Measuring Professionalism in Physical Therapy

INTRODUCTION: Professionalism has no clear definition and remains ambiguous throughout all health care disciplines. The American Physical Therapy Association (APTA) included professionalism in Vision 2020 as an important construct to advance the development of the profession. In 2002, the APTA identified seven Core Values of Professionalism that serve as a definition for practice. Presently, there is no valid instrument available for measuring professionalism behaviors of the individual physical therapist. PURPOSE: The purpose of this research was to develop and validate a survey for measuring professionalism behaviors among practicing physical therapists. METHODOLOGY: Grounded theory techniques guided development of a common set of indicators in initial survey development. A systematic review of cross-sectional research literature examining general measures of professionalism in physical therapy, medicine, and pharmacy was conducted. Face validation was obtained via a convenience sample of 10 practicing physical therapists representing multiple practice sites. An expert panel of four physical therapist professionalism content experts and one survey design expert participated in initial survey content validation. A sample of 161 licensed physical therapists from the Commonwealth of Virginia participated in the construct validation for the newly developed survey instrument. Exploratory factor analyses in the form of principal component analysis were used in construct validation. RESULTS: Face validation and four rounds of content validation resulted in a 39-item survey designed as a self-assessment for measuring professionalism in physical therapy. Exploratory factor analysis resulted in the development of a five-factor solution, which accounted for 51.4 percent of the unique variance in the data. The five factors are named: Accountability, Patient- Centered Care, Advancement, Participation, and Values. Accordingly, individual professionalism represents behaviors that progress in development across individual, patient/client, institutional, and societal levels. All seven Core Values of Professionalism are represented in the survey. CONCLUSIONS: The new survey, Professionalism in Physical Therapy, is unique in the physical therapy literature. The survey is of reasonable length and is designed for easy data collection. The instrument demonstrates content and initial construct validity and thus may be used to measure individual practitioner professionalism in physical therapy practice. As physical therapy approaches Vision 2020, physical therapist practitioners are expected to demonstrate more advanced professional behaviors in patient/client interactions, among practitioners within and among practices and representing the needs of the community and the profession at the societal level. These results contribute to the growing body of literature defining and measuring professional behaviors in health care and may be used to direct academic and professional development programming and substantiate professionalization of physical therapy

Systematics and Plastome Evolution in Schizaeaceae.

While the family Schizaeaceae (Schizaeales) represents only about 0.4% of the extant fern species diversity, it differs from other ferns greatly in gross morphologies, niche preferences, and life histories. One of the most notable features in this family is its mycoheterotrophic life style in the gametophytic stage, which appears to be associated with extensive losses of plastid genes. However, the limited number of sequenced plastomes, and the lack of a well-resolved phylogenetic framework of Schizaeaceae, makes it difficult to gain any further insight. Here, with a comprehensive sampling of ~77% of the species diversity of this family, we first inferred a plastid phylogeny of Schizaeaceae using three DNA regions. To resolve the deep relationships within this family, we then reconstructed a plastome-based phylogeny focusing on a selection of representatives that covered all the major clades. From this phylogenomic backbone, we traced the evolutionary histories of plastid genes and examined whether gene losses were associated with the evolution of gametophytic mycoheterotrophy. Our results reveal that extant Schizaeaceae is comprised of four major clades-Microschizaea, Actinostachys, Schizaea, and Schizaea pusilla. The loss of all plastid NADH-like dehydrogenase (ndh) genes was confirmed to have occurred in the ancestor of extant Schizaeaceae, which coincides with the evolution of mycoheterotrophy in this family. For chlorophyll biosynthesis genes (chl), the losses were interpreted as convergent in Schizaeaceae, and found not only in Actinostachys, a clade producing achlorophyllous gametophytes, but also in S. pusilla with chlorophyllous gametophytes. In addition, we discovered a previously undescribed but phylogenetically distinct species hidden in the Schizaea dichotoma complex and provided a taxonomic treatment and morphological diagnostics for this new species-Schizaea medusa. Finally, our phylogenetic results suggest that the current PPG I circumscription of Schizaea is non-monophyletic, and we therefore proposed a three-genus classification moving a subset of Schizaea species sensu PPG I to a third genus-Microschizaea

