Perceptions of emergency department staff of the role of physiotherapists in the system: a qualitative investigation.

OBJECTIVES: To investigate the perceptions of doctors, nurses and physiotherapists of emergency department physiotherapy for acute patients, and explore the scope of its contribution in an otherwise nontraditional allied health setting in Australia. DESIGN: Qualitative investigation using semi-structured interviews. SETTING: A large, metropolitan tertiary hospital with a well-established emergency department physiotherapy/allied health network in place. PARTICIPANTS: Two emergency department doctors, two emergency department nurses and two senior physiotherapists working in an emergency department were recruited purposefully from the study hospital. INTERVENTIONS: Semi-structured interviews lasting from 20 minutes to 1 hour were conducted with each participant by the lead investigator. Data were analysed using NVivo software, coded manually and verified with member checking, facilitating constant case comparisons. RESULTS: Issues explored included defining the role of physiotherapists, uncovering organisational themes from the introduction of physiotherapy into the established emergency department setting, and conflicts around preserving and expanding an allied health identity in a highly-medicalised clinical environment. CONCLUSIONS: Participants described the benefits of having physiotherapists located in the emergency department, and the physiotherapists were eager to advance their roles and responsibilities, but were, at times, restricted by a complicated organisational landscape influencing professional autonomy and capacity for professional advocacy. Ongoing evidence supporting the breadth of physiotherapy practice in the emergency department is needed to further advocate the usefulness of the profession in this acute setting.

Self-efficacy beliefs and confidence of rural physiotherapists to undertake specialist paediatric caseloads: a paediatric example.

INTRODUCTION: Rural physiotherapists are faced with unique challenges, one of which is the necessity to extend their skills and knowledge to areas that would be covered by a specialist physiotherapist in an urban setting. The effects of this on the physiotherapist's confidence and self-belief has not been studied. The present study aimed to measure the self-efficacy and confidence of rural physiotherapists who undertake service delivery in the specialist field of paediatrics. METHOD: A descriptive, cross-sectional design survey was made of rural and remote physiotherapists working in north-west Queensland, Australia. Responses were coded and analysed using descriptive statistics and cross tabs to compare existing relationships among variables. RESULTS: Twenty-three (of 56) completed surveys were returned (41% response rate). Rural and remote physiotherapist's are likely to be sole practitioners or part of a small group of clinicians, working full time in a hospital or private practice. These physiotherapists reported less peer support than urban physiotherapists and were required to treat multiple cases across specialist areas. Physiotherapists working in such a demanding, unsupported environment have a low belief in their abilities and poor coping strategies, causing them to develop low self-efficacy. CONCLUSION: Rural physiotherapists having low self-efficacy can mean they have low levels of confidence in their ability to practise, and hold the belief that they lack the skills and attributes to practice. This could mean a conflict with professional conduct and ethical standards. Early identification of low self-efficacy gives time to review, develop and sustain strategies to help address the problems faced by the rural physiotherapist workforce, and to re-develop this workforce into one that is more stable and supportive.

A DEFICIENS homolog from the dioecious tree black cottonwood is expressed in female and male floral meristems of the two-whorled, unisexual flowers.

We isolated PTD, a member of the DEFICIENS (DEF) family of MADS box transcription factors, from the dioecious tree, black cottonwood (Populus trichocarpa). In females, in situ hybridization experiments showed that PTD mRNA was first detectable in cells on the flanks of the inflorescence meristem, before differentiation of individual flowers was visually detectable. In males, the onset of PTD expression was delayed until after individual flower differentiation had begun and floral meristems were developing. Although PTD was initially expressed throughout the inner whorl meristem in female and male flowers, its spatial expression pattern became sex-specific as reproductive primordia began to form. PTD expression was maintained in stamen primordia, but excluded from carpel primordia, as well as vegetative tissues. Although PTD is phylogenetically most closely related to the largely uncharacterized TM6 subfamily of the DEF/APETELA3(AP3)/TM6 group, its spatio-temporal expression patterns are more similar to that of DEF and AP3 than to other members of the TM6 subfamily.

Diverse effects of overexpression of LEAFY and PTLF, a poplar (Populus) homolog of LEAFY/FLORICAULA, in transgenic poplar and Arabidopsis.

PTLF, the Populus trichocarpa homolog of LEAFY (LFY) and FLORICAULA, was cloned to assess its function in a dioecious tree species. In situ hybridization studies showed that the gene was expressed most strongly in developing inflorescences. Expression was also seen in leaf primordia and very young leaves, most notably in apical vegetative buds near inflorescences, but also in seedlings. Although ectopic expression of the PTLF cDNA in Arabidopsis accelerated flowering, only one of the many tested transgenic lines of Populus flowered precociously. The majority of trees within a population of 3-year-old transgenic hybrid Populus lines with PTLF constitutively expressed showed few differences when compared to controls. However, phenotypic effects on growth rate and crown development, but not flowering, were seen in some trees with strong PTLF expression and became manifest only as the trees aged. Competence to respond to overexpression of LFY varied widely among Populus genotypes, giving consistent early flowering in only a single male P. tremula x P. tremuloides hybrid and causing gender change in another hybrid genotype. PTLF activity appears to be subject to regulation that does not affect heterologously expressed LFY, and is dependent upon tree maturation. Both genes provide tools for probing the mechanisms of delayed competence to flower in woody plants.

Structure and expression of duplicate AGAMOUS orthologues in poplar.

To investigate the homeotic systems underlying floral development in a dioecious tree, and to provide tools for the manipulation of floral development, we have isolated two Populus trichocarpa genes, PTAG1 and PTAG2, homologous to the Arabidopsis floral homeotic gene AGAMOUS (AG). PTAG1 and PTAG2 are located on separate linkage groups, but their non-coding regions are highly similar, consistent with a phylogenetically recent duplication. Intron/exon structure is conserved in relation to AG and the Antirrhinum AG orthologue, PLENA (PLE), and low-stringency Southern analysis demonstrated the absence of additional genes in the poplar genome with significant PTAG1/2 homology. PTAG1 and PTAG2 exhibit an AG-like floral expression pattern, and phylogenetic analysis of the AG subfamily strongly supports evolutionary orthology to C-class organ identity genes. The high degree of similarity shared by PTAG1 and PTAG2 in both sequence (89% amino acid identity) and expression indicates that they are unlikely to be functionally associated with specification of tree gender. Unexpectedly, PTAG transcripts were consistently detected in vegetative tissues.