Preferred Pace Research Articles

QOL-17. REFLECTIONS ON A PSYCHOEDUCATION INTERVENTION FOR PATIENTS WITH NEWLY DIAGNOSED BRAIN TUMORS (NEUROPATHWAYS): A QUALITATIVE STUDY

Abstract BACKGROUND Patients with newly diagnosed primary malignant brain tumors (PMBT) face unique challenges processing and absorbing information regarding their diagnosis, often while contending with cognitive and communication deficits. Limited research exists regarding optimal information provision and support for this highly distressed population. We used input from clinician, patient, and caregiver stakeholders to design a population-specific, psychoeducation intervention (“NeuroPathways”) to address these needs. METHODS We conducted a single-arm study (N=12) to pilot and refine NeuroPathways in English-speaking patients within six-weeks of a PMBT diagnosis. Neuropathways comprises 1) a comprehensive (105 pages) handbook covering information about PMBT diagnosis, treatment, coping, self-care, and vetted resources, and 2) four brief, individual telehealth sessions with a trained interventionist (e.g., psychologist, physician) over 4-8 weeks to assist and empower patients to obtain information, support, and coping guidance at their preferred depth and pace, using the handbook as a resource. Ten participants completed all four sessions and participated in semi-structured exit interviews. We used rapid qualitative analysis to explore participants’ perceptions of intervention delivery, content, and benefit. RESULTS Participants (83% male, median age=52 years) uniformly described NeuroPathways as accessible, citing the telehealth format as particularly important for facilitating participation given logistical challenges related to cancer treatment. Perceived benefits of participation included: a) access to well-organized information targeting both current and future disease- and treatment-related concerns; b) increased skill in problem solving and communication with loved ones and/or medical providers; c) personalized emotional support from interventionists. While most felt the timing was appropriate, several who enrolled later in the eligibility window stated a desire for earlier intervention. CONCLUSION Participant feedback highlights the accessibility and potential benefits of this psychoeducation intervention for patients with newly diagnosed PMBT. These data will inform refinement of NeuroPathways in preparation for a pilot randomized controlled trial to formally assess feasibility and acceptability.

Successful management of complete heart block in checkpoint inhibitor induced myocarditis by left bundle branch area pacing: a case report

Abstract Background Optimal management of checkpoint inhibitor-induced complete heart block is unknown. Previous reports showed relatively high incidence of pacing failure due to the co-existing myocarditis. Case summary A 71-year-old male with a prior history of stage IV metastatic squamous cell lung cancer presents was admitted for dyspnoea and hypotension 10 days after checkpoint inhibitor treatment using pembrolizumab. He was found to have myocarditis, third-degree AV block, severe left ventricular systolic dysfunction with EF 35%, and required pressure support. A dual chamber pacemaker using left bundle branch area pacing (LBBAP) was urgently placed that immediately improved his haemodynamics. Both the cathode and anode were able to capture the ventricle at different pacing outputs. The patient was taken off all intravenous pressors and successfully transferred to a larger centre for further management of the myocarditis with no further arrhythmia or hypotension. Discussion In conclusion, because of the unique ability to capture a large amount of myocardium from both the tip and ring electrodes as well as the ability to deliver cardiac resynchronization therapy, LBBAP may be the preferred pacing strategy in patients who develop complete heart block due to checkpoint inhibitor-induced myocarditis.

Effects of word presentation during treadmill walking on episodic memory and gait

Entrainment emerges when oscillatory movements synchronize with environmental stimuli processing. The purpose of this experiment was to assess how cognitive-motor entrainment during a dual-task would influence the quality of gait and affect episodic long-term memory. Twenty-one participants (22.56 y/o; 64 % F) walked at preferred paces while listening to 40-item word lists. In separate sessions, unique word lists were presented predictably on every fourth stride, unpredictably related to stepping, or predictably while standing. Memory tests administered 24-hr after encoding revealed that predictable word presentation led to better free-recall performance than unpredicted (p = .044); recognition memory was not impacted. Gait phase parameters during the predicted condition were more stable than the unpredicted condition or baseline assessments. Cognitive-motor entrainment may alleviate dual-task costs and enhance memory retention.

