Background: To maintain adequate oxygen delivery to tissue, resuscitation of critically ill patie... more Background: To maintain adequate oxygen delivery to tissue, resuscitation of critically ill patients is guided by assessing surrogate markers of perfusion. As there is no direct indicator of cerebral perfusion used in routine critical care, identifying an accurate strategy to monitor brain perfusion is paramount. Near-infrared spectroscopy (NIRS) is a non-invasive technique to quantify regional cerebral oxygenation (rSO 2) that has been used for decades during cardiac surgery which has led to targeted algorithms to optimize rSO 2 being developed. However, these targeted algorithms do not exist during critical care, as the physiological determinants of rSO 2 during critical illness remain poorly understood. Materials and methods: This prospective observational study was an exploratory analysis of a nested cohort of patients within the CONFOCAL study (NCT02344043) who received high-fidelity vital sign monitoring. Adult patients (≥ 18 years) admitted < 24 h to a medical/surgical intensive care unit were eligible if they had shock and/or required mechanical ventilation. Patients underwent rSO 2 monitoring with the FORESIGHT oximeter for 24 h, vital signs were concurrently recorded, and clinically ordered arterial blood gas samples and hemoglobin concentration were also documented. Simultaneous multiple linear regression was performed using all available predictors, followed by model selection using the corrected Akaike information criterion (AICc). Results: Our simultaneous multivariate model included age, heart rate, arterial oxygen saturation, mean arterial pressure, pH, partial pressure of oxygen, partial pressure of carbon dioxide (PaCO 2), and hemoglobin concentration. This model accounted for a significant proportion of variance in rSO 2 (R 2 = 0.58, p < 0.01) and was significantly associated with PaCO 2 (p < 0.05) and hemoglobin concentration (p < 0.01). Our selected regression model using AICc accounted for a significant proportion of variance in rSO 2 (R 2 = 0.54, p < 0.01) and was significantly related to age (p < 0.05), PaCO 2 (p < 0.01), hemoglobin (p < 0.01), and heart rate (p < 0.05). Conclusions: Known and established physiological determinants of oxygen delivery accounted for a significant proportion of the rSO 2 signal, which provides evidence that NIRS is a viable modality to assess cerebral oxygenation in critically ill adults. Further elucidation of the determinants of rSO 2 has the potential to develop a NIRS-guided resuscitation algorithm during critical illness.
Journal of neuroengineering and rehabilitation, Jan 31, 2018
The KINARM robot produces a granular dataset of participant performance metrics associated with p... more The KINARM robot produces a granular dataset of participant performance metrics associated with proprioceptive, motor, visuospatial, and executive function. This comprehensive battery includes several behavioral tasks that each generate 9 to 20 metrics of performance. Therefore, the entire battery of tasks generates well over 100 metrics per participant, which can make clinical interpretation challenging. Therefore, we sought to reduce these multivariate data by applying principal component analysis (PCA) to increase interpretability while minimizing information loss. Healthy right-hand dominant participants were assessed using a bilateral KINARM end-point robot. Subjects (Ns = 101-208) were assessed using 6 behavioral tasks and automated software generated 9 to 20 metrics related to the spatial and temporal aspects of subject performance. Data from these metrics were converted to Z-scores prior to PCA. The number of components was determined from scree plots and parallel analysis, ...
Evolutionary psychology : an international journal of evolutionary approaches to psychology and behavior
Humans perceive and treat self-resembling others in ways that suggest that self-resemblance is a ... more Humans perceive and treat self-resembling others in ways that suggest that self-resemblance is a cue of kinship. However, we know little about how individuals respond to treatment by self-resembling others. Here we approach this problem by connecting facial self-resemblance to social rejection. Given that individuals should expect to cooperate with kin, we hypothesized that (1) social inclusion by perceived kin should elicit lesser feelings of rejection and (2) social exclusion by perceived kin should elicit greater feelings of rejection relative to inclusion or exclusion, respectively, by nonkin. To test these hypotheses, we recruited 90 participants to play two games of Cyberball, a virtual ball-tossing game, with separate pairs of ostensible partners. In one game, the ostensible partners were programed to fully include the participants in group play and, in the other game, they were programed to exclude the participants after a few rounds; the order of inclusion and exclusion was...
