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Malerier.

The relentless pace of the acceptance of quality as a fundamental basis for business management continues unabated. More organizations are adopting methods and management practices that comply with total quality principles, but it can often be difficult for specialist departments to see how their role within a company benefits as a result of such a system. By focusing on the role of quality in the financial field, this study explores the benefits that come to financial management when TQM is adopted.

The overall goal of this work is to identify how healthcare professionals define successful outcome after acute unilateral ACL rupture in athletes and how neuromuscular compensations and interventions affect impairments and the ability of the patients to participate in their activity of choice. Establishing a consensus opinion from clinicians around the world provides a standardized set of criteria by which interventions can be judged. A better understanding of neuromuscular impairments will improve the care provided to patients with ACL injury to return them to sport as quickly and safely as possible. The first two studies described in this work involved a web-based survey of orthopedic surgeons and rehabilitation specialists from across the globe. The survey asked respondents which criteria were important measures to identify a successful outcome after ACL injury or reconstruction. Subgroups of respondents from Europe and North America were identified for analysis. Six criteria were identified as important measures of successful outcome after ACL injury or reconstruction: the absence of giving way, patient return to sport, patient reported outcome measures, quadriceps strength, functional performance tests, and the presence of no more than a mild knee joint effusion. Patient reported outcomes that measured multiple aspects of function were identified as important measures of successful outcomes after ACL injury or reconstruction. Our first experimental study prospectively evaluated quadriceps femoris function of the ACL injured knee. Nearly half (43%) of patients presenting to physical therapy within 100 days of injury demonstrated a central activation ratio of less than 95%. A combination of factors including knee joint effusion, quadriceps strength and time from injury were unable to reliably predict whether or not central activation ratio was greater or less than 95%. These results indicate that in the absence of electrophysiological testing, clinicians should assume that patients with ACL injury have a central activation ratio of less than 95% and should implement measures to remedy this impairment. Our second experimental study evaluated the effectiveness of an abbreviated course of perturbation training on improving clinical measures of function and patient reported outcomes. This case-controlled design demonstrated that completing ten sessions of perturbation training did not significantly improve performance or symmetry in functional hop tests and did not significantly improve patients' self-reported function. Completing ten sessions of perturbation training is not necessary to achieve clinical definitions of symmetry or return to sport status. Individualized patient performance is more important than a time based intervention. The final project was a pilot study to investigate the mechanisms underlying perturbation training and the development of selective stabilization strategies without global co-contraction. The greatest changes in baseline muscle activity during perturbation training were found in the least specific muscles after injury: the vastus lateralis, medial hamstrings and lateral gastrocnemius. Increases in peak activity of the vastus lateralis, vastus medialis and medial hamstrings were seen, indicating a more forceful stabilization strategy in the face of ligament deficiency. No changes in the duration of high intensity muscle responses were seen.