Adapting Ourselves, Instead of the Environment: An Inquiry into Human Enhancement for Function and Beyond

Technology enables humans not only to adapt their environment to their needs but also to modify themselves. Means of Human Enhancement - embodied technologies to improve the human body's capabilities or to create a new one - are the designated means of adapting ourselves instead of the environment. The debate about these technologies is typically fought on ethical soil. However, alarmist, utopian, and science fiction scenarios distract from the fact that Human Enhancement is a historical and pervasive phenomenon incorporated into many everyday practices. In the vein of disentangling conceptual difficulties, we claim that means of Human Enhancement are either physiologically or psychologically embodied, rendering the merging with the human user their most defining aspect. To fulfill its purpose, an enhancement must pass the test-in-the-world, i.e., assisting with effective engagement with a dynamic world. Even if failing in this regard: Human Enhancement is the fundamental and semi-targeted process of changing the users relationship with the world through the physical or psychological embodiment of a hitherto external object and/or change of one's body. This can potentially change the notion of being human. Drawing on a rich body of theoretical and empirical literature, we aim to provide a nuanced analysis of the transformative nature of this phenomenon in close proximity to human practice. Stakeholders are invited to apply the theory presented here to interrogate their perspective on technology in general and Human Enhancement in particular.

A Precarious Path to Partnership? The Moderating Effects of Labour Market Regulations on the Relationship Between Unstable Employment and Union Formation in Europe

Rising employment uncertainty featured by higher risks of being temporarily employed or unemployed is often seen as the driving force behind delayed and declined partnering in Western countries. However, such an employment-partnering relationship is contextualized by labour market institutions and thus could diverge across countries over time. This paper aims to investigate how country-level variations in labour market regulations moderate individual-level effects of unstable employment on union formation, including the transitions into marriage or cohabitation unions. Using comparative panel data for 26 countries from the European Union Statistics on Income and Living Conditions (the years 2010-2019), our multilevel fixed effects models showed that temporary employment and unemployment negatively affected the probability of union formation for single women and men in Europe. Moreover, the negative relationship between unstable employment and union formation was reinforced when labour market reforms were stimulating insider-outsider segregations or decreasing welfare provisions. Specifically, stricter employment protection legislations and higher coverage rates of collective bargaining agreements could reinforce the negative effects of temporary employment and unemployment on union formation, while more generous provisions of unemployment benefits could buffer such negative effects.

Improving hand hygiene of young children with a digital intervention: a cluster-randomised controlled field trial

Contagious diseases that affect young children place a great burden on them and their families. Proper hand hygiene is an important measure to reduce the disease burden, however, its implementation in day care centres is challenging. This paper introduces a digital intervention to support independent and good handwashing among young children. The intervention leverages animated instructions triggered by water and soap use, together with a symbolic reward shown to children on a screen during and immediately after handwashing. We tested the intervention in a pre-registered, cluster-randomised controlled field trial in 4 day care centres in Finland and Germany with 162 children over 42 days. The intervention increased soaping time, used as a proxy for handwashing quality, by 5.30 s (+ 62%, p < 0.001). The effect occurs immediately at the onset of the intervention and is maintained throughout the intervention phase.

Explaining improvement in diabetes distress: a longitudinal analysis of the predictive relevance of resilience and acceptance in people with type 1 diabetes

AIMS

To analyze if midterm improvement in diabetes distress can be explained by resilience, diabetes acceptance, and patient characteristics.

METHODS

N = 179 adults with type 1 diabetes were enrolled during their stay at a tertiary diabetes center (monocentric enrolment) and followed up over three months in a prospective, observational study ('DIA-LINK1'). Improvement in diabetes distress was assessed as reduction in the Problem Areas in Diabetes Scale score from baseline to follow-up. Resilience (Resilience Scale-13), acceptance (Diabetes Acceptance Scale), and patient characteristics were analyzed as predictors of improvement in diabetes distress using hierarchical multiple regression.