Researchers have proposed that the emergence of religion was a cultural adaptation necessary for ... more Researchers have proposed that the emergence of religion was a cultural adaptation necessary for promoting self-control. Self-control, in turn, may serve as a psychological pillar supporting a myriad of adaptive psychological and behavioral tendencies. If this proposal is true, then subtle reminders of religious concepts should result in higher levels of self-control. In a series of four experiments, we consistently found that when religious themes were made implicitly salient, people exercised greater self-control, which, in turn, augmented their ability to make decisions in a number of behavioral domains that are theoretically relevant to both major religions and humans’ evolutionary success. Furthermore, when self-control resources were minimized, making it difficult for people to exercise restraint on future unrelated self-control tasks, we found that implicit reminders of religious concepts refueled people’s ability to exercise self-control. Moreover, compared with morality- or...
Two studies examined the impact of trait and category diagnosticity on the social information pro... more Two studies examined the impact of trait and category diagnosticity on the social information processing of depressed and non-depressed participants. As suggested by the Weary, Marsh, Gleicher, and Edwards model of the effects of depression on social information processing, it was predicted that depressed participants would be especially sensitive to the diagnosticity of the available information when forming an impression of another person. In Study 1, depressed participants were more sensitive than nondepressed participants to trait diagnosticity when forming an impression. In Study 2, depressed participants were more sensitive than nondepressed participants to both trait and category diagnosticity when forming an impression.
This study describes longitudinal changes in the composition and accuracy of modal life-sustainin... more This study describes longitudinal changes in the composition and accuracy of modal life-sustaining treatment preferences as predictors of patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; treatment preferences. Healthy outpatients age 65 and older and their surrogate decision makers recorded preferences for 4 treatments in 9 hypothetical illness scenarios 3 times over a period of 2 years. A statistical prediction model, based on patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; modal preferences, was created using initial responses and updated 2 years later. When reestimating the model at 2 years, 4 of 27 items in the model created using baseline responses no longer reached the threshold for inclusion, but 5 new items did meet criteria. All modal preference changes reflected a trend toward refusing treatment. Both the original and updated models were more accurate in predicting patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; preferences than were surrogates making concurrent predictions. Adding covariates (e.g., gender, age, presence of plans for future medical care) did not alter the model&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s predictive superiority over surrogates. Models using modal preferences are useful to patients, surrogates, and physicians when trying to accurately discern end-of-life treatment choices, but the models must be updated periodically.
Objective.Policy and law encouraging individuals to document their wishes for life-sustaining med... more Objective.Policy and law encouraging individuals to document their wishes for life-sustaining medical treatment in advance of serious illness assumes that these wishes are unaffected by changes in health condition. To test this assumption, the authors examine the life-sustaining treatment preferences of a sample of elderly adults prior to, soon after, and several months after a hospitalization experience. Subjects and Methods. As part of the Advance Directives, Values Assessment, and Communication Enhancement (ADVANCE) project, 401 individuals older than age 65 participated in 3 annual interviews. A subsample of 88 individuals who were hospitalized for greater than 48 hours during the course of the study participated in an additional “recovery” interview conducted soon after their release from the hospital (M = 14 days postdischarge). At each interview, subjects indicated their desire to receive 4 life-sustaining medical treatments in 4 serious illness scenarios. Results. Treatment ...
Visceral cues indicating proximity to objects of desire can lead people to be disproportionately ... more Visceral cues indicating proximity to objects of desire can lead people to be disproportionately influenced by the anticipated rewards of immediate gratification rather than the risks of consummatory behavior. Two studies examined this hypothesis. In Study 1, participants were given the choice of playing a game in which they risked time in the lab to win chocolate chip cookies. Participants who could see and smell the cookies while they made their decision were less sensitive to risk information than were participants for whom the cookies were merely described. In Study 2, male condom users either saw a video or read a description depicting a young couple deciding whether to have sex without a condom. Participants seeing the video expressed a greater likelihood of having unprotected sex in the situation than did participants reading the description. The underappreciated role of visceral factors in social cognition theory and research is discussed.
