Critical success factors for creating sustainable digital health applications: A systematic review of the German case.

Objective: The Covid-19 pandemic has accelerated the adoption of digital technologies to address social needs, leading to increased investments in digital healthcare applications. Germany implemented a special law called the "Digitales Versorgungsgesetz" (DVG-Digital Supply Act) in 2019, which enables the reimbursement of digital health applications, including digital therapeutics (DTx), through a fast-track process. The Federal Institute for Drugs and Medical Devices (BfArM), the German federal authority responsible for overseeing digital health applications, has implemented legislative adjustments since the law's introduction, which have increased requirements for these applications and potentially led to the removal of some from the directory as well as a slowdown in the addition of new ones. To counteract this trend, this work aimed to identify key success factors for digital health applications (DiGAs). Methods: This research identifies critical success factors through a structured literature review for developing sustainable digital health applications within the European healthcare systems, specifically DiGAs. The study aims to support the ongoing digital transformation in healthcare. Results: The identified success factors that significantly impact the sustainability of DiGAs include patient-centered design, application effectiveness, user-friendliness, and adherence to data protection and information security regulations using standardized approaches. These factors are crucial in preventing the failure of DiGA manufacturers in European countries. Conclusion: By considering and implementing these critical success factors, DiGA manufacturers can enhance their chances of long-term success and contribute to the digital transformation of the healthcare system in Europe.

Factors contributing to the mental wellbeing of Afghan migrants in Iran during the COVID-19 pandemic.

This study aims to explore the factors contributing mental health of Afghan migrants residing in Iran during the COVID-19 pandemic. With a deep understanding of the unique challenges encountered by migrants, especially during times of crisis, this research delves into the influential factors of experienced anxiety, social cohesion, and stress and their significant contribution to the development of depression among Afghan migrants. The study included a sample of 469 individuals from the Afghan migrant community, aged 15 to 80 years. Data collection took place from December to March 2022 in Iran. The study revealed that anxiety and the burden of the COVID-19 pandemic significantly influenced the occurrence of depression among Afghan migrants. Furthermore, the relationship between these factors and depression was mediated by the experience of stress. Conversely, higher levels of perceived social cohesion in the host country were linked to reduced stress and depression among the migrants. As Afghan migrants in Iran face a heightened risk of developing depression, the importance of social support and integration is underscored by the association between higher levels of perceived social cohesion in the host country and reduced levels of stress and depression. Recognizing the vulnerabilities of this population, it becomes evident that fostering social support networks and promoting integration can play a crucial role in mitigating the negative impact of migration-related stressors and enhancing mental wellbeing among this population.

Predicting instabilities: an embodied perspective on unstable experiences with art and design.

Predictive Processing (PP) provides a theoretical framework that describes perception as a process attempting to increase the predictability of stimulations by updating predictions or exploring new sensations. Moreover, perception and action are assumed to be closely linked within this process. While organisms seem to strive for predictability, we sometimes expose ourselves to objects and situations that challenge sense-making-such conditions often break perceptual habits or offer multiple possible meanings. This paper updates a previous qualification of these experiences of 'Semantic Instability' (SeIns) by following an embodied and situated understanding of perception and cognition. We suggest that art perception essentially differs from problem-solving as in engaging with art, we typically integrate contradictory elements dynamically and without the ultimate goal of resolving the contradictions-on the contrary, SeIns itself can generate aesthetic hedonics and interest. We discuss how current embodied accounts of PP might help understand what motivates such unstable yet insightful and pleasurable nonlinear sense-making processes. This article is part of the theme issue 'Art, aesthetics and predictive processing: theoretical and empirical perspectives'.

About the Need for a More Adequate Way to Get an Understanding of the Experiencing of Aesthetic Items.