RESULTS

Greater reductions in diabetes distress were significantly explained by lower diabetes acceptance at baseline (β = -0.34, p < 0.01), while resilience, diabetes complications, and other person-related variables were not significantly related to changes in diabetes distress (all p > 0.05). When change in diabetes acceptance from baseline to follow-up was added to the model, improved diabetes distress was explained by increasing diabetes acceptance (β = 0.41, p < 0.01) and a shorter duration of diabetes (β = -0.18, p = 0.03), while baseline diabetes acceptance was no longer significantly associated (β = -0.14, p > 0.05).

CONCLUSIONS

Diabetes acceptance is inversely related to diabetes distress, and increasing acceptance explained greater improvement in diabetes distress. These findings suggest that increasing diabetes acceptance may facilitate the reduction of diabetes distress. Treatment approaches targeting acceptance might be useful for the mental healthcare of people with type 1 diabetes and clinically elevated diabetes distress.

Health inequalities among young workers: the mediating role of working conditions and company characteristics

OBJECTIVE

Few studies have investigated health inequalities among young workers. The objectives of this study are to assess the extent of health inequalities in a sample of job starters and to explore the contribution of job demands and organisational factors.

METHODS

We analyze data from the BIBB/BAuA Youth Employment Survey 2012. The cross-sectional survey includes a representative sample of 3214 German employees, apprentices, and trainees aged 15-24 years. Individuals were grouped by their years of schooling into low (< 12 years) and high levels of education (≥ 12 years). Regression analysis estimated the link between education and four health outcomes: self-rated health, number of health events, musculoskeletal symptoms, and mental health problems over the last 12 months. Counterfactual mediation analysis tested for indirect effects of education via working conditions (i.e., physical and psychosocial job demands) and company characteristics (i.e., company size, health prevention measures, financial situation, downsizing). All analyses were adjusted for age, sex, nationality, region, working hours, job tenure, employment relationship, and economic sector.

RESULTS

Highly educated workers reported better self-rated health (b = 0.24, 95% CI 0.18-0.31) and lower numbers of health events (Rate Ratio (RR) = 0.74, 95% CI 0.67-0.82), musculoskeletal symptoms (RR = 0.73, 95% CI 0.66-0.80) and mental health problems (RR = 0.84, 95% CI 0.76-0.93). Total job demands explained between 21.6% and 87.2% of the educational differences (depending on health outcome). Unfavourable company characteristics were associated with worse health, but showed no or only small mediation effects.

CONCLUSIONS

Health inequalities are already present at the early working career due to socio-economically stratified working hazards. To enhance prevention measures that aim at reducing inequalities in workplace health, we propose shifting attention towards earlier stages of life.

Adolescent leisure reading and its longitudinal association with prosocial behavior and social adjustment

Reading is a popular leisure activity for children, teenagers, and adults. Several theories agree that reading might improve social cognition, but the empirical evidence remains tentative, with research on adolescents especially lacking. We employed a very large, and nationally representative, longitudinal dataset from the National Educational Panel Study (NEPS) in Germany to examine this hypothesis. Specifically, we tested whether reading prospectively predicted future self-reported prosocial behavior and social adjustment in adolescents, controlling for a number of covariates. Two-way cross-lagged panel analyses probed the longitudinal relationship between leisure reading and these social outcomes from Grade 6 to Grade 9. In addition, we examined the effect of cumulative reading experience across Grades 5-8 on future social outcomes, using structural equation modeling. We also explored the unique contributions of cumulative reading experience in different literary genres (classic literature, popular literature, nonfiction, comic books). Cumulative reading in general did not predict future prosocial behavior and social adjustment. However, cumulative reading of modern classic literature was positively associated with later prosocial behavior and social adjustment. PROTOCOL REGISTRATION: The stage 1 protocol for this Registered Report was accepted in principle on 08 November 2021. The protocol, as accepted by the journal, can be found at: https://doi.org/10.17605/OSF.IO/KSWY7 .