Background: Depression is associated with profound impairments in social functioning. Past resear... more Background: Depression is associated with profound impairments in social functioning. Past research and theory suggests that these impairments may be related to a difficulty in the ability of depressed individuals to identify and decode others' social cues. However, the nature of this difficulty is equivocal. This investigation is the first to adopt a theory-of-mind framework to examine unipolar depressed individuals' ability to identify complex mental states from eye expressions. Methods: Women with unipolar clinical depression (N = 52) and nondepressed controls (N = 30) completed the bReading the Mind in the Eyes TaskQ (Baron
Objective: To examine people's false memories for end-of-life decisions. Design: In Study 1, olde... more Objective: To examine people's false memories for end-of-life decisions. Design: In Study 1, older adults decided which life-sustaining treatments they would want if they were seriously ill. They made these judgments twice, approximately 12 months apart. At Time 2, older adults and their self-selected surrogate decision makers tried to recall the older adults' Time 1 decisions. In Study 2, younger adults made treatment decisions twice, approximately 4 months apart. At Time 2, younger adults tried to recall their Time 1 decisions. Main Outcome Measures: Percentage of participants who falsely remembered that their original treatment decisions were the same as their current decisions. Results: In Study 1, older adults falsely remembered that 75% of their original decisions were the same as their current decisions; surrogates falsely thought that 86% of older adults' decisions were the same. In Study 2, younger adults falsely remembered that 69% of their original decisions were the same as their current decisions. Conclusion: Age alone cannot account for people's false memories of their end-of-life decisions; we discuss other mechanisms. The results have practical implications for policies that encourage people to make legal documents specifying their end-of-life treatment decisions.
The use of instructional advance directives assumes that preferences for life-sustaining medical ... more The use of instructional advance directives assumes that preferences for life-sustaining medical treatment remain stable over time and across changes in life condition. A sample of 332 older adults recorded their preferences for 4 life-sustaining treatments in 9 illness scenarios. These preferences were elicited again 1 and 2 years after the original interview. Overall, preferences for life-sustaining treatment were moderately stable over time, but stability varied significantly across judgments. Preferences were most stable for illness scenarios that were most and least serious and for decisions to refuse treatment. Age, gender, education, and prior completion of an advance directive were all related to preference stability, and evidence indicated that declines in physical or psychological functioning resulted in decreased interest in life-sustaining treatment.
... Based on the discussion of the two concepts thus far, it should be clear that causal uncertai... more ... Based on the discussion of the two concepts thus far, it should be clear that causal uncertainty and depressive predictive certainty differ in their proposed roles within the larger nomological network of depression. Of these two ...
Background: To maintain adequate oxygen delivery to tissue, resuscitation of critically ill patie... more Background: To maintain adequate oxygen delivery to tissue, resuscitation of critically ill patients is guided by assessing surrogate markers of perfusion. As there is no direct indicator of cerebral perfusion used in routine critical care, identifying an accurate strategy to monitor brain perfusion is paramount. Near-infrared spectroscopy (NIRS) is a non-invasive technique to quantify regional cerebral oxygenation (rSO 2) that has been used for decades during cardiac surgery which has led to targeted algorithms to optimize rSO 2 being developed. However, these targeted algorithms do not exist during critical care, as the physiological determinants of rSO 2 during critical illness remain poorly understood. Materials and methods: This prospective observational study was an exploratory analysis of a nested cohort of patients within the CONFOCAL study (NCT02344043) who received high-fidelity vital sign monitoring. Adult patients (≥ 18 years) admitted < 24 h to a medical/surgical intensive care unit were eligible if they had shock and/or required mechanical ventilation. Patients underwent rSO 2 monitoring with the FORESIGHT oximeter for 24 h, vital signs were concurrently recorded, and clinically ordered arterial blood gas samples and hemoglobin concentration were also documented. Simultaneous multiple linear regression was performed using all available predictors, followed by model selection using the corrected Akaike information criterion (AICc). Results: Our simultaneous multivariate model included age, heart rate, arterial oxygen saturation, mean arterial pressure, pH, partial pressure of oxygen, partial pressure of carbon dioxide (PaCO 2), and hemoglobin concentration. This model accounted for a significant proportion of variance in rSO 2 (R 2 = 0.58, p < 0.01) and was significantly associated with PaCO 2 (p < 0.05) and hemoglobin concentration (p < 0.01). Our selected regression model using AICc accounted for a significant proportion of variance in rSO 2 (R 2 = 0.54, p < 0.01) and was significantly related to age (p < 0.05), PaCO 2 (p < 0.01), hemoglobin (p < 0.01), and heart rate (p < 0.05). Conclusions: Known and established physiological determinants of oxygen delivery accounted for a significant proportion of the rSO 2 signal, which provides evidence that NIRS is a viable modality to assess cerebral oxygenation in critically ill adults. Further elucidation of the determinants of rSO 2 has the potential to develop a NIRS-guided resuscitation algorithm during critical illness.