Asynchronous Learning Experiences for Visually Impaired Students: Exploring Processes and Challenges

Asynchronous learning facilitates students' convenient access to learning materials and enables them to engage with each other at their preferred pace. This type of learning, characterized by its lack of time constraints, grants students the freedom to acquire knowledge whenever they deem fit. Regrettably, visually impaired students have not been able to fully benefit from the widespread adoption of asynchronous learning, despite its proven effectiveness for diverse groups in gaining both academic knowledge and practical skills through LMS-based platforms. Consequently, this study endeavors to uncover the processes, obstacles, and educational experiences encountered by visually impaired students in the application of LMS-based asynchronous learning. The research employs a qualitative method, relying on in-depth interviews to gather comprehensive information. The collected data is subsequently transcribed, categorized, and carefully analyzed to derive conclusive study outcomes. The results reveal the specific requirements of visually impaired students in asynchronous learning via LMS, highlighting challenges such as comprehending video presentations, limited teacher interaction, accessibility issues, and incompatible reading formats.

Impact of distinct cognitive domains on gait variability in individuals with mild cognitive impairment and dementia.

Gait variability is a common feature in neurodegenerative diseases and has been linked to cognitive impairment. Despite this link, the influence of specific cognitive domains, such as memory, visual spatial skills, executive function, and verbal function on gait variability is not well-understood. To investigate the predictive value of these specific cognitive domains on gait variability in people with mild cognitive impairment (MCI) and dementia during preferred and dual task walking. One hundred and two participants with either MCI or dementia underwent a comprehensive cognitive assessment and completed preferred and dual-task walking trials on a pressure-sensing walkway. Gait variability was assessed using the PKMAS software. Lower extremity function was evaluated with a self-reported validated scale. Our findings indicate that only visual spatial abilities had a moderate predictive value on gait variability [F (1, 78) = 17.30, p < 0.01, r = 0.43], both in preferred pace walking (70% direct effect) and dual-task walking (90% direct effect) (p's < 0.05). Additionally, lower extremity functional skills had a significant indirect effect (30%) on gait variability in preferred walking contexts. For individuals diagnosed with MCI or dementia, increased gait variability may be driven by deficits in visual spatial processing. An increased understanding of the role of visual spatial processing in gait variability can aid in the assessment and management of individuals with MCI or dementia, potentially leading to targeted interventions to improve mobility and safety.

Characterizing ambulatory function in children with PPP2R5D-related neurodevelopmental disorder

BackgroundIndividuals with PPP2R5D-related neurodevelopmental disorder have an atypical gait pattern characterized by ataxia and incoordination. Structured, quantitative assessments are needed to further understand the impact of these impairments on function. Research questionHow do gait parameters and ambulatory function of individuals with PPP2R5D-related neurodevelopmental disorder compare to age and sex matched healthy norms? MethodsTwenty-six individuals with PPP2R5D pathogenic genetic variants participated in this observational, single visit study. Participants completed at least one of the following gait assessments: quantitative gait analysis at three different speeds (preferred pace walking (PPW), fast paced walking (FPW) and running, six-minute walk test (6MWT), 10-meter walk run (10MWR), and timed up and go (TUG). Descriptive statistics were used to summarize gait variables. Percent of predicted values were calculated using published norms. Paired t-tests and regression analyses were used to compare gait variables. ResultsThe median age of the participants was 8 years (range 4–27) and eighteen (69.2 %) were female. Individuals with PPP2R5D-related neurodevelopmental disorder walked slower and with a wider base of support than predicted for their age and sex. Stride velocity ranged from 48.9 % to 70.1 % and stride distance from 58.5 % to 81.9 % of predicted during PPW. Percent of predicted distance walked on the 6MWT ranged from 30.6 % to 71.1 % representing varied walking impairment. Increases in stride distance, not cadence, were associated with changes in stride velocity in FPW (R2 = 0.675, p =< 0.001) and running conditions (R2 = 0.918, p =< 0.001). SignificanceWe quantitatively assessed the abnormal gait in individuals with PPP2R5D-related neurodevelopmental disorder. These impairments may affect ability to adapt to environmental changes and participation in daily life.Rehabilitative interventions targeting gait speed and balance may improve function and safety for individuals with PPP2R5D-related neurodevelopmental disorder.