Lying on the Dissection Table: Anatomizing Faked Responses

Research has shown that even experts cannot detect faking above chance, but recent studies have suggested that machine learning may help in this endeavor. However, faking differs between faking conditions, previous efforts have not taken these differences into account, and faking indices have yet to be integrated into such approaches. We reanalyzed seven data sets (N = 1,039) with various faking conditions (high and low scores, different constructs, naïve and informed faking, faking with and without practice, different measures [self-reports vs. implicit association tests; IATs]). We investigated the extent to which and how machine learning classifiers could detect faking under these conditions and compared different input data (response patterns, scores, faking indices) and different classifiers (logistic regression, random forest, XGBoost). We also explored the features that classifiers used for detection. Our results show that machine learning has the potential to detect faking, but detection success varies between conditions from chance levels to 100%. There were differences in detection (e.g., detecting low-score faking was better than detecting high-score faking). For self-reports, response patterns and scores were comparable with regard to faking detection, whereas for IATs, faking indices and response patterns were superior to scores. Logistic regression and random forest worked about equally well and outperformed XGBoost. In most cases, classifiers used more than one feature (faking occurred over different pathways), and the features varied in their relevance. Our research supports the assumption of different faking processes and explains why detecting faking is a complex endeavor.

Coordination of glucose monitoring, self-care behaviour and mental health: achieving precision monitoring in diabetes

Monitoring of glucose plays an essential role in the management of diabetes. However, to fully understand and meaningfully interpret glucose levels, additional information on context is necessary. Important contextual factors include data on behaviours such as eating, exercise, medication-taking and sleep, as well as data on mental health aspects such as stress, affect, diabetes distress and depressive symptoms. This narrative review provides an overview of the current state and future directions of precision monitoring in diabetes. Precision monitoring of glucose has made great progress over the last 5 years with the emergence of continuous glucose monitoring (CGM), automated analysis of new glucose variables and visualisation of CGM data via the ambulatory glucose profile. Interestingly, there has been little progress in the identification of subgroups of people with diabetes based on their glycaemic profile. The integration of behavioural and mental health data could enrich such identification of subgroups to stimulate precision medicine. There are a handful of studies that have used innovative methodology such as ecological momentary assessment to monitor behaviour and mental health in people's everyday life. These studies indicate the importance of the interplay between behaviour, mental health and glucose. However, automated integration and intelligent interpretation of these data sources are currently not available. Automated integration of behaviour, mental health and glucose could lead to the identification of certain subgroups that, for example, show a strong association between mental health and glucose in contrast to subgroups that show independence of mental health and glucose. This could inform precision diagnostics and precision therapeutics. We identified just-in-time adaptive interventions as a potential means by which precision monitoring could lead to precision therapeutics. Just-in-time adaptive interventions consist of micro-interventions that are triggered in people's everyday lives when a certain problem is identified using monitored behaviour, mental health and glucose variables. Thus, these micro-interventions are responsive to real-life circumstances and are adaptive to the specific needs of an individual with diabetes. We conclude that, with current developments in big data analysis, there is a huge potential for precision monitoring in diabetes.

Eine hohe Lebensqualität reduziert depressive Symptome von Maßregelvollzugspatientinnen und -patienten

Einleitung

Die restriktiven Unterbringungsbedingungen im Maßregelvollzug beeinflussen die Lebensqualität und Depressivität der Untergebrachten und damit die psychische Gesundheit und den Behandlungserfolg therapeutischer Maßnahmen.

Ziele

Ziel der Arbeit ist es, eine Übersicht über die Lebensqualität und die Belastung durch depressive Symptome aus Patientensicht zu erhalten. Es soll analysiert werden, welche Bereiche der Lebensqualität im Zusammenhang mit Depressivität stehen, und ob die Dauer der Maßregel Einfluss auf die Depressivität der Untergebrachten nimmt.

