Search Results (331)

This study addresses the ongoing challenge of optimizing chatbot interactions to significantly enhance customer experience and satisfaction through personalized, empathetic responses. Using advanced NLP tools and strong statistical methodologies, we developed and evaluated a multi-layered analytical framework to accurately identify user intents, assess customer feedback, and generate emotionally intelligent interactions. With over 270,000 customer chatbot interaction records in our dataset, we employed spaCy-based NER and clustering algorithms (HDBSCAN and K-Means) to categorize customer queries precisely. Text classification was performed using random forest, logistic regression, and SVM, achieving near-perfect accuracy. Sentiment analysis was conducted using VADER, Naive Bayes, and TextBlob, complemented by semantic analysis via LDA. Statistical tests, including Chi-square, Kruskal–Wallis, Dunn’s test, ANOVA, and logistic regression, confirmed the significant impact of tailored, empathetic response strategies on customer satisfaction. Correlation analysis indicated that traditional measures like sentiment polarity and text length insufficiently capture customer satisfaction nuances. The results underscore the critical role of context-specific adjustments and emotional responsiveness, paving the way for future research into chatbot personalization and customer-centric system optimization. Full article

Background/Objectives: Cognitive Disengagement Syndrome (CDS) is a clinical condition primarily characterized by inattention, hypoactivity, and mind-wandering, which has not yet been recognized as an official diagnostic category. Although there are overlaps between CDS and ADHD, evidence supports the semi-independence of CDS from the ADHD-Inattentive subtype. Importantly, while the impact of ADHD on parenting styles has been studied, no previous research has investigated the potential influence of CDS difficulties on parenting behaviors. Both CDS and ADHD are associated with internalizing and externalizing symptoms, which are influenced by negative parenting styles. The severity of ADHD is known to predict the use of dysfunctional parenting patterns; however, no studies have yet investigated how CDS difficulties might affect parenting styles. Due to the similarities between CDS and ADHD, it is reasonable to hypothesize a similar relationship. This study aims to examine the potential mediating role of parenting styles—both negative and positive—in the relationship between CDS difficulties and internalizing and externalizing symptoms. Methods: The sample is composed of 369 Italian school-aged children (9.38 ± 2.34 years old). Parents reported on their children’s psychopathology, CDS difficulties, and their own parenting strategies. Results: Analyses conducted using Hayes’ PROCESS tool indicated that only negative parenting styles partially mediated the relationship between CDS difficulties and parent-reported youth anxiety, depression, and oppositional defiant disorder. Conclusions: These findings highlight the importance of interventions aimed at both addressing CDS in children and improving parenting strategies to enhance youth psychopathological outcomes. Full article

To cut a long story short, the term “emotion” is predominantly employed as a comprehensive designation, encompassing phenomena such as feelings, affective processing, experiences, expressions, and, on occasion, cognitive processes. This has given rise to a plethora of schools of thought that diverge in their inclusion of these phenomena, not to mention the discordance regarding what emotions belong to the so-called set of discrete emotions in the first place. This is a problem, because clear and operational definitions are paramount for ensuring the comparability of research findings across studies and also across different disciplines. In response to this disagreement, it is here proposed to simplify the definition of the term “emotion”, instead of using it as an umbrella term overarching an unclear set of multiple phenomena, which is exactly what left all of us uncertain about the question what an emotion actually is. From an etymological perspective, the simplest suggestion is to understand an emotion as behavior (from the Latin verb ‘emovere’, meaning to move out, and thus the noun ‘emotion’ meaning out-movement). This suggests that an emotion should not be understood as something felt, nor as a physiological reaction, or anything including cognition. Instead, emotions should be understood as behavioral outputs (not as information processing), with their connection to feelings being that they convey them. Consider fear, which should not be classified as an emotion, it should be understood as a feeling (fear is felt). The specific body posture, facial expression, and other behavioral manifestations resulting from muscle contractions should be classified as emotions with their purpose being to communicate the felt fear to conspecifics. The underlying causative basis for all that exists is affective processing (i.e., neural activity), and it provides evaluative information to support decision-making. The essence of this model is that if affective processing responds above a certain threshold, chemicals are released, which leads to a feeling (e.g., felt fear) if the respective organism is capable of conscious experience. Finally, the communication of these feelings to conspecifics is happening by emotion-behavior (i.e., emotions). In summary, affective processing guides behavior, and emotions communicate feelings. This perspective significantly simplifies the concept of an emotion and will prevent interchangeable use of emotion-related terms. Last but not least, according to the current model, emotions can also be produced voluntarily in order to feign a certain feeling, which is performed in various social settings. Applications of this model to various fields, including clinical psychology, show how beneficial it is. Full article