A phylogeny of Lophocoleaceae-Plagiochilaceae-Brevianthaceae and a revised classification of Plagiochilaceae

The Lophocoleaceae-Plagiochilaceae-Brevianthaceae clade is a largely terrestrial, subcosmopolitan lineage of jungermannialean leafy liverworts that may include significantly more than 1000 species. Here we present the most comprehensively sampled phylogeny available to date based on the nuclear ribosomal internal transcribed spacer region and the chloroplast markers rbcL and rps4 of 372 accessions. Brevianthaceae (consisting of Brevianthus and Tetracymbaliella) form a sister relationship with Lophocoleaceae; this lineage is in turn sister to Plagiochilaceae. Plagiochila is resolved monophyletic subsequent to exclusion of Plagiochila radiculosa; this species is placed in a new genus Cryptoplagiochila. Chiastocaulon and a polyphyletic Acrochila nest in Plagiochilion; these three genera are united under Chiastocaulon to include the Plagiochilaceae species with dominating or exclusively ventral branching. The generic classification of the Lophocoleaceae is still unresolved. We discuss alternative approaches to obtain strictly monophyletic genera by visualizing their consistence with the obtained consensus topology. The presented phylogeny will serve as a basis for follow-up studies including several thousand accessions. These studies will enable revision of current hypotheses on species diversity and distribution of Lophocoleaceae-Plagiochilaceae-Brevianthaceae and allow for a reconstruction of their evolution in time and space

Molecular Phylogeny of the Leafy Liverwort Lejeunea (Porellales): Evidence for a Neotropical Origin, Uneven Distribution of Sexual Systems and Insufficient Taxonomy

Background: Lejeunea is a largely epiphytic, subcosmopolitan liverwort genus with a complex taxonomic history. Species circumscriptions and their relationships are subject to controversy; biogeographic history and diversification through time are largely unknown. Methodology and Results: We employed sequences of two chloroplast regions (trnL-trnF, rbcL) and the nuclear ribosomal ITS region of 332 accessions to explore the phylogeny of the Harpalejeunea-Lejeunea-Microlejeunea complex. Lejeunea forms a well-supported clade that splits into two main lineages corresponding to L. subg. Lejeunea and L. subg. Crossotolejeunea. Neotropical accessions dominate early diverging lineages of both main clades of Lejeunea. This pattern suggests an origin in the Neotropics followed by several colonizations from the Neotropics into the Paleotropics and vice versa. Most Afro- Madagascan clades are related to Asian clades. Several temperate Lejeunea radiations were detected. Eighty two of the 91 investigated Lejeunea species could be identified to species level. Of these 82 species, 54 were represented by multiple accessions (25 para- or polyphyletic, 29 monophyletic). Twenty nine of the 36 investigated species of L. subg. Lejeunea were monoicous and 7 dioicous. Within L. subg. Crossotolejeunea, 15 of the 46 investigated species were monoicous and 31 dioicous. Some dioicous as well as some monoicous species have disjunct ranges. Conclusions/Significance: We present the first global phylogeny of Lejeunea and the first example of a Neotropical origin of a Pantropical liverwort genus. Furthermore, we provide evidence for the Neotropics as a cradle of Lejeunea lineages and detect post-colonization radiations in Asia, Australasia, Afro-Madagascar and Europe. Dioicy/monoicy shifts are likely nonrandomly distributed. The presented phylogeny points to the need of integrative taxonomical studies to clarify many Lejeunea binomials. Most importantly, it provides a framework for future studies on the diversification of this lineage in space and time, especially in the context of sexual systems in Lejeuneaceae.Open-Access-Publikationsfonds 201