Methode

Die Lebensqualität wurde mittels einer an die Gegebenheiten des Maßregelvollzugs adaptierten Version des Fragebogens Measuring the Quality of Prison Life (MQPL) erhoben. Depressivität wurde anhand der Allgemeinen Depressionsskala (ADS) erfragt. Insgesamt nahmen N = 73 Personen an der Studie teil.

Ergebnisse

Die Lebensqualität wurde im Mittel als positiv bewertet. Am höchsten wurde die Beziehung zum therapeutischen Personal eingeschätzt. Es zeigten sich signifikante Unterschiede in der Lebensqualität zwischen depressiv auffälligen und nichtauffälligen Untergebrachten. Die Dauer der Unterbringung war signifikanter Prädiktor für die Depressionswerte suchterkrankter Untergebrachter.

Fazit

Lebensqualität und Depressivität stehen in signifikant negativem Zusammenhang. Zur Verbesserung der Unterbringungs- und Versorgungsqualität sollte das Klinikpersonal die Lebensqualität der Untergebrachten in den identifizierten Bereichen bestmöglich fördern und besonders zum Aufnahmezeitpunkt sowie bei längeren Behandlungsdauern depressive Symptome identifizieren und behandeln. Hierbei sollte ein Augenmerk auf das Erreichen einer stabilen therapeutischen Allianz gelegt werden.

Home learning environment and out-of-home activities: their relations to prosocial behaviour and peer relationships in primary school children

There is consensus that child socio-emotional development is influenced by various contexts, such as the family one. Research on influencing factors on child socio-emotional skills mainly investigated the effects of home learning environment, whereas the effects of out-of-home activities were often analysed mainly in samples of adolescents. The present study aimed to shed light on effects of preschool home learning environment and out-of-home activities on two facets of socio-emotional skills at the beginning of primary school: Prosocial behaviour and peer relationships. The information on the child prosocial behaviour and peer relationships at preschool age was included with the aim to control for most of the differences across children. Using data from a large sample of children (N = 1,818; M age = 7.08 years, SD = 0.15; 49.9% girls), results of regression analyses show significant effects of out-of-home activities on prosocial behaviour after controlling a range of child- and family-related influencing factors on prosocial behaviour as well as prosocial behaviour at preschool age. The effects of home learning environment were significant after controlling a range of child- and family-related influencing factors on both facets of socio-emotional skills but became nonsignificant after taking into account respective behaviour at preschool age. The results of the present study suggest that fostering participation in out-of-home activities might contribute to an increase of prosocial behaviour in primary school children.

When perception is stronger than physics: Perceptual similarities rather than laws of physics govern the perception of interacting objects

When several multistable displays are viewed simultaneously, their perception is synchronized, as they tend to be in the same perceptual state. Here, we investigated the possibility that perception may reflect embedded statistical knowledge of physical interaction between objects for specific combinations of displays and layouts. We used a novel display with two ambiguously rotating gears and an ambiguous walker-on-a-ball display. Both stimuli produce a physically congruent perception when an interaction is possible (i.e., gears counterrotate, and the ball rolls under the walker's feet). Next, we gradually manipulated the stimuli to either introduce abrupt changes to the potential physical interaction between objects or keep it constant despite changes in the visual stimulus. We characterized the data using four different models that assumed (1) independence of perception of the stimulus, (2) dependence on the stimulus's properties, (3) dependence on physical configuration alone, and (4) an interaction between stimulus properties and a physical configuration. We observed that for the ambiguous gears, the perception was correlated with the stimulus changes rather than with the possibility of physical interaction. The perception of walker-on-a-ball was independent of the stimulus but depended instead on whether participants responded about a relative motion of two objects (perception was biased towards physically congruent motion) or the absolute motion of the walker alone (perception was independent of the rotation of the ball). None of the two experiments supported the idea of embedded knowledge of physical interaction.