We live in times when neuroscientific methods have become standard methods that many researchers can easily use. While this offers excellent opportunities to understand brain activities linked with aesthetic processing, we face the problem of using sophisticated techniques without a proper and valid theoretical foundation of aesthetics. A further problem arises from sophisticated methods often demanding strict constraints in presenting and experiencing aesthetic stimuli. However, when experiencing aesthetic items, contextual factors matter, e.g., social and situational affordances are essential in triggering a true and deep "Kunsterlebnis" (Experience of Art). Additionally, in Art, it is often not the artwork as an object that matters but the close relationship with and the processing of the artwork. However, art is only one facet of the whole aesthetic domain, beside, e.g., design, architecture, everyday aesthetics, dance, literature, music, and opera. In the present paper, I propose a dynamic and holistic aesthetic perspective that includes the respective context, situation, cognitive and affective traits and state of the beholder, ongoing processes of understanding, Zeitgeist, and other cultural factors, which can be applied to different aesthetic domains. When ignoring such temporal and dynamic factors, we will not understand the qualia of aesthetic processing. These considerations might help researchers in the field of aesthetics to better understand the experiencing of aesthetic items of all kinds-if we ignore these factors, we are missing the essence of experiencing aesthetic items, especially artworks. We aim to sensitize and inform readers about these ideas to inspire a deeper understanding of experiencing aesthetic items and the advancement of a theoretical framework addressing the experiencing of aesthetics from different domains.

Looking for the Edge of the World: How 3D Immersive Audio Produces a Shift from an Internalised Inner Voice to Unsymbolised Affect-Driven Ways of Thinking and Heightened Sensory Awareness.

In this practice-based case study, we investigate the subjective aesthetic and affective responses to a shift from 2D stereo-based modelling to 3D object-based Dolby Atmos in an audio installation artwork. Dolby Atmos is an infinite object-based audio format released in 2012 but only recently incorporated into more public-facing formats. Our analysis focuses on the artist Sadia Sadia's 30-channel audio installation 'Notes to an Unknown Lover', based on her book of free verse poetry of the same title, which was rebuilt and reformatted in a Dolby Atmos specified studio. We examine what effect altered spatiality with an infinite number of 'placements' has on the psychoacoustic and neuroaesthetic response to the text. The effectiveness of three-dimensional (3D) object-based audio is interrogated against more traditional stereo and two-dimensional (2D) formats regarding the expression and communication of emotion and what effect altered spatiality with an infinite number of placements has on the psychoacoustic and neuroaesthetic response to the text. We provide a unique examination of the consequences of a shift from 2D to wholly encompassing object-based audio in a text-based artist's audio installation work. These findings may also have promising applications for health and well-being issues.

Neither entrepreneurship nor intrapreneurship: a review of how to become an innovative split-off start-up.

Splitting off departments from corporations in order to establish corporate start-ups has become of strategic importance for the performance and innovation of corporations. While the settlement process is widely practiced, there is a lack of knowledge of how entrepreneurship may exist in such split-offs. The main aim of this study was to explore how entrepreneurship in corporate start-ups can exist in order to contribute to corporate performance. Based on a systematic literature review from 2021 to 2023, which resulted in a total of 1,516 scientific, English-language articles in economic journals, a total of 150 articles were analyzed in-depth. Our research shows that it is of crucial importance that corporations position leaders with an appropriate mindset and behavior at all levels as early as starting the split-off process, which is, however, neither entrepreneurship nor intrapreneurship. The niche corporative start-up area shows that entrepreneurship is a continuum and requires a new definition of corporate start-up entrepreneurship (CSE). For corporate start-ups to be successful, we revealed that there needs to be (1) the appropriate legal form, which ensures ownership but also the risk of the leaders, (2) an explorative business rather than exploitation, (3) variable compensation rather than fixed and (4) corporate entrepreneurs rather than employees and managers. Implications of the findings for entrepreneurial leadership theory development and future research are discussed.

When a bank becomes a bank, and a bank is the bank but not the bank: Multistability of homonyms' meaning.

Perceptual multistability is well-known and mostly visually demonstrated: Common examples are Necker's cube or Rubin's face-vase that produce qualitatively different percepts continuously oscillating between the solutions despite physically stable stimuli. We lack knowledge about similar phenomena in other domains, for instance in linguistics, where we are faced with homonyms that create multistability of cognitive semantics, differently assigned meanings of identical words. Our participants listened to repeated presentations of homonyms for which two or even three meanings could be assigned, and they reported the dominant meaning perceived at a certain point in time. Results showed that most participants experienced multistability of meaning for homonyms, with semiperiodic changes in dominant meaning similar to multistabity in perception. These findings suggest that multistability is a general property of the brain's neural architecture that resolves ambiguity irrespective of the level of representation.

