Practice Patterns and Responses to the Patient-Driven Groupings Model and Coronavirus Disease 2019 Pandemic in Home Health Occupational Therapy: A Pilot Survey Study.

The purpose of the pilot survey was to understand current practice patterns and responses to the Patient-Driven Groupings Model and the coronavirus disease 2019 (COVID-19) pandemic in home health occupational therapy care. Fifty home health occupational therapy practitioners from 27 states in the United States completed the survey. Descriptive analysis was used to organize and summarize survey responses. The survey items on practice patterns included assessment tools, treatment approaches, and care coordination with physical therapy colleagues. The most reported assessment of occupational performance was the Barthel Index. The common treatment approaches included activities of daily living retraining, energy conservation, and functional mobility and transfer. The majority of respondents (n = 44) communicated with their physical therapy colleagues at least once a week. The communications were often related to scheduling and changes in a patient's condition. Seventy percent of practitioners experienced a reduction in home visits during the recent Medicare payment reform and the pandemic. These practitioners perceived that some patients might have been discharged from home health care prematurely. Additional studies to investigate the impact of policy changes and the pandemic on therapy intensity and patients' functional outcomes are warranted.

Population responses to a historic drought across the range of the common monkeyflower (Mimulus guttatus).

PREMISE: Due to climate change, more frequent and intense periodic droughts are predicted to increasingly pose major challenges to the persistence of plant populations. When a severe drought occurs over a broad geographical region, independent responses by individual populations provide replicated natural experiments for examining the evolution of drought resistance and the potential for evolutionary rescue. METHODS: We used a resurrection approach to examine trait evolution in populations of the common monkeyflower, Mimulus guttatus, exposed to a record drought in California from 2011 to 2017. Specifically, we compared variation in traits related to drought escape and avoidance from seeds collected from 37 populations pre- and post-drought in a common garden. In a parallel experiment, we evaluated fitness in two populations, one which thrived and one which was nearly extirpated during the drought, under well-watered and dry-down conditions. RESULTS: We observed substantial variation among populations in trait evolution. In the subset of populations where phenotypes changed significantly, divergence proceeded along trait correlations with some populations flowering rapidly with less vegetative tissue accumulation and others delaying flowering with greater vegetative tissue accumulation. The degree of trait evolution was only weakly correlated with drought intensity but strongly correlated with initial levels of standing variation. Fitness was higher in the post-drought than pre-drought accessions in both treatments for the thriving population, but lower in both treatments for the nearly extirpated population. CONCLUSIONS: Together, our results indicate that evolutionary responses to drought are context dependent and reflect the standing genetic variation and genetic correlations present within populations.

The Genetic Architecture of Plant Defense Trade-offs in a Common Monkeyflower.

Determining how adaptive combinations of traits arose requires understanding the prevalence and scope of genetic constraints. Frequently observed phenotypic correlations between plant growth, defenses, and/or reproductive timing have led researchers to suggest that pleiotropy or strong genetic linkage between variants affecting independent traits is pervasive. Alternatively, these correlations could arise via independent mutations in different genes for each trait and extensive correlational selection. Here we evaluate these alternatives by conducting a quantitative trait loci (QTL) mapping experiment involving a cross between 2 populations of common monkeyflower (Mimulus guttatus) that differ in growth rate as well as total concentration and arsenal composition of plant defense compounds, phenylpropanoid glycosides (PPGs). We find no evidence that pleiotropy underlies correlations between defense and growth rate. However, there is a strong genetic correlation between levels of total PPGs and flowering time that is largely attributable to a single shared QTL. While this result suggests a role for pleiotropy/close linkage, several other QTLs also contribute to variation in total PPGs. Additionally, divergent PPG arsenals are influenced by a number of smaller-effect QTLs that each underlie variation in 1 or 2 PPGs. This result indicates that chemical defense arsenals can be finely adapted to biotic environments despite sharing a common biochemical precursor. Together, our results show correlations between defense and life-history traits are influenced by pleiotropy or genetic linkage, but genetic constraints may have limited impact on future evolutionary responses, as a substantial proportion of variation in each trait is controlled by independent loci.