Knee biomechanics variability before and after total knee arthroplasty: an equality of variance prospective study

This study evaluated gait variability in patients before and after total knee arthroplasty (TKA) using the equality of variance method to determine where variability differences occur in the movement cycle. Twenty-eight patients underwent TKA with cruciate-sacrificed implants. Patients underwent motion analysis which measured knee biomechanics as they walked overground at their preferred pace before and 12 months after TKA. Equality of variance results were compared with 14 healthy controls of similar age. Before surgery, patients had reduced knee extension moment variability throughout the early stance phase (4–21% gait cycle, p < 0.05) compared to controls. Knee power variability was lower preoperatively compared to controls for most of the stance phase (0–13% and 17–60% gait cycle, p < 0.05). Sagittal knee moment and power variability further decreased following TKA. Knee extension moment variability was lower postoperatively throughout stance phase compared to preoperatively (4–22% and 36–60% gait cycle, p < 0.05) and compared to controls (4–30% and 45–60% gait cycle, p < 0.05). Knee power variability remained lower following TKA throughout stance phase compared to preoperatively (10–24% and 36–58% gait cycle, p < 0.05) and controls (3–60% gait cycle, p < 0.05). TKA patients may be less stable, and this may be in part due to an unresolved adaptation developed while awaiting TKA surgery and the cruciate sacrificing design of the implants utilized in this study.

Assessment of Behavioral Intention to Adopt Educational Mobile Application in Advanced Mathematics for Engineering Education

Technology has long played a crucial role in society, including its application in education. The learning experiences of students in higher education have been significantly transformed. This study explores the adoption and acceptance of the Advanced Math mobile application among students, focusing on four key variables: social influence, performance expectancy, effort expectancy, and facilitating conditions. The study involved 253 participants who downloaded and used the Advanced Math mobile application as a supplemental study tool. The findings indicate that social influence significantly impacts students' decisions to use the application. The performance of the mobile application enhances students' productivity by providing easy access to lecture information, thereby supporting their learning process and motivating them to use the application. Facilitating conditions enable students to work independently at their preferred pace and access the application anytime and anywhere. The behavioral intention to use the mobile application is associated with positive feelings, leading students to use it as an additional resource for learning Advanced Math. Mobile applications have the potential to revolutionize educational settings by enhancing engagement, accessibility, and personalized learning. However, their effective use in the classroom necessitates robust pedagogical frameworks that align with learning objectives and provide continuous support for educators. Future research should continue to explore the challenges and opportunities of integrating mobile applications into the classroom to support both teachers and students in an increasingly digital society.

Gender differences on the age-related distal-to-proximal shift in joint kinetics during running.

The increased running participation in women and men over 40 years has contributed to scientific interest on the age-related and gender differences in running performance and biomechanics over the last decade. Gender differences in running biomechanics have been studied extensively in young runners, with inconsistent results. Understanding how gender influences the age-related differences in running mechanics could help develop population-specific training interventions or footwear to address any potential different mechanical demands. The purpose of this study was to assess gender and age effects on lower limb joint mechanics while running. Middle-aged men (57 ± 5 years) and women (57 ± 8 years) and young men (28 ± 6 years) and women (30 ± 6 years) completed five overground running trials at a set speed of 2.7 m/s while lower limb kinematics and ground reaction forces were collected. Lower limb joint kinetics were computed, normalized to body mass and compared between age and gender groups using two-factor analyses of variance. Women reported slower average running paces than men and middle-aged runners reported slower running paces than young runners. We confirmed that young runners run with more ankle, but less hip positive work and peak positive power compared to middle-aged runners (i.e., age-related distal-to-proximal shift in joint kinetics). We also present a novel finding that women run with more ankle, but less hip peak positive power compared to men suggesting an ankle dominant strategy in women at a preferred and comfortable running pace. However, the age-related distal-to-proximal shift in joint kinetics was not different between genders.

Assessing lower limb angles from sagittal plane images captured with a smartphone for post-stroke gait