Chemical hazards in food present a significant health risk. The objective of our review is to understand health risks associated with chemical contaminants in products of animal origin (POAO) in Cambodia, where there is no known published study. We followed the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines. A total of 23 reports were included for review. The findings are presented according to the PRISMA guidelines. The studies mostly focused on fishery products, with arsenic and mercury being the most frequently studied hazards. The evidence of banned substances such as chloramphenicol and certain organochlorine pesticides (OCPs), including chlordane and Mirex, was reported in fish and meat. Additionally, mercury levels were measured in beef, pork, viscera, and eggs, but the average concentration remained significantly below the hazard index. The average concentration of polycyclic aromatic hydrocarbons (PAH) in smoked fish exceeded the EU limits, ranging from 0.034 to 17.2 mg/kg, with an average mean concentration of 1.92 mg/kg. The pooled geometric means of arsenic and mercury in fish were 0.40 mg/kg (95% CI: 0.25–0.66) and ~0.14 mg/kg (95% CI: 0.087 to 0.223), respectively. The health risk of mercury contamination in fishery products needs the attention of the risk managers. However, industrial contaminants such as polybrominated diphenyl ethers (PBDEs) and butyl tin in marine fishes were lower than those reported elsewhere, such as Japan. We discuss the implications of the findings for human health and national food control systems (NFCS), the capacity of different agencies to undertake chemical risk assessment, the utility of systematic literature reviews (SLRs) for risk assessment and communication in low- and middle-income countries (LMICs), and the need for further research. Full article

This entry provides a brief introduction to some of the main aspects of the work of C.G. Jung, followed by a description of how his work was developed by others during his lifetime and afterward. This entry provides an overview of the Jungian tradition in Depth Psychology. It begins with a discussion of how Jung’s ideas differed from those of Freud and opened a distinct tradition of analytic (Jungian) psychology. By identifying the other influential people who contributed to the amplification of Jung’s work, this article then details how these ideas expanded beyond the work of training analysts to become a more influential, impactful, and widespread phenomenon. Full article

Data on the genetic and environmental factors underlying the co-occurrence of Cognitive Disengagement Syndrome (CDS), Attention Deficit Hyperactivity Disorder (ADHD), and Emotional Dysregulation (ED) are limited. This study aimed to explore the nature of the associations between CDS, ADHD with ED, and to assess the role of shared etiological factors in explaining their comorbidity. We analyzed a sample of 400 Italian twin pairs aged 8–18, from Northern Italy and enrolled in the Italian Twin Registry. Bivariate genetic analyses were conducted using parent-rated CBCL scores for CDS, ADHD, and ED. For both CDS–ED and ADHD–ED associations, the best-fitting models were Cholesky AE models (−2LL = −849.167 and −339.030, respectively; p > 0.05), suggesting that the covariation was mainly due to additive genetic factors (CDS–ED—A = 0.81, 95% CI [0.66–0.95]; ADHD–ED—A = 0.86, 95% CI [0.75–0.95]). More than half of the genes were shown to be shared among the phenotypes. Non-shared environmental contributions were smaller (CDS–ED—E = 0.19, 95% CI [0.05–0.34]; ADHD–ED—E = 0.14, 95% CI [0.05–0.25]), indicating interrelated but distinct constructs. Despite some limitations, particularly the exclusive use of the CBCL, findings highlight the importance of monitoring ED symptoms in individuals with CDS or ADHD, and vice versa. Full article