Mobile Heart Rate Variability Biofeedback as a Complementary Intervention After Myocardial Infarction: a Randomized Controlled Study

BACKGROUND

To enhance effective prevention programs after myocardial infarction (MI), the study examined the effects and feasibility of mobile biofeedback training on heart rate variability (HRV-BF).

METHODS

Forty-six outpatients aged 41 to 79 years with a documented MI were randomized to HRV-BF versus usual care. Generalized estimating equation (GEE) analyses were performed to test improvements in measures of short- and long-time HRV, namely, the standard deviation of the normal-to-normal intervals (SDNN) and well-being after 12 weeks of HRV-BF.

RESULTS

There were intervention effects for short-time HRV (d > 0.4, p < 0.04), which were partly replicated in the GEE models that accounted for control variables: In the HRV-BF group, the high-frequency HRV (group × time interaction: β = 0.59, p = 0.04) compensated for significantly lower baseline levels than the group with usual care. In an optimal dose sample (on average two HRV-BF sessions a day), SDNN significantly increased after HRV-BF (p = 0.002) but not in the waitlist control group. Compensatory trends of HRV-BF were also found for high-frequency HRV and self-efficacy. No adverse effects of the intervention were found but neither were effects on long-time HRV measures.

CONCLUSION

The results showed the feasibility of self-guided HRV-BF for almost all post-MI patients. HRV-BF as an adjunctive behavioral treatment increased HRV, which is an indicator of lower cardiovascular risk, and self-efficacy, which suggests heightened psychological resilience. These benefits warrant confirmation and tests of sustainability in larger studies.

TRIAL REGISTRATION

The trial has not been registered due to its starting point in 2017 predating the publication of the applicable CONSORT extension for reporting social and psychological intervention trials in 2018.

[Longer Unemployment Insurance Benefits in Times of Crisis? Covid-19 and the Appropriate Maximum Benefit Duration]

This article deals with the question of which unemployment benefit durations are considered fair for which groups. In addition, it examines the extent to which individuals consider longer unemployment insurance benefit durations to be appropriate in times of economic crisis, such as the current situation during the Covid-19 pandemic. Longer reference periods can stabilize the income situation of benefit recipients and can provide time to search for an adequate job and thus increase matching quality. However, they also initially reduce the pressure to look for a job, and they lengthen the period of unemployment in the longer term. Using survey data from two online surveys done in November 2019 and during the crisis in May 2020, we examine which unemployment benefit durations employees consider appropriate. For this purpose, we presented vignettes to the survey participants describing hypothetical unemployed people whose characteristics varied randomly. The results show that the same respondents considered similar reference periods to be appropriate at both dates. In addition, the respondents took into account criteria of contribution as well as neediness when assessing the appropriate duration of benefits for the unemployed. Characteristics such as the age of the unemployed and any existing culpability, life benefits, or contribution periods influenced the duration of the benefit receipt that respondents judged to be appropriate.

A pragmatic randomised controlled trial referring to a Personalised Self-management SUPport Programme (P-SUP) for persons enrolled in a disease management programme for type 2 diabetes mellitus and/or for coronary heart disease