BACKGROUND: Clinical gait analysis of sagittal plane lower-limb kinematics using video images is a quantitative tool for clinicians. However, the reliability and validity of limb kinematics after stroke using video images has not been fully investigated. OBJECTIVE: This study aimed to examine the within-session inter-rater reliability and criterion-related validity of lower limb angles measured in sagittal plane images captured using a smartphone for assessing post-stroke gait and to determine which asymmetric parameters are associated with faster gait velocity. METHODS: Thirty-two patients with stroke were included; video images were recorded as they walked at their preferred pace for 1–3 cycles. Lower limb angles (contact, push-off, and excursion angles) and degree of asymmetry were determined based on video images using markers of acromion, greater trochanter, and fifth metatarsal head. Measurement reliability was calculated using the two-way random effects model of intraclass correlation coefficients and minimal detectable change. The criterion validity investigated Pearson’s correlation between lower limb angles and their asymmetry and gait velocity. RESULTS: The lower value of the 95% confidence interval of intraclass correlation coefficients (2.3) of the lower limb was 0.891, and the maximum minimal detectable change was 9.6 degrees. Push-off angle showed a moderate-to-strong correlation with gait velocity, whereas the asymmetry of the push-off angle showed a weak correlation with gait velocity. CONCLUSIONS: Assessing post-stroke gait utilizing video images using a smartphone is feasible. The push-off angle, in particular, may provide insight into the clinical assessment of post-stroke gait.

Influence of transcutaneous electrical nerve stimulation on walking kinematics and standing balance of older adults who differ in walking speed.

The purpose was to determine the impact of transcutaneous electrical nerve stimulation (TENS) on measures of walking kinematics and standing balance of healthy older adults who were stratified into two groups based on differences in the distance walked during the 6-min test of walking endurance. Regression models were developed to explain the variance in the 6-min distance and to assess the predictive power of balance metrics to categorize the 26 older adults (72 ± 5.4 yrs) as either slow or fast walkers. Walking kinematics were measured during 6- and 2-min walk tests that were performed with and without the concurrent application of TENS to the hip flexor and ankle dorsiflexor muscles. Participants walked briskly during the 6-min test and at a preferred pace during the 2-min test. The supplementary sensory stimulation provided by TENS did not alter the power of the models to explain the variance in the Baseline 6-min distance: Baseline, R2 = 0.85; TENS, R2 = 0.83. In contrast, TENS improved the explanatory power of the data obtained during the 2-min walk to account for the variance in the Baseline 6-min distance: no TENS, R2 = 0.40; TENS, R2 = 0.64. Logistic regression models based on force-plate and kinematic data obtained during the balance tasks were able to discriminate between the two groups with excellent certainty. The impact of TENS was greatest when older adults walked at a preferred speed but not when they walked at a brisk pace or performed tests of standing balance.

The effect of carbon fiber plated shoes on submaximal running mechanics in non-elite runners

Running shoes constructed with midsole carbon fiber (CF) plates are often worn by elite long-distance runners and may result in mechanical and physiological changes (e.g. increased ground reaction forces, metabolic savings, and speed); however, the effect of these shoes is unknown in a non-elite population. We investigated biomechanical variables in non-elite runners running at submaximal speeds wearing the Nike ZoomX Vaporfly NEXT% 2 shoes (Next%), a shoe with CF plates and specialized energy-returning foam, compared to a shoe without CF plates (Pegasus). 12 male (20.75 ± 0.62 years) and 18 female (22.94 ± 5.06 years) runners were recruited. Following a warmup (400 m) in their own shoes at their preferred pace, runners ran 800 m twice, once in each shoe: Pegasus or Next%. Stride frequency during the shoe trials was controlled (via metronome) to preferred stride frequency recorded in the warmup. Wearable running analysis IMUs were worn to collect data. Stride length was significantly greater (p < 0.000) in Next% (2.97 ± 0.49 m) than in Pegasus (2.85 ± 0.46 m). Horizontal GRF was significantly higher (p = 0.009) in Next% (9.35 ± 1.92 N/kg/s) than in Pegasus (8.72 ± 1.41 N/kg/s). While wearing the Next% shoe, non-elite runners exhibited a significant increase in stride length and horizontal GRF while maintaining a constant stride frequency which ultimately resulted in an increase in running speed.

Left bundle branch area pacing prevents pacing induced cardiomyopathy in long-term observation.

