Childhood emotional invalidation and right hemispheric mu suppression during a pain empathy task: An EEG study

Empathy is a critical aspect of social behavior, and impairment in empathic processing is linked to hindered social interactions and several disorders. Despite much interest in this topic, our understanding of the developmental and neural involvement for empathic processing is limited. Recent evidence suggests the Mirror Neuron System (MNS) may play a role in this behavior, and that mu rhythm suppression found over the sensorimotor cortices may be a proxy for the MNS. Therefore, we aimed to measure mu rhythm oscillations in response to empathic processing during observation of painful action-based situations using electroencephalogram (EEG). Our second goal was to examine how perceived parental emotional invalidation (EI) during childhood may relate to empathy and influence mu suppression. Our results showed that mu rhythm suppression was strongest over the right hemisphere. EI had a significant influence on this suppression between painful and non-painful images, and was negatively correlated with behavioral measures of empathy. Our findings suggest that perceived childhood EI may decrease empathizing abilities and influence neural responses to the painful experiences of others. Implications from this study could entail clinical intervention targeted at emotional invalidation to foster the healthy development of empathy.     

Evaluation of anticoagulation and nonsurgical major bleeding in recipients of continuous‐flow left ventricular assist devices

Continuous‐flow left ventricular assist device (LVAD) placement has become a standard of care in advanced heart failure treatment. Bleeding is the most frequently reported adverse event after LVAD implantation and may be increased by antithrombotic agents used for prevention of pump thrombosis. This retrospective cohort included 85 adult patients implanted with a Heartmate II LVAD. Major bleeding was defined as occurring >7 days after implant and included intracranial hemorrhage, events requiring 2 units of packed red blood cells within a 24‐h period, and death from bleeding. Primary outcome was intensity of anticoagulation between patients with or without at least one incidence of nonsurgical major bleeding. Major bleeding occurred in 35 (41%) patients with 0.48 events per patient year and a median (IQR) time to first bleed of 134.5 (39.3, 368.5) days. The median (IQR) INR at time of bleed was 1.7 (1.4, 2.5). Median INR during follow‐up did not differ between groups and patients with major bleeding were not more likely to have a supra‐therapeutic INR. Patients who bled were more likely to have received LVAD for destination therapy, to have lower weight, worse renal function, and lower hemoglobin at baseline. Duration of LVAD support and survival were similar between groups with no difference in occurrence of thrombosis. Incidence of nonsurgical major bleeding was not significantly associated with degree of anticoagulation. Certain baseline characteristics may be more important than anticoagulation intensity to identify patients at risk for bleeding after LVAD implant. Modification of anticoagulation alone is not a sufficient management strategy and early intervention may be required to mitigate bleeding impact.     

Editorial Commentary: Tibial Attachment of the Anterior Cruciate Ligament: Just 1 Piece to the Complex Puzzle of Individualized,Anatomic Anterior Cruciate Ligament Reconstruction

The anterior cruciate ligament (ACL) is a complex, biologic structure that continues to be explored in the literature. Given the individual uniqueness of the ACL, variation exists, and studies continue to attempt to tease out what is truly important for ACL reconstruction. Although individual components of the ACL structure provide function, the ACL works as a dynamic structure, in unison with the surrounding bony morphology, to produce normal knee kinematics. Ultimately, in ACL reconstruction, the surgeon is tasked with restoring the native dimensions, collagen orientation, and insertion sites according to the individual anatomy.     

Is territorial expansion a mechanism for crossmodal plasticity?

Crossmodal plasticity is the phenomenon whereby, following sensory damage or deprivation, the lost sensory function of a brain region is replaced by one of the remaining senses. One of several proposed mechanisms for this phenomenon involves the expansion of a more active brain region at the expense of another whose sensory inputs have been damaged or lost. This territorial expansion hypothesis was examined in the present study. The cat ectosylvian visual area (AEV) borders the auditory field of the anterior ectosylvian sulcus (FAES), which becomes visually reorganized in the early deaf. If this crossmodal effect in the FAES is due to the expansion of the adjoining AEV into the territory of the FAES after hearing loss, then the reorganized FAES should exhibit connectional features characteristic of the AEV. However, tracer injections revealed significantly different patterns of cortical connectivity between the AEV and the early deaf FAES, and substantial cytoarchitectonic and behavioral distinctions occur as well. Therefore, the crossmodal reorganization of the FAES cannot be mechanistically attributed to the expansion of the adjoining cortical territory of the AEV and an overwhelming number of recent studies now support unmasking of existing connections as the operative mechanism underlying crossmodal plasticity.     

The Persistence of the Pamphlet: On the Continued Relevance of the Health Information Pamphlet in the Digital Age

Since the early 2000s, web and digital health information and education has progressed in both volume and innovation (Dutta-Bergman 2006; Mano, Computers in Human Behavior 39 404 412, 2014). A growing number of leading Canadian health institutions (e.g., hospitals, community health centers, and health ministries) are migrating much of their vital public health information and education, once restricted to pamphlets and other physically distributed materials, to online platforms. Examples of these platforms are websites and web pages, eLearning modules, eBooks, streamed classrooms, audiobooks, and online health videos. The steady migration of health information to online platforms is raising important questions for fields of patient education, such as cancer education. These questions include, but are not limited to (a) are pamphlets still a useful modality for patient information and education when so much is available on the Internet? (b) If so, what should be the relationship between print-based and online health information and education, and when should one modality take precedence over the other? This article responds to these questions within the Canadian health care context.