Naturalistic face adaptation: How we adapt to freckles fast and sustainably.

While sunbathing, our skin becomes susceptible to quite remarkable changes in visual appearance, that is, freckles appear or increase in intensity-most obviously on the face. Research on face adaptation repeatedly showed that the inspection of manipulated versions of faces (so-called adaptor faces) leads to robust and sustainable changes in the perception of subsequently presented faces. Therefore, during the adaptation phase of the present study, participants saw faces with either strongly increased or decreased intensities of freckles. After a 5-minute break, during the test phase, participants had to identify the veridical (non-manipulated) face out of two faces (a slightly manipulated face combined with a non-manipulated face). Results showed strong adaptation effects to increased and decreased levels of freckles. We conclude that updating facial representations in memory is relatively fast, and these representation updates seem to sustain over a certain time span (at least 5 minutes). Face-specificity of our effects will be discussed. The results align with our everyday experience that the appearance of freckles in spring is a salient change in a familiar face; however, we seem to not register these changes after a few exposures due to a loss of information quality.

Emotions behind a mask: the value of disgust.

The impact of face masks on social cognition and interaction became a popular topic due to the long-lasting COVID-19 pandemic. This theme persists in the focus of attention beyond the pandemic, since face covering not only reduces the overall amount of face information available but also introduces biases and prejudices affecting social perception at large. Many questions are still open. One of them is whether gender of beholders affects inferring of emotions covered by face masks. Reading covered faces may be particularly challenging for individuals with mental disorders, most of which are gender-specific. Previous findings are not only sparse, but inconclusive because most research had been conducted online with resulting samples heavily dominated by females. Here in a face-to-face study, females and males were presented with a randomized set of faces covered by masks. In a two-alternative forced-choice paradigm, participants had to indicate facial emotions displayed by posers. In general, the outcome dovetails with earlier findings that face masks affect emotion recognition in a dissimilar way: Inferring some emotions suffers more severely than others, with the most pronounced influence of mask wearing on disgust and close to ceiling recognition of fear and neutral expressions. Contrary to our expectations, however, males were on overall more proficient in emotion recognition. In particular, males substantially excelled in inferring disgust. The findings help to understand gender differences in recognition of disgust, the forgotten emotion of psychiatry, that is of substantial value for a wide range of mental disorders including schizophrenia. Watch Prof. Marina Pavlova discussing this her work and this article: https://vimeo.com/860126397/5966610f49?share=copy .

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.

Under the sun: adaptation effects to changes in facial complexion.

BACKGROUND: Many Western people enjoy sunshine, and through the sun's stimulated increase in melanin, the skin tone or skin complexion will darken (and lighten again during winter). Although the initial salience of such a new look is remarkable - especially in the face - we seem to adapt to this new look relatively quickly. Research on face adaptation in general repeatedly showed that the inspection of manipulated versions of faces (so-called adaptor faces) leads to a change of the perception of subsequently presented faces. The present study investigates face adaptation to very natural changes in faces such as changes in complexion. METHODS: During the adaptation phase in the present study, participants saw faces with either strongly increased or decreased complexion. After a pause of 5 min, participants had to identify the veridical (non-manipulated) face out of two faces (a face slightly manipulated in complexion combined with the non-manipulated face) during a test phase. RESULTS: Results show strong adaptation effects to decreased complexion intensities. DISCUSSION: It seems that we are updating our facial representations in memory quite quickly (i.e., optimizing our processing through adaptation) and seem to sustain those new representations over a certain timespan (at least 5 min). Our results demonstrate that changes in complexion draw our attention for deeper analysis (at least with decreased complexion). However, it loses its informative quality quickly via fast and relatively sustainable adaptation.

Reconstructing a disambiguation sequence that forms perceptual memory of multistable displays via reverse correlation method: Bias onset perception but gently.