Background: Arterial hypertension (HTN) is the leading modifiable cardiovascular risk factor for overall mortality worldwide. In Austria, 1.6 million individuals above the age of 15, representing 20% of the total population and 70% of adults aged 65 and older, suffer from HTN. Despite numerous antihypertensive treatment options on the European market, only 38.8% of patients on optimal medical treatment (OMT) reach their treatment goal. Primary prevention remains a challenge, particularly for HTN and the consequential risk of cardiovascular diseases (CVDs). Thus, there is an urgent need for Disease Management Programs (DMPs). We sought to study a possible trial to diagnose hypertension in a non-medical setting at a very early stage of the disease and raise awareness for hypertension in affected people to avoid future complications of unrecognized and untreated HTN. For a non-medical setting, hairdressers fulfil many criteria for an optimal blood pressure (BP) measurement. Methods: This is a pilot study. A total of 193 individuals were included at a Viennese hairdresser. Metric data were described either using mean ± SD given normal distribution or median otherwise. Categorical data were described using absolute frequencies and percentages. For comparison, either independent t-tests or Mann–Whitney U tests or chi² tests were assessed. The staff received expert training on how to measure blood pressure in a guideline-compliant way. All members signed the written and informed consent and received a questionnaire about their demographic data and cardiovascular risk factors. Results: Of the 193 participants in this study, 56.5% (109/193) were female and 43.5% (84/193) were male. The mean age was 54 ± 15.1 years. In the automatically measured office blood pressure (AOBP) measurement, the mean systolic BP was 137.1 ± 17.8 and the mean diastolic BP was 91.6 ± 11.2. Of all participants, 65.8% (127/193) were hypertensive, whereof 74.8% (95/127) had no treatment at all. Among 127 individuals evaluated, 63% (80/127) were unaware of their elevated blood pressure levels, while 28% (44/127) had a prior diagnosis of HTN. The control rate of the individuals with previously diagnosed HTN was very low, with only 18.5% [10.4; 30.9] reaching normotensive values in the current measurement. There was no difference in BP values of patients with previously diagnosed HTN and patients who were unaware of their disease. Antihypertensive treatment was being received by 20.2% (39/193), while 62.2% had not taken their prescribed blood pressure medication on the day of recruitment. Conclusions: This is the first Austrian study to show that screening for HTN in an unconventional non-medical setting is effective to diagnose HTN and raise awareness. Based on the even-higher-than-expected prevalence of HTN, we plan to conduct a cohort study in Vienna, inviting all hairdressers in socially deprived districts to act as gate openers for hypertensive subjects to raise awareness and to contact a regional GP for provision of medical care. An implementation of such a cost-effective and feasible disease management program in Austria might therefore reduce the burden of preventable cardiovascular events associated with HTN. Full article

Rheumatoid arthritis (RA) is a chronic autoimmune disease marked by joint inflammation and progressive disability. While biological disease-modifying antirheumatic drugs (bDMARDs) have significantly improved disease control, predicting individual treatment response remains clinically challenging. This study presents a machine learning approach to predict 12-month disease activity, measured by DAS28-CRP, in RA patients beginning bDMARD therapy. We trained and evaluated eight regression models, including Ridge, Lasso, Support Vector Regression, and XGBoost, using baseline clinical features from 154 RA patients treated at University Hospital Erlangen. A rigorous nested cross-validation strategy was applied for internal model selection and validation. Importantly, model generalizability was assessed using an independent external dataset from the Austrian BioReg registry, which includes a more diverse, real-world RA patient population from across multiple clinical sites. The Ridge regression model achieved the best internal performance (MAE: 0.633, R²: 0.542) and showed strong external validity when applied to unseen BioReg data (MAE: 0.678, R²: 0.491). These results indicate robust cross-cohort generalization. By predicting continuous DAS28-CRP scores instead of binary remission labels, our approach supports flexible, individualized treatment planning based on local or evolving clinical thresholds. This work demonstrates the feasibility and clinical value of externally validated, data-driven tools for precision treatment planning in RA. Full article

This cross-sectional study aims to identify clusters of internalizing and externalizing traits during adolescence using a bottom-up approach. The second aim is to investigate whether the different clusters differ by environmental risk factors and specific epigenetic profiles. A total of 205 adolescents, who had been referred for psychopathology in childhood, were recruited. Behavioral problems were assessed using the Child Behavior Checklist/6–18 (CBCL). Different clusters of psychopathological profiles were analyzed using a Finite mixture model. Differences in environmental risk factors and epigenetic profiles were tested with χ²-tests and Bonferroni-corrected t-tests. Two clusters were identified: a LOW cluster (51% of the sample), characterized by the presence of subclinical mean scores in both internalizing and externalizing problems, and a HIGH cluster (49% of the sample), characterized by high mean scores in both domains. The HIGH cluster had a significantly greater number of perinatal complications and changes in methylation of specific CpG sites of Brain-derived neurotrophic factor, Insulin-like growth factor-2, and Oxytocin receptor, whereas no difference was found for FK506-binding protein 5. Our results confirm the existence of a strong association between early adverse events, DNA methylation, and the presence of behavioral problems and psychopathological traits in adolescence. Full article