Left bundle branch area pacing (LBBAP) is one of the methods to deliver conduction system pacing which potentially avoids the negative impact of conventional right ventricular pacing. To assess echocardiographic outcomes in a long-term observation in patients with LBBAP implemented for bradyarrhythmia indications. A total of 151 patients with symptomatic bradycardia and LBBAP pacemaker implanted, were prospectively included in the study. Subjects with left bundle branch block and CRT indications (n = 29), ventricular pacing burden <40% (n = 11), and loss of LBBAP (n = 10) were excluded from further analysis. At baseline and the last follow-up visit, echocardiography with global longitudinal strain (GLS) assessment, 12-lead ECG, pacemaker interrogation, and blood level of NT-proBNP were performed. The median follow-up period was 23 months (15.5-28). None of the analyzed patients fulfilled the criteria for pacing induced cardiomyopathy (PICM). Improvement in left ventricular ejection fraction (LVEF) and GLS was observed in patients with LVEF <50% at baseline (n = 39): 41.4 ± 9.2% versus 45.6 ± 9.9%, and 12.9±3.6% versus 15.5±3.7%, respectively. In the subgroup with preserved EF (n = 62), LVEF and GLS remained stable at follow-up: 59.3 ± 5.5% versus 60 ± 5.5%, and 19 ± 3.9% versus 19.4 ± 3.8%, respectively. LBBAP prevents PICM in patients with preserved LVEF and improves left ventricle function in subjects with depressed LVEF. LBBAP might be the preferred pacing modality for bradyarrhythmia indications.

Attentional focus effects on joint covariation in a reaching task

Adopting an external focus of attention (EF) has been found beneficial over internal focus (IF) for performing motor skills. Previous studies primarily examined focus of attention (FOA) effects on performance outcomes (such as error and accuracy), with relatively less emphasis on movement coordination. Given that human movements are kinematically and kinetically abundant (Gefland & Latash, 1998), FOA instructions may change how motor abundance is utilized by the CNS. This study applied the uncontrolled manifold analysis (UCM) to address this question in a reaching task. Healthy young adults (N = 38; 22 ± 1 yr; 7 men, 31 women) performed planar reaching movements to a target using either the dominant or nondominant arm under two different FOA instructions: EF and IF. Reaching was performed without online visual feedback and at a preferred pace. Joint angles of the clavicle-scapula, shoulder, elbow, and wrist were recorded, and their covariation for controlling dowel endpoint position was analyzed via UCM. As expected, IF led to a higher mean radial error than EF, driven by increases in aiming bias and variability. Consistent with this result, the UCM analysis showed that IF led to higher goal-relevant variance among the joints (VORT) compared to EF starting from the first 20% of the reach to the end. However, the goal-irrelevant variance (VUCM)—index of joint variance that does not affect the end-effector position—did not show FOA effects. The index of stability of joint coordination with respect to endpoint position (ΔV) was also not different between the EF and IF. Consistent with the constrained action hypothesis, these results provide evidence that IF disrupted goal-relevant joint covariation starting in the early phases of the reach without affecting goal-irrelevant coordination.

PO-05-110 MULTI-CONTACT LEAD TO FACILITATE LEFT BUNDLE BRANCH PACING

Left bundle branch pacing (LBBP) has emerged as a preferred physiological pacing approach, however it is constrained by difficult implantation techniques and inconsistent LBB capture. Therefore, to facilitate LBBP and to improve implantation success, a novel pacing lead specifically for cardiac conduction system pacing that addresses these limitations is necessary. Develop a multi-contact lead (MCL) to facilitate pacing the conduction system at low threshold. A novel lead with five contacts at the distal end was designed and prototyped with fine silver wire wrapped around a central stainless-steel shaft. Insulation was removed from the silver wire with an Ultraviolet laser. The contacts were spaced apart from each other at distances ranging from 0.2 mm to 1.0 mm. The MCLs were tested on five isolated, perfused adult canine hearts. The right ventricular (RV) septum was exposed by opening the RV and leads were inserted from the RV septum to near the left ventricular (LV) septal surface. A standard clinical lead (Medtronic 3830) was also implanted from the RV septal surface. RV apex pacing was performed with a pair of pacing wires. Pacing thresholds for LBB capture were determined and QRS duration was measured from the pseudo-ECG recorded in perfusion bath. LBB capture was achieved for the standard lead and all combinations of MCL. LBB capture threshold was lower for the lowest combination of contacts on MCL compared to the standard 3830 lead values (0.68 ± 0.3 V vs. 1.63 ± 0.7 V, respectively, P < 0.01, Fig A). LBB capture was verified by comparing the shortest MCL QRS duration in each study with sinus rhythm and right ventricular pacing QRS durations (63.8 ± 9.6, 56.4 ± 5.9, and 106.8 ± 16.7 ms, respectively, Fig B). The novel MCL has the potential to facilitate the physiologic pacing process of LBBP. MCL enables a narrowly paced QRS complex and a low pacing capture threshold with a high success rate.