When multistable displays are presented intermittently with long blank intervals, their onset perception is determined by perceptual memory of multistable displays. We investigated when and how it is formed using a reverse correlation method and bistable kinetic depth effect displays. Each experimental block consisted of interleaved fully ambiguous probe and exogenously disambiguated prime displays. The purpose of the former was to "read out" the perceptual memory, whereas the latter contained purely random disambiguation sequences that were presented at the beginning of the prime display, throughout the entire presentation, or at the beginning and the end of the presentation. For each experiment and condition, we selected a subset of trials with disambiguation sequences that led to a change in perception of either the prime itself (sequences that modified perception) or the following fully ambiguous probe (sequences that modified perceptual memory). We estimated average disambiguation sequences for each participant using additive linear models. We found that an optimal sequence started at the onset with a moderate disambiguation against the previously dominant state (dominant perception for the previous probe) that gradually reduced until the display is fully ambiguous. We also show that the same sequence leads to an altered perception of the prime, indicating that perception and perceptual memory form at the same time. We suggest that perceptual memory is a consequence of an earlier evidence accumulation process and is informative about how the visual system treated ambiguity in the past rather than how it anticipates an uncertain future.

History-dependent changes to distribution of dominance phases in multistable perception.

Multistability - spontaneous switches of perception when viewing a stimulus compatible with several percepts - is often characterized by the distribution of durations of dominance phases. For continuous viewing conditions, these distributions are similar for various multistable displays and share two characteristic features: a Gamma-like distribution shape and dependence of dominance durations on the perceptual history. Both properties depend on a balance between self-adaptation (also conceptualized as a weakening stability prior) and noise. Prior experimental work and simulations that systematically manipulated displays showed that faster self-adaptation leads to a more "normal-like" distribution and, typically, to more regular dominance durations. We used a leaky integrator approach to estimate accumulated differences in self-adaptation between competing representations and used it as a predictor when fitting two parameters of a Gamma distribution independently. We confirmed earlier work showing that larger differences in self-adaptation led to a more "normal-like" distribution suggesting similar mechanisms that rely on the balance between self-adaptation and noise. However, these larger differences led to less regular dominance phases suggesting that longer times required for recovery from adaptation give noise more chances to induce a spontaneous switch. Our results also remind us that individual dominance phases are not "independent and identically distributed."

Connecting the beholder with the artwork: Thoughts on gaining liveliness by the usage of paraphernalia.

When we attend sculptures in museums, they might fascinate us due to the mastery of the material, the inherent dynamics of body language or due to contrapposto or the sheer size of some of these statues such as Michelangelo's David. What is less convincing, however, is the life-alikeness of the face. Actually, most visitors experience dead faces, dead eyes, and static expressions. By merely adding paraphernalia to a face (e.g., a facemask or sunglasses), such unalive sculptures gain vividness and liveliness. This striking effect is demonstrated by applying a facemask and sunglasses to a sculpture on public display in Bamberg, but it can easily be demonstrated on any available sculpture. This simple method might help connect people with sculptures or artworks, in general, to lower the barrier between the beholder and artwork and increase their interaction.

The unnoticed zoo: Inattentional deafness to animal sounds in music.

Inattentional unawareness potentially occurs in several different sensory domains but is mainly described in visual paradigms ("inattentional blindness"; e.g., Simons & Chabris, 1999, Perception, 28, 1059-1074). Dalton and Fraenkel (2012, Cognition, 124, 367-372) were introducing "inattentional deafness" by showing that participants missed by 70% a voice repeatedly saying "I'm a Gorilla" when focusing on a primary conversation. The present study expanded this finding from the acoustic domain in a multifaceted way: First, we extended the validity perspective by using 10 acoustic samples-specifically, excerpts of popular musical pieces from different music genres. Second, we used as the secondary acoustic signal animal sounds. Those sounds originate from a completely different acoustic domain and are therefore highly distinctive from the primary sound. Participants' task was to count different musical features. Results (N = 37 participants) showed that the frequency of missed animal sounds was higher in participants with higher attentional focus and motivation. Additionally, attentional focus, perceptual load, and feature similarity/saliency were analyzed and did not have an influence on detecting or missing animal sounds. We could demonstrate that for 31.2% of the music plays, people did not recognize highly salient animal voices (regarding the type of acoustic source as well as the frequency spectra) when executing the primary (counting) task. This uncovered, significant effect supports the idea that inattentional deafness is even available when the unattended acoustic stimuli are highly salient.

Perceptions of persons who wear face coverings are modulated by the perceivers' attitude.

