Thesis, PlanB (M.S.)--University of Wisconsin--Stout, 1998. / Includes bibliographical references.

Thesis (Ed.D.)--University of Wyoming, 2008. / Title from PDF title page (viewed on June 25, 2009). Includes bibliographical references (p. 100-111).

Thesis (Ed.D.)--University of Wyoming, 2008. / Title from PDF title page (viewed on June 23, 2009). Includes bibliographical references (p. 100-106).

Thesis (Ed.D.)--University of Wyoming, 2008. / Title from PDF title page (viewed on July 14, 2009). Includes bibliographical references (p. 101-115).

Thesis (Ph. D.)--University of Washington, 2000. / Vita. Includes bibliographical references (leaves 152-163).

Thesis (Ph. D.)--Civil and Environmental Engineering, Georgia Institute of Technology, 2006. / Michael Meyer, Committee Chair ; Adjo Amekudzi, Committee Member ; Randall Guensler, Committee Member ; David Sawicki, Committee Member ; Michael Dobbins, Committee Member. Includes bibliographical references.

Zugl.: Hamburg, Helmut-Schmidt-Univ., Diss., 2009

Thesis (Ed.D.)--University of Wyoming, 2008. / Title from PDF title page (viewed on Nov. 20, 2009). Includes supplemental PDF file of case studies of Wyoming schools/districts. Includes bibliographical references (p. 103-111).

The management of people on dialysis is complex and requires a multi-disciplinary multi-professional approach. Observational studies in dialysis care have demonstrated a correlation between key clinical indicators and survival. However, achieving change in such a complex setting is difficult, with limited evidence from controlled studies of the effectiveness of interventions to improve these indicators. There is little evaluation of how best to implement and sustain known best practice into clinical care. UK renal registry data shows that whilst overall standards have improved, variation between units remains unchanged. This variation demonstrates that feedback alone is not enough to implement best practise, and that it is also necessary to understand cultural, structural, organisational and process factors. Quality Improvement (QI) is the process by which change can be implemented in systems. Methodologies vary, and highlight the need for bespoke approaches tailored to fit the clinical context. In 2010 the Salford Royal renal network introduced a two-year programme of QI to improve clinical indicators in dialysis care. Results were followed up on completion of the programme to establish whether outcomes were sustained. This thesis starts with a literature review summarising the evidence to date on modifiable factors affecting outcomes in renal replacement therapy and the rationale for addressing these factors in our chronic dialysis population, the development of QI in healthcare, and the evidence for its use to improve outcomes in renal replacement therapy. The first aim of this thesis was to analyse the outcomes of the Salford quality improvement programme. This found that the programme was successful in improving attainment of clinical indicators, and there was evidence of a reduction in hospitalisation and its associated costs. The second aim was to analyse in more detail one aspect of the programme- reduction in peritonitis. Key themes that emerged from this were the role of audit and continuous measurement, the importance of local leadership, learning from best practice elsewhere, and a patient-centred approach to reducing avoidable harm. The last question centred on the sustainability of results. Review of two years' follow up data on urea reduction ratio and bacteraemia identified that whilst not all changes to practice were sustained, both improved clinical outcomes were broadly sustained. However, additional themes emerged from the analyses, highlighting the need to embed ongoing continuous review into practice. Finally, I have described potential future work arising from this thesis.

Earthworm inoculation for soil amelioration has been shown to be valuable in a range of experiments. At present, inoculation on a large scale is limited by the supply of larger deep-burrowing species of earthworm. This work aimed to assess the feasibility of intensively producing deep-burrowing earthworms for soil amelioration projects. Lwnbricus terrestris, whose behaviour is well documented, was chosen. The scientific literature was used to identify points within the life cycle of this earthworm where manipulation of conditions might lead to increased rates of production. Feed quality, environmental temperature, time of year, population density and age of breeding stock were all recognised as important variables. Experiments were performed to identify the optimal conditions for L.rerrestris reproduction, cocoon development and growth. Results suggested that reproduction would occur throughout the year and mean annual figures of 37 cocoons per worm were recorded from intensively produced earthworms. Recently matured worms showed greatest levels of cocoon production. As previously reported seasonal variation in reproduction was found even at constant temperature. Cocoon development was most rapid at a temperature of 20°C, taking 70 days, with a cocoon viability of 83%. Growth from a mean hatchling weight of 53mg to sexual maturity at 5g, took twelve weeks. Growth at constant temperatures of 15 and 20°C was not significantly different. A synthetic feed, with a carbon to nitrogen ratio of 40:1, created from paper waste and yeast extract, led to greatest recorded figures for both growth and cocoon production. The results suggest that an intensive production system is technically feasible, and the economic viability needs to be tested.