Responding to an Emerging Need: Implementing Telehealth in Acute Hospital Rehabilitation.

This article outlines a multidisciplinary approach to implementing a telehealth program in the acute care hospital setting during the coronavirus disease 2019 (COVID-19) pandemic. Telehealth has been used in many practice areas, although it can be a particular challenge to establish in an acute care hospital given the fast-paced environment. However, the COVID-19 pandemic presented a unique situation. In-person treatment interactions became increasingly high risk for both patient and provider, and there was an emerging need to conserve personal protective equipment and limit exposure. In response to these developments, physical therapists, occupational therapists, and speech language pathologists treating an adult population turned to telehealth to supplement in-person treatment. This article outlines the clinical reasoning and practical application to implementing a telehealth program in an acute care hospital and includes regulations, identified successful strategies, barriers, considerations, decision-making algorithms, and discipline-specific interventions.

Domain adaptation and self-supervised learning for surgical margin detection.

PURPOSE: One in five women who undergo breast conserving surgery will need a second revision surgery due to remaining tumor. The iKnife is a mass spectrometry modality that produces real-time margin information based on the metabolite signatures in surgical smoke. Using this modality and real-time tissue classification, surgeons could remove all cancerous tissue during the initial surgery, improving many facets of patient outcomes. An obstacle in developing a iKnife breast cancer recognition model is the destructive, time-consuming and sensitive nature of the data collection that limits the size of the datasets. METHODS: We address these challenges by first, building a self-supervised learning model from limited, weakly labeled data. By doing so, the model can learn to contextualize the general features of iKnife data from a more accessible cancer type. Second, the trained model can then be applied to a cancer classification task on breast data. This domain adaptation allows for the transfer of learnt weights from models of one tissue type to another. RESULTS: Our datasets contained 320 skin burns (129 tumor burns, 191 normal burns) from 51 patients and 144 breast tissue burns (41 tumor and 103 normal) from 11 patients. We investigate the effect of different hyper-parameters on the performance of the final classifier. The proposed two-step method performed statistically significantly better than a baseline model (p-value < 0.0001), by achieving an accuracy, sensitivity and specificity of 92%, 88% and 92%, respectively. CONCLUSION: This is the first application of domain transfer for iKnife REIMS data. We showed that having a limited number of breast data samples for training a classifier can be compensated by self-supervised learning and domain adaption on a set of unlabeled skin data. We plan to confirm this performance by collecting new breast samples and extending it to incorporate other cancer tissues.

An Extended Photoperiod Increases Milk Yield and Decreases Ovulatory Activity in Dairy Goats.

Short day length is associated with reduced milk production in dairy ruminants. Dairy ruminants have been kept in lit sheds during winter to extend the day length and stimulate milk production. However, there studies are few on the effect of an extended photoperiod on the ensuing reproductive performance of dairy goats. The aim of this study was to examine the effect of long day photoperiod (LDPP) and exposure to bucks on milk production and plasma progesterone and prolactin in dairy goats. The study was conducted in 122 non-pregnant lactating dairy goats over 18 weeks from April to August (late autumn and winter in the Southern Hemisphere). The goats were kept in open sided sheds in which the control treatment received ambient lighting while the LDPP treatment received 16 h of light, including artificial lighting. In June, July and August synchronised does were randomly assigned each month to the presence or absence of a buck and ovulatory activity determined from plasma progesterone. Plasma progesterone concentrations were reduced (0.73 vs. 0.46 pmol, p < 0.001) while prolactin concentrations were increased (0.095 vs. 1.33 ng/mL, p < 0.001) in LDPP goats. The former response was most marked in late winter (0.58 vs. 0.004 pmol, p < 0.001) indicating a lack of functional corpora lutea. While there was no overall effect of buck exposure on plasma progesterone concentrations there was a three-way interaction such that plasma progesterone concentrations were increased (p < 0.05) by exposure to bucks in LDPP goats in August (late winter) but not at other times. Milk production was increased in LDPP goats over the latter stages of the study (1. 55 vs. 1.82 L/d, p < 0.05). Also, persistency of lactation was greater in LDPP goats with fewer goats drying off (13 vs. 0%, p < 0.05). These findings suggest that LDPP can increase milk production and persistence while decreasing ovulatory activity in dairy goats.