monkey in utero (15). Despite the widespread distribution of EGF-R in the fetal lung and the effectiveness of exogenous EGF, relatively little is known about endogenous ligands for the EGF-R. EGF precursor mRNA and epitopes common to this precursor have been localized to the developing mouse lung by using in situ hybridization and immunodetection techniques, respectively, and confirmed with PCR detection of fetal mouse lung EGF precursor RNA (37). In late gestational human lung, immunoreactive EGF is limited to nonmucous cells of the submucosal glands of the upper airways (1 6). In fetal sheep, a novel alternative EGF-R ligand, lipocortin-1, has been immunolocalized in airway epithelium (10).We were interested in...

Study Objectives: Our objective is to describe a model for process improvement evaluation that utilizes trained undergraduate student research assistants to collect provider-patient encounter data in the acute care environment. Process evaluation is imperative when making changes in a complex environment. This is especially true when the overall goal is to improve process efficiency and outcomes for critically ill and injured patients. The department of emergency medicine at the University of New Mexico uses an iterative approach to evaluate protocol changes in its Emergency Department Resuscitation Unit (EDRU), a nine-bed acute care unit internal to our emergency department. The collection of provider-patient encounter data by our student research assistants provides department leadership with evidence for assessing implementation problems and evaluating outcomes for protocol and practice changes. Methods: As part of a multi-semester course entitled Research in Acute Care, students collect data on provider-patient encounters in the EDRU on a secure electronic tool. Findings from the data collection are compiled and regularly presented to a workgroup of EM clinical faculty who in turn make recommendations on protocol revisions and continued education and training for personnel in the EDRU. Results: In 2018, student research assistants spent over 1500 hours in the EDRU. This resulted in the collection of data on 1327 provider-patient encounters, including 26 instances of cardiopulmonary resuscitation (CPR), 418 of high acuity trauma, 112 strokes, and 164 cases of sepsis. During this same time period, the workgroup met 9 times to review findings from this and other data collections. The program has resulted in recommendations for additional training activities, identification and solutions for protocol related tools and missing equipment in the EDRU, and the identification of areas for research on patientprovider encounters. Conclusion: Our dynamic program is capable of meeting many of the department's process improvement data gathering needs. The program provides invaluable experience in emergency medicine to future health care professionals through clinical environment exposure and first-hand experience in quality improvement research. We will continue to adapt our data collection program as existing protocols are revised and new protocols are implemented. We hope to expand our program and its data collection capabilities through increasing student coverage in the EDRU and possibly expanding to other units in the emergency department.

gastrointestinal bleeding events was similar for VKA and DOACs (25 each); VKA had a higher rate of intracranial bleeding (16/27, 59%) vs DOAC (11/27, 41%). All remaining MBE occurred in VKA patients. There were no deaths directly attributable to any MBE in either the DOAC or VKA group. A substantial number of patients with MBE were transferred for urgent neurosurgical evaluation (26/27 intracranial bleeds and the 1 spinal epidural hematoma). 52/55 (94%) of the remaining MBE patients were admitted to a critical care area. The mean INR of the VKA patients was 4.99 (range, 2.3-10). Anti-Xa activity was not routinely assessed in the patients on DOACs. During the period reviewed, there were an average of 2,351 patients/month being managed on VKA and 3,155 patients/month being managed on DOACs.Conclusion: Major bleeding events occurred in patients on both VKA and DOACs. While similar rates of MBE involving the gastrointestinal tract were seen, in all other MBE there were a greater number of bleeds involving VKA. Though there was substantial morbidity, there were no deaths reported in either group. Further study is needed to determine the safety risk of VKA vs DOAC's in our population.

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