BACKGROUND

Type 2 diabetes mellitus (T2DM) and coronary heart disease (CHD) are two chronic diseases that cause a tremendous burden. To reduce this burden, several programmes for optimising the care for these diseases have been developed. In Germany, so-called disease management programmes (DMPs), which combine components of Disease Management and the Chronic Care Model, are applied. These DMPs have proven effective. Nevertheless, there are opportunities for improvement. Current DMPs rarely address self-management of the disease, make no use of peer support, and provide no special assistance for persons with low health literacy and/or low patient activation. The study protocol presented here is for the evaluation of a programme that addresses these possible shortcomings and can be combined with current German DMPs for T2DM and CHD. This programme consists of four components: 1) Meetings of peer support groups 2) Personalised telephone-based health coaching for patients with low literacy and/or low patient activation 3) Personalised patient feedback 4) A browser-based web portal METHODS: Study participants will be adults enrolled in a DMP for T2DM and/or CHD and living in North Rhine-Westphalia, a state of the Federal Republic of Germany. Study participants will be recruited with the assistance of their general practitioners by the end of June 2021. Evaluation will be performed as a pragmatic randomised controlled trial with one intervention group and one waiting control group. The intervention group will receive the intervention for 18 months. During this time, the waiting control group will continue with usual care and the usual measures of their DMPs. After 18 months, the waiting control group will also receive a shortened intervention. The primary outcome is number of hospital days. In addition, the effects on self-reported health-state, physical activity, nutrition, and eight different psychological variables will be investigated. Differences between values at month 18 and at the beginning will be compared to judge the effectiveness of the intervention.

DISCUSSION

If the intervention proves effective, it may be included into the DMPs for T2DM and CHD.

TRIAL REGISTRATION

The study was registered in the German Clinical Trials Registry (Deutsches Register Klinischer Studien (DRKS)) in early 2019 under the number 00020592. This registry has been affiliated with the WHO Clinical Trials Network ( https://www.drks.de/drks_web/setLocale_EN.do ) since 2008. It is based on the WHO template, but contains some additional categories for which information has to be given ( https://www.drks.de/drks_web/navigate.do?navigationId=entryfields&messageDE=Beschreibung%20der%20Eingabefelder&messageEN=Description%20of%20entry%20fields ). A release and subsequent number assignment only take place when information for all categories has been given.

Mental health prevalence and predictors among university students in nine countries during the COVID-19 pandemic: a cross-national study

The student population has been highly vulnerable to the risk of mental health deterioration during the coronavirus disease (COVID-19) pandemic. This study aimed to reveal the prevalence and predictors of mental health among students in Poland, Slovenia, Czechia, Ukraine, Russia, Germany, Turkey, Israel, and Colombia in a socioeconomic context during the COVID-19 pandemic. The study was conducted among 2349 students (69% women) from May-July 2020. Data were collected by means of the Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-8), Perceived Stress Scale (PSS-10), Gender Inequality Index (GII), Standard & Poor's Global Ratings, the Oxford COVID-19 Government Response Tracker (OxCGRT), and a sociodemographic survey. Descriptive statistics and Bayesian multilevel skew-normal regression analyses were conducted. The prevalence of high stress, depression, and generalized anxiety symptoms in the total sample was 61.30%, 40.3%, and 30%, respectively. The multilevel Bayesian model showed that female sex was a credible predictor of PSS-10, GAD-7, and PHQ-8 scores. In addition, place of residence (town) and educational level (first-cycle studies) were risk factors for the PHQ-8. This study showed that mental health issues are alarming in the student population. Regular psychological support should be provided to students by universities.

Vaccination against SARS-CoV-2: a human enhancement story

BACKGROUND

Vaccination is an essential strategy for mitigating the COVID-19 pandemic. Besides its significance as a public health measure, vaccination is a sophisticated example of modern biotechnology. Since vaccination gives the human body an ability that it does not naturally possess, the question arises as to its classification as Human Enhancement.

MAIN BODY

Exemplified on a selection of different definitions, we conclude that vaccinations may indeed be classified and treated as a form of Human Enhancement. This raises some ethical issues that are notorious in the broad field of Human Enhancement. A study with N = 67 participants revealed that vaccinations are perceived neither as a clear nor poor example of Human Enhancement.

CONCLUSION

 We argue that qualifying vaccination technology as Human Enhancement does not provide convincing arguments to reject vaccination. By examining the Human Enhancement debate and the similarities to the issue of vaccination shown here, policymakers can learn valuable lessons regarding mass vaccination programs' current and future handling.