Code Crimson: A Postpartum Hemorrhage Bundled Intervention Quality Improvement Project.

BACKGROUND: Postpartum hemorrhage (PPH) is a leading cause of maternity mortality in the United States. The Code Crimson project aimed to enhance PPH management by implementing a standardized intervention bundle to mitigate morbidity and mortality associated with PPH. LOCAL PROBLEM: At a large Philadelphia tertiary hospital, health disparities existed for severe maternal morbidity and mortality, and PPH was a significant factor. METHODS: A quality improvement design, using Plan-Do-Study-Act cycles and interrupted time series analysis, was undertaken. INTERVENTIONS: The Code Crimson project implemented a standardized bundle to manage PPH, including blood product administration and massive transfusion protocol activation. RESULTS: After implementing the Code Crimson bundle, there was a significant decrease in blood product use ( P < .001), with minor reductions in packed red blood cell administration over 4 units and mean blood loss. CONCLUSIONS: The Code Crimson bundle effectively reduced blood product utilization for PPH treatment.

Woody debris contribution to the carbon budget of selectively logged and maturing mid-latitude forests.

Woody debris (WD) is an important component of forest C budgets, both as a C reservoir and source of CO2 to the atmosphere. We used an infrared gas analyzer and closed dynamic chamber to measure CO(2) efflux from downed coarse WD (CWD; diameter>or=7.5 cm) and fine WD (FWD; 7.5 cm>diameter>or=2 cm) to assess respiration in a selectively logged forest and a maturing forest (control site) in the northeastern USA. We developed two linear regression models to predict WD respiration: one based on WD temperature, moisture, and size (R2=0.57), and the other on decay class and air temperature (R2=0.32). WD respiration (0.28+/-0.09 Mg C ha-1 year-1) contributed only approximately 2% of total ecosystem respiration (12.3+/-0.7 Mg C ha-1 year-1, 1999-2003), but net C flux from CWD accounted for up to 30% of net ecosystem exchange in the maturing forest. C flux from CWD on the logged site increased modestly, from 0.61+/-0.29 Mg C ha-1 year-1 prior to logging to 0.77+/-0.23 Mg C ha-1 year-1 after logging, reflecting increased CWD stocks. FWD biomass and associated respiration flux were approximately 7 times and approximately 5 times greater, respectively, in the logged site than the control site. The net C flux associated with CWD, including inputs and respiratory outputs, was 0.35+/-0.19 Mg C ha-1 year-1 (net C sink) in the control site and -0.30+/-0.30 Mg C ha-1 year-1 (net C source) in the logged site. We infer that accumulation of WD may represent a small net C sink in maturing northern hardwood forests. Disturbance, such as selective logging, can enlarge the WD pool, increasing the net C flux from the WD pool to the atmosphere and potentially causing it to become a net C source.

Carbon in Amazon forests: unexpected seasonal fluxes and disturbance-induced losses.

The net ecosystem exchange of carbon dioxide was measured by eddy covariance methods for 3 years in two old-growth forest sites near Santarém, Brazil. Carbon was lost in the wet season and gained in the dry season, which was opposite to the seasonal cycles of both tree growth and model predictions. The 3-year average carbon loss was 1.3 (confidence interval: 0.0 to 2.0) megagrams of carbon per hectare per year. Biometric observations confirmed the net loss but imply that it is a transient effect of recent disturbance superimposed on long-term balance. Given that episodic disturbances are characteristic of old-growth forests, it is likely that carbon sequestration is lower than has been inferred from recent eddy covariance studies at undisturbed sites.