Based on the principles of neuroplasticity, the purpose of this crossover study was to determine if improvement in upper extremity (UE) function and independence could be achieved in patients 6 months to 7 years poststroke following an outpatient rehabilitation program (supervised 1.5 hours per week for 8 weeks reinforced with home gloving unaffected side and attended, graded, repetitive sensory and motor training activities). Twenty-one subjects (right or left hemiparesis; able to walk 100 feet with or without a cane; partially opened and closed the hand; partially elevated the shoulder and elbow against gravity) were randomly assigned to Group A (sensory training 4 weeks, motor training 4 weeks) or Group B (motor training 4 weeks, sensory training 4 weeks). Greater than 20% (P < 0.01) improvement was measured in functional independence and UE function (fine motor, sensory discrimination, and musculoskeletal performance). Gains were hemispheric and training specific and maintained over 3 months. This study provides evidence documenting significant improvement in function in the late poststroke recovery period following 12 hours of supervised learning based sensory motor training.

More than a decade of research has supported a robust consensus: Acute stress impairs memory retrieval. We aimed to determine whether a highly effective learning technique could strengthen memory against the negative effects of stress. To bolster memory, we used retrieval practice, or the act of taking practice tests. Participants first learned stimuli by either restudying or engaging in retrieval practice. Twenty-four hours later, we induced stress in half of the participants and assessed subsequent memory performance. Participants who learned by restudying demonstrated the typical stress-related memory impairment, whereas those who learned by retrieval practice were immune to the deleterious effects of stress. These results suggest that the effects of stress on memory retrieval may be contingent on the strength of the memory representations themselves.

The global pandemic of COVID-19 has challenged the management of hypoxaemic respiratory failure and strained intensive care unit resources. While prone positioning (PP) is an established therapy in mechanically ventilated patients with acute respiratory distress syndrome (ARDS), its role in conscious patients is less well defined. We retrospectively reviewed our experience of implementing early PP in a cohort of 24 patients with acute hypoxaemic respiratory failure due to COVID-19 who required support with continuous positive airway pressure (CPAP). The use of PP alongside CPAP significantly increased both the ROX index and arterial oxygen pressure:fractional inspired oxygen (PaO2:FiO2) ratio from baseline values (ROX index: 7.0±2.5 baseline vs 11.4±3.7 CPAP+PP, p<0.0001; PaO2:FiO2 ratio: 143±73 mm Hg baseline vs 252±87 mm Hg CPAP+PP, p<0.01), and the changes to both the ROX index and PaO2:FiO2 ratio remained significant 1 hour after cessation of proning. The mean duration of PP in the first 24 hours was 8±5 hours. Few complications were observed and PP was continued for a mean of 10±5 days. From our experience in a dedicated COVID-19 respiratory high care unit, PP alongside CPAP therapy was feasible, tolerated, safe and improved oxygenation. The use of conscious PP in ARDS warrants further investigation in randomised controlled trials.

Anthropomorphism has recently emerged in the literature as a useful tool for conservation. Within the current conservation literature, description of the development of anthropomorphisms and the range of species that can be anthropomorphized overlooks established and emerging evidence from anthropological and other social science studies of human-animal relationships. This research shows that people anthropomorphize a very broad range of species, including plants. We discuss how people construct anthropomorphic meanings around species, through a diversity of mechanisms and with both positive and negative effects. We then review the many gradations and forms of anthropomorphism, and some related conceptions in non-Western cultures, which have different types of utility for conservation. Finally we discuss cases where animals are anthropomorphized but with negative outcomes for human-animal interactions and conservation. Limiting the use of anthropomorphism in conservation to prosocial, intelligent, suffering animals risks suggesting that other species are not worthy of conservation because they are not like humans in the ''right'' ways. It would also mean overlooking the application of a powerful tool to the promotion of low-profile species with high biological conservation value. We emphasize that negative outcomes and conflicts with ecosystem-level conservation actions are also possible and need to be carefully managed. Use of anthropomorphism in 123Biodivers Conserv (2013( ) 22:1577( -1589( DOI 10.1007 conservation must take into account how people engage with species and attribute value to their characteristics.

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Background Many internal medicine (IM) programs have reorganized their resident continuity clinics to improve trainees' ambulatory experience. Downstream effects on continuity of care and other clinical and educational metrics are unclear.