Continuing Professional Development Model in the Schools Division of Sarangani

This study explored and determined the extent of the Continuing Professional Development (CPD) implementation in government school institutions in the Sarangani Division for School Year 2022-2023. The 375 respondents from a total population of 6, 042 public school teacher were randomly selected across the 23 school districts. Based on the findings, the hypothesis on no significant relationship between the extent of the CPD implementation and the teacher’s competencies is accepted because of the Pearson’s r-value of -0.081 with negligible correlation 0.118 p-value. However, the hypothesis on no significant relationship between the contributing factors and the extent of CPD implementation is rejected and the model is a partial mediation. Sobel test yielded a z-value of -3.10600817 with a p-value of 0.00189631 that means significant at 0.05 level. Further, three major themes surfaced from the informant’s in-depth interview after an intensive analysis of the data gathered, namely: Limited Training Offered, Insufficient Execution of the Program, and Participatory Barriers to CPD Training. The indicated training need, preferred CPD modalities and pace, as well as monitoring, evaluation, and offering technical support to schools in terms of CPD may be taken into consideration by DepEd Offices. Hence, a CPD Model is recommended to take effect in the Schools Division of Sarangani to address the actual competency gap and relevant training needs for teachers’ professional growth and development.

Biomechanical Effects of Manipulating Preferred Cadence During Treadmill Walking in Patients With ACL Reconstruction.

Abnormal gait is common after anterior cruciate ligament reconstruction (ACLR) which may influence osteoarthritis risk in this population. Yet few gait retraining options currently exist in ACLR rehabilitation. Cueing cadence changes is a simple, low-cost method that can alter walking mechanics in healthy adults, but few studies have tested its effectiveness in an ACLR population. Here, we evaluated the acute effects of altering cadence on knee mechanics in patients 9 to 12 months post ACLR. Cueing larger steps will facilitate larger knee angles and moments, while cueing smaller steps would induce smaller knee angles and moments. Randomized cross-sectional design. Level 3. Twenty-eight patients with unilateral ACLR underwent gait assessments on a treadmill at preferred pace. Preferred walking gait was assessed first to obtain preferred cadence. Participants then completed trials while matching an audible beat set to 90% and 110% of preferred cadence in a randomized order. Three-dimensional sagittal and frontal plane biomechanics were evaluated bilaterally. Compared with preferred cadence, cueing larger steps induced larger peak knee flexion moments (KFMs) and knee extension excursions bilaterally (P < 0.01), whereas cueing smaller steps only reduced knee flexion excursions (P < 0.01). Knee adduction moments remain unchanged across conditions and were similar between limbs (P > 0.05). Peak KFMs and excursions were smaller in the injured compared with uninjured limb (P < 0.01). Frontal plane gait outcomes were unchanged across conditions suggesting acute cadence manipulations result in mainly sagittal plane adaptations. Follow-up studies using a longitudinal cadence biofeedback paradigm may be warranted to elucidate the utility of this gait retraining strategy after ACLR. Cueing changes in walking cadence can target sagittal plane knee loading and joint range of motion in ACLR participants. This strategy may offer high clinical translatability given it requires relatively minimal equipment (ie, free metronome app) outside of a treadmill.

Relative Aerobic Load of Daily Activities After Stroke.

Individuals after stroke are less active, experience more fatigue, and perform activities at a slower pace than peers with no impairments. These problems might be caused by an increased aerobic energy expenditure during daily tasks and a decreased aerobic capacity after stroke. The aim of this study was to quantify relative aerobic load (ie, the ratio between aerobic energy expenditure and aerobic capacity) during daily-life activities after stroke. Seventy-nine individuals after stroke (14 in Functional Ambulation Category [FAC] 3, 25 in FAC 4, and 40 in FAC 5) and 22 peers matched for age, sex, and body mass index performed a maximal exercise test and 5 daily-life activities at a preferred pace for 5minutes. Aerobic energy expenditure (mLO2/kg/min) and economy (mLO2/kg/unit of distance) were derived from oxygen uptake ($\dot{\mathrm{V}}{\mathrm{O}}_2$). Relative aerobic load was defined as aerobic energy expenditure divided by peak aerobic capacity (%$\dot{\mathrm{V}}{\mathrm{O}}_2$peak) and by $\dot{\mathrm{V}}{\mathrm{o}}_2$ at the ventilatory threshold (%$\dot{\mathrm{V}}{\mathrm{o}}_2$-VT) and compared in individuals after stroke and individuals with no impairments. Individuals after stroke performed activities at a significantly higher relative aerobic load (39%-82% $\dot{\mathrm{V}}{\mathrm{o}}_2$peak) than peers with no impairments (38%-66% $\dot{\mathrm{V}}{\mathrm{o}}_2$peak), despite moving at a significantly slower pace. Aerobic capacity in individuals after stroke was significantly lower than that in peers with no impairments. Movement was less economical in individuals after stroke than in peers with no impairments. Individuals after stroke experience a high relative aerobic load during cyclic daily-life activities, despite adopting a slower movement pace than peers with no impairments. Perhaps individuals after stroke limit their movement pace to operate at sustainable relative aerobic load levels at the expense of pace and economy. Improving aerobic capacity through structured aerobic training in a rehabilitation program should be further investigated as a potential intervention to improve mobility and functioning after stroke.