Journal of neuroengineering and rehabilitation, Jan 31, 2018
The KINARM robot produces a granular dataset of participant performance metrics associated with p... more The KINARM robot produces a granular dataset of participant performance metrics associated with proprioceptive, motor, visuospatial, and executive function. This comprehensive battery includes several behavioral tasks that each generate 9 to 20 metrics of performance. Therefore, the entire battery of tasks generates well over 100 metrics per participant, which can make clinical interpretation challenging. Therefore, we sought to reduce these multivariate data by applying principal component analysis (PCA) to increase interpretability while minimizing information loss. Healthy right-hand dominant participants were assessed using a bilateral KINARM end-point robot. Subjects (Ns = 101-208) were assessed using 6 behavioral tasks and automated software generated 9 to 20 metrics related to the spatial and temporal aspects of subject performance. Data from these metrics were converted to Z-scores prior to PCA. The number of components was determined from scree plots and parallel analysis, ...
Evolutionary psychology : an international journal of evolutionary approaches to psychology and behavior
Humans perceive and treat self-resembling others in ways that suggest that self-resemblance is a ... more Humans perceive and treat self-resembling others in ways that suggest that self-resemblance is a cue of kinship. However, we know little about how individuals respond to treatment by self-resembling others. Here we approach this problem by connecting facial self-resemblance to social rejection. Given that individuals should expect to cooperate with kin, we hypothesized that (1) social inclusion by perceived kin should elicit lesser feelings of rejection and (2) social exclusion by perceived kin should elicit greater feelings of rejection relative to inclusion or exclusion, respectively, by nonkin. To test these hypotheses, we recruited 90 participants to play two games of Cyberball, a virtual ball-tossing game, with separate pairs of ostensible partners. In one game, the ostensible partners were programed to fully include the participants in group play and, in the other game, they were programed to exclude the participants after a few rounds; the order of inclusion and exclusion was...
Researchers have proposed that the emergence of religion was a cultural adaptation necessary for ... more Researchers have proposed that the emergence of religion was a cultural adaptation necessary for promoting self-control. Self-control, in turn, may serve as a psychological pillar supporting a myriad of adaptive psychological and behavioral tendencies. If this proposal is true, then subtle reminders of religious concepts should result in higher levels of self-control. In a series of four experiments, we consistently found that when religious themes were made implicitly salient, people exercised greater self-control, which, in turn, augmented their ability to make decisions in a number of behavioral domains that are theoretically relevant to both major religions and humans’ evolutionary success. Furthermore, when self-control resources were minimized, making it difficult for people to exercise restraint on future unrelated self-control tasks, we found that implicit reminders of religious concepts refueled people’s ability to exercise self-control. Moreover, compared with morality- or...
Two studies examined the impact of trait and category diagnosticity on the social information pro... more Two studies examined the impact of trait and category diagnosticity on the social information processing of depressed and non-depressed participants. As suggested by the Weary, Marsh, Gleicher, and Edwards model of the effects of depression on social information processing, it was predicted that depressed participants would be especially sensitive to the diagnosticity of the available information when forming an impression of another person. In Study 1, depressed participants were more sensitive than nondepressed participants to trait diagnosticity when forming an impression. In Study 2, depressed participants were more sensitive than nondepressed participants to both trait and category diagnosticity when forming an impression.
This study describes longitudinal changes in the composition and accuracy of modal life-sustainin... more This study describes longitudinal changes in the composition and accuracy of modal life-sustaining treatment preferences as predictors of patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; treatment preferences. Healthy outpatients age 65 and older and their surrogate decision makers recorded preferences for 4 treatments in 9 hypothetical illness scenarios 3 times over a period of 2 years. A statistical prediction model, based on patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; modal preferences, was created using initial responses and updated 2 years later. When reestimating the model at 2 years, 4 of 27 items in the model created using baseline responses no longer reached the threshold for inclusion, but 5 new items did meet criteria. All modal preference changes reflected a trend toward refusing treatment. Both the original and updated models were more accurate in predicting patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; preferences than were surrogates making concurrent predictions. Adding covariates (e.g., gender, age, presence of plans for future medical care) did not alter the model&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s predictive superiority over surrogates. Models using modal preferences are useful to patients, surrogates, and physicians when trying to accurately discern end-of-life treatment choices, but the models must be updated periodically.
