Effectiveness of a quality improvement collaborative in reducing time to surgery for patients requiring emergency cholecystectomy.

BACKGROUND: Acute gallstone disease is a high-volume emergency general surgery presentation with wide variations in the quality of care provided across the UK. This controlled cohort evaluation assessed whether participation in a quality improvement collaborative approach reduced time to surgery for patients with acute gallstone disease to fewer than 8 days from presentation, in line with national guidance. METHODS: Patients admitted to hospital with acute biliary conditions in England and Wales between 1 April 2014 and 31 December 2017 were identified from Hospital Episode Statistics data. Time series of quarterly activity were produced for the Cholecystectomy Quality Improvement Collaborative (Chole-QuIC) and all other acute National Health Service hospitals (control group). A negative binomial regression model was used to compare the proportion of patients having surgery within 8 days in the baseline and intervention periods. RESULTS: Of 13 sites invited to join Chole-QuIC, 12 participated throughout the collaborative, which ran from October 2016 to January 2018. Of 7944 admissions, 1160 patients had a cholecystectomy within 8 days of admission, a significant improvement (P < 0·050) from baseline performance. This represented a relative change of 1·56 (95 per cent c.i. 1·38 to 1·75), compared with 1·08 for the control group. At the individual site level, eight of the 12 Chole-QuIC sites showed a significant improvement (P < 0·050), with four sites increasing their 8-day surgery rate to over 20 per cent of all emergency admissions, well above the mean of 15·3 per cent for control hospitals. CONCLUSION: A surgeon-led quality improvement collaborative approach improved care for patients requiring emergency cholecystectomy

Transport impacts on wellbeing and liveability

This research set out to show how the transport sector contributes to better living conditions for all New Zealand citizens through investment in related capital. Maximum wellbeing benefits will be achieved by ensuring that everyone has access to high quality, low-carbon, transport systems that promote health and social connection and generate high levels of travel satisfaction. The built environment, especially urban density, has a significant impact on the viability of active and public transport systems

Embedded voxel colouring with adaptive threshold selection using globally minimal surfaces

mage-based 3D reconstruction remains a competitive field of research as state-of-the-art algorithms continue to improve. This paper presents a voxel-based algorithm that adapts the earliest space-carving methods and utilises a minimal surface technique to obtain a cleaner result. Embedded Voxel Colouring is built in two stages: (a) progressive voxel carving is used to build a volume of embedded surfaces and (b) the volume is processed to obtain a surface that maximises photo-consistency data in the volume. This algorithm combines the strengths of classical carving techniques with those of minimal surface approaches. We require only a single pass through the voxel volume, this significantly reduces computation time and is the key to the speed of our approach. We also specify three requirements for volumetric reconstruction: monotonic carving order, causality of carving and water-tightness. Experimental results are presented that demonstrate the strengths of this approach