The Effect of Online Interaction via Microsoft Teams Private Chat on Enhancing the Communicative Competence of Introverted Students

The history of language education has witnessed the emergence of various approaches and methods to circumvent learning difficulties. Some of them were very effective and continue to be popular, whereas others were short-lived and less effective. The latest trend is technology-enhanced language learning, which became necessary during the recent pandemic. As a result, various learning platforms were created and tested to enhance online education. Despite the apparent disadvantages of online learning, it has undoubtedly produced a positive impact on learning styles. A notable change is the possibilities for individualised instruction and self-learning, which can provide additional support to introverted students. The major challenges introverted students face in second language acquisition are low self-esteem, lack of motivation and high anxiety. These negative attitudes often hinder successful language learning. However, one of the latest learning platforms, MS Teams Meeting, offers an additional feature for interaction known as Private Chat, which enables learners to communicate with their teachers and peers without disrupting the regular class. Besides, it helps students regulate the learning process according to their preferred time and pace and get extended one-on-one support from teachers. Moreover, this technology-based interactive tool facilitates asynchronous learning, thus enabling introverted students to overcome learning difficulties that act as affective filters and become independent learners. This small-scale experimental study shows that the use of Microsoft Private Chat for teacher-student interaction significantly contributes to the communicative competence of introverted students as it helps lower anxiety and boosts motivation and self-confidence.

Clinical Outcomes in Conduction System Pacing Compared to Right Ventricular Pacing in Bradycardia

BackgroundConduction system pacing (CSP) provides more physiological ventricular activation than right ventricular pacing (RVP). ObjectivesThis study evaluated the differences in clinical outcomes in patients receiving CSP and RVP. MethodsConsecutive patients with pacemakers implanted for bradycardia from 2016 to 2021 in 2 centers were prospectively followed for the primary composite outcome of heart failure (HF) hospitalizations, upgrade to biventricular pacing, or all-cause mortality, stratified by ventricular pacing burden (Vp) . ResultsAmong 860 patients (mean age 74 ± 11 years, 48% female, 48% atrioventricular block), 628 received RVP and 231 received CSP (95 His-bundle pacing, 136 left bundle branch pacing). The primary outcome occurred in 217 (25%) patients, more commonly in patients with RVP than CSP (30% vs 13%, P < 0.001). In multivariable analyses, CSP was independently associated with 47% reduction of the primary outcome (adjusted hazard ratio [AHR]: 0.53; 95% CI: 0.29-0.97; P = 0.04) and HF hospitalization alone (AHR: 0.40; 95% CI: 0.17-0.95; P = 0.04), among only patients with Vp >20%. The incidence of the primary outcome was highest among RVP with Vp >20% and lowest in CSP with Vp >20% (35% vs 10%, P < 0.001). Compared with RVP with Vp >20%, both CSP with Vp >20% (AHR: 0.51; 95% CI: 0.28-0.91; P = 0.02) and all patients with Vp ≤20% (AHR: 0.73; 95% CI: 0.54-0.99; P = 0.04) were independently associated with reduced primary outcome, driven primarily by reductions in HF hospitalizations (P < 0.05). Event-free survival was similar between CSP with Vp >20% and those needing ≤20% Vp. ConclusionsCSP significantly reduced adverse clinical outcomes for bradycardic patients requiring ventricular pacing and should be the preferred pacing modality of choice.