Ninety-five-year-old Doris Held, a great niece of Sigmund Freud, has been convening the Shakespeare Reading Group in Northampton, Massachusetts, my hometown, since she moved here in 2016. In the following essay, which is a personal response to my experience of this group of Shakespearean readers, to Doris Held, and to the work of Shakespeare in general, I attempt to chart the full impact of the Bard’s work on my life and on the world around me. I am neither a scholar nor a historian. In a true sense, I am a bystander Shakespearean, who has received deep reward and benefit from the experience, but it is Doris Held and her group who opened my eyes to the precise nature of this unexamined reward. Doris brought the spirit of the group from Cambridge, Massachusetts, where she had been a dues-paying member for decades of something called the Old Cambridge Shakespeare Association, which itself dates to 1880. My wife Debra and I attended the first meeting in Northampton more than a decade ago, and we have been receiving emails from Doris four times a year ever since. While these communications often induce guilt, they invariably lead to pleasures that I would never want to relinquish. That is a complicated dynamic in my routine, and I try to grapple with its ebb and flow in the pages that follow. Each time I get one, I have a version of the same conversation in my head. Is Doris still doing this? Haven’t they done all the plays by now? All things considered, wouldn’t they—and I—rather be home watching a true crime documentary about Gaby Petito on Netflix? What the hell is William Shakespeare to me anyway? At this point, if I’m honest, Shakespeare is Doris. The experience with this group led me in two directions. One took me back to my now long-ago history with Shakespeare’s work as an actor in college. The other took me via historical research into the prehistory of Doris Held’s previous Shakespeare group in Cambridge, Massachusetts. The two paths gave me a deeper grasp of the influence of his work across the world and on my own life. Full article

Background: Metacognition refers to the ability to reflect on and regulate cognitive processes. Despite advances in neuroimaging and lesion studies, its neural correlates, as well as their interplay with other cognitive domains, remain poorly understood. The orbitofrontal cortex (OFC) is proposed as a potential substrate for metacognitive processing due to its contribution to evaluating and integrating reward-related information, decision-making, and self-monitoring. Methods: This study examined OFC involvement in metacognition using transcranial direct current stimulation (tDCS) while participants performed a two-alternative forced choice task with confidence ratings to assess their metacognitive sensitivity. Before stimulation, the subjects completed the Metacognitions Questionnaire-30 and a monetary intertemporal choice task for the quantification of delay discounting. Results: Linear mixed-effects models showed that anodal tDCS over the left OFC reduced participants’ metacognitive sensitivity compared to sham stimulation, leaving perceptual decision-making accuracy unaffected. Moreover, real stimulation increased self-reported confidence ratings compared to the sham. Significant correlations were found between metacognitive sensitivity and negative beliefs about thinking. Conclusions: These results highlight the potential involvement of the OFC in the processing of retrospective second-order judgments about decision-making performance. Additionally, they support the notion that OFC overstimulation contributes to metacognitive dysfunctions detected in clinical conditions, such as difficulties in assessing the reliability of one’s thoughts and decision outcomes. Full article

Obesity and Type 2 Diabetes Mellitus (T2DM) are interrelated chronic conditions whose global prevalence continues to rise, posing significant clinical and socioeconomic challenges. Their pathophysiological intersection—commonly referred to as “diabesity”—is sustained by a complex interplay of mechanisms, including visceral adipose tissue inflammation, macrophage polarization, disrupted insulin signaling, and adipokine imbalance. These processes contribute to chronic low-grade systemic inflammation, impair pancreatic β-cell function, and exacerbate glucose intolerance. This review critically explores the mechanistic connections between obesity and T2DM, with a focus on recent advances in pharmacological therapies—such as GLP-1 receptor agonists, SGLT2 inhibitors, and dual GIP/GLP-1 receptor agonists—alongside evidence-based lifestyle modifications and bariatric procedures. By integrating current translational and clinical findings, we aim to provide a comprehensive perspective to support the development of more effective and individualized treatment strategies for diabesity. Full article

Cognitive Disengagement Syndrome (CDS) is a clinical construct characterized by symptoms such as excessive daydreaming, mental confusion, slowed behavior, and reduced cognitive and motor activity. Increasing evidence suggests a potential overlap between CDS and Emotional Dysregulation (ED), a transdiagnostic construct associated with difficulties in regulating emotional responses. This narrative review synthesizes current empirical findings and theoretical perspectives on the co-occurrence of CDS and ED, with a particular focus on insights provided by behavioral genetics—especially twin studies. We describe the core principles and models used in twin research and evaluate how they have been applied to disentangle genetic and environmental contributions to these phenotypes and their overlap. While some studies support a shared etiology between