We examined if the effect of facial coverings on person perception is influenced by the perceiver's attitudes. We used two online experiments in which participants saw the same human target persons repeatedly appearing with and without a specific piece of clothing and had to judge the target persons' character. In Experiment 1 (N = 101), we investigated how the wearing of a facial mask influences a person's perception depending on the perceiver's attitude toward measures against the COVID-19 pandemic. In Experiment 2 (N = 114), we examined the effect of wearing a head cover associated with Arabic culture on a person's perception depending on the perceiver's attitude toward Islam. Both studies were preregistered; both found evidence that a person's perception is a process shaped by the personal attitudes of the perceiver as well as merely the target person's outward appearance. Integrating previous findings, we demonstrate that facial covers, as well as head covers, operate as cues which are used by the perceivers to infer the target persons' underlying attitudes. The judgment of the target person is shaped by the perceived attitude toward what the facial covering stereotypically symbolizes.

An application of the dual identity model and active categorization to increase intercultural closeness.

The enhancement of social inclusion is a key to maintaining cohesion in society and to foster the benefits of cultural diversity. Using insights from the Dual Identity Model (DIM) with a special focus on active categorization, we develop an intervention to increase social inclusion. Our intervention encourages the participants to (re-)categorize on a superordinate level (i.e., a human identity) while being exposed to their own culture. Across a set of experiments, we test the efficacy of our intervention against control conditions on the effect of social inclusion, measured by perceived social distance. Results show an increase in cultural closeness and provide preliminary support for the use of a DIM-based intervention to increase intercultural inclusion.

Reading Emotions in Faces With and Without Masks Is Relatively Independent of Extended Exposure and Individual Difference Variables.

The ability to read emotions in faces helps humans efficiently assess social situations. We tested how this ability is affected by aspects of familiarization with face masks and personality, with a focus on emotional intelligence (measured with an ability test, the MSCEIT, and a self-report scale, the SREIS). To address aspects of the current pandemic situation, we used photos of not only faces per se but also of faces that were partially covered with face masks. The sample (N = 49), the size of which was determined by an a priori power test, was recruited in Germany and consisted of healthy individuals of different ages [M = 24.8 (18-64) years]. Participants assessed the emotional expressions displayed by six different faces determined by a 2 (sex) × 3 (age group: young, medium, and old) design. Each person was presented with six different emotional displays (angry, disgusted, fearful, happy, neutral, and sad) with or without a face mask. Accuracy and confidence were lower with masks-in particular for the emotion disgust (very often misinterpreted as anger) but also for happiness, anger, and sadness. When comparing the present data collected in July 2021 with data from a different sample collected in May 2020, when people first started to familiarize themselves with face masks in Western countries during the first wave of the COVID-19 pandemic, we did not detect an improvement in performance. There were no effects of participants' emotional intelligence, sex, or age regarding their accuracy in assessing emotional states in faces for unmasked or masked faces.

On the Parental Influence on Children's Physical Activities and Mental Health During the COVID-19 Pandemic.

Background: While neighborhood safety and stranger danger have been mostly canonized to play a part in parents' physical activity (PA) avoidance, less is known about the impact of parental stress and perceived risk on children's PA avoidance and consequently on children's level of PA and wellbeing. Understanding the contributors to children's wellbeing during pandemic disease is the first critical step in contributing to children's health during epidemic diseases. Methods: This study employed 276 healthy children, aged 10-12 years, and their parents. Data were collected in October and November 2020, about 9 months after the local closing of schools due to the coronavirus disease 2019 (COVID-19) pandemic. Parents and children answered a separate set of questions. Besides the demographic information, the parents responded to questions on their stress level, perceived risk of COVID-19, and PA avoidance for children. Children responded to questions on their PA and wellbeing in the last week. Data were analyzed using SmartPLS and IBM SPSS 22. Results: The result of the study supported the four directional research hypotheses of the sequential study model. As hypothesized, parents' stress and perceived risk levels of COVID-19 negatively affected children's PA. The PA level was shown to predict children's wellbeing and mental health. Housing type, parents' job security, number of siblings, number of members living together in-home, and history of death or hospitalization of relatives or family members due to COVID-19 were found to be associated with parents' stress and children's mental health. Conclusion: This study sheds light on parents' role in children's wellbeing and mental health during the COVID-19 pandemic. Parents with higher stress and high restrictive behaviors might put their children at risk of mental disorders in the end.