Objective.Policy and law encouraging individuals to document their wishes for life-sustaining med... more Objective.Policy and law encouraging individuals to document their wishes for life-sustaining medical treatment in advance of serious illness assumes that these wishes are unaffected by changes in health condition. To test this assumption, the authors examine the life-sustaining treatment preferences of a sample of elderly adults prior to, soon after, and several months after a hospitalization experience. Subjects and Methods. As part of the Advance Directives, Values Assessment, and Communication Enhancement (ADVANCE) project, 401 individuals older than age 65 participated in 3 annual interviews. A subsample of 88 individuals who were hospitalized for greater than 48 hours during the course of the study participated in an additional “recovery” interview conducted soon after their release from the hospital (M = 14 days postdischarge). At each interview, subjects indicated their desire to receive 4 life-sustaining medical treatments in 4 serious illness scenarios. Results. Treatment ...
Visceral cues indicating proximity to objects of desire can lead people to be disproportionately ... more Visceral cues indicating proximity to objects of desire can lead people to be disproportionately influenced by the anticipated rewards of immediate gratification rather than the risks of consummatory behavior. Two studies examined this hypothesis. In Study 1, participants were given the choice of playing a game in which they risked time in the lab to win chocolate chip cookies. Participants who could see and smell the cookies while they made their decision were less sensitive to risk information than were participants for whom the cookies were merely described. In Study 2, male condom users either saw a video or read a description depicting a young couple deciding whether to have sex without a condom. Participants seeing the video expressed a greater likelihood of having unprotected sex in the situation than did participants reading the description. The underappreciated role of visceral factors in social cognition theory and research is discussed.
Background: Depression is associated with profound impairments in social functioning. Past resear... more Background: Depression is associated with profound impairments in social functioning. Past research and theory suggests that these impairments may be related to a difficulty in the ability of depressed individuals to identify and decode others' social cues. However, the nature of this difficulty is equivocal. This investigation is the first to adopt a theory-of-mind framework to examine unipolar depressed individuals' ability to identify complex mental states from eye expressions. Methods: Women with unipolar clinical depression (N = 52) and nondepressed controls (N = 30) completed the bReading the Mind in the Eyes TaskQ (Baron
Objective: To examine people's false memories for end-of-life decisions. Design: In Study 1, olde... more Objective: To examine people's false memories for end-of-life decisions. Design: In Study 1, older adults decided which life-sustaining treatments they would want if they were seriously ill. They made these judgments twice, approximately 12 months apart. At Time 2, older adults and their self-selected surrogate decision makers tried to recall the older adults' Time 1 decisions. In Study 2, younger adults made treatment decisions twice, approximately 4 months apart. At Time 2, younger adults tried to recall their Time 1 decisions. Main Outcome Measures: Percentage of participants who falsely remembered that their original treatment decisions were the same as their current decisions. Results: In Study 1, older adults falsely remembered that 75% of their original decisions were the same as their current decisions; surrogates falsely thought that 86% of older adults' decisions were the same. In Study 2, younger adults falsely remembered that 69% of their original decisions were the same as their current decisions. Conclusion: Age alone cannot account for people's false memories of their end-of-life decisions; we discuss other mechanisms. The results have practical implications for policies that encourage people to make legal documents specifying their end-of-life treatment decisions.
The use of instructional advance directives assumes that preferences for life-sustaining medical ... more The use of instructional advance directives assumes that preferences for life-sustaining medical treatment remain stable over time and across changes in life condition. A sample of 332 older adults recorded their preferences for 4 life-sustaining treatments in 9 illness scenarios. These preferences were elicited again 1 and 2 years after the original interview. Overall, preferences for life-sustaining treatment were moderately stable over time, but stability varied significantly across judgments. Preferences were most stable for illness scenarios that were most and least serious and for decisions to refuse treatment. Age, gender, education, and prior completion of an advance directive were all related to preference stability, and evidence indicated that declines in physical or psychological functioning resulted in decreased interest in life-sustaining treatment.
... Based on the discussion of the two concepts thus far, it should be clear that causal uncertai... more ... Based on the discussion of the two concepts thus far, it should be clear that causal uncertainty and depressive predictive certainty differ in their proposed roles within the larger nomological network of depression. Of these two ...
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Papers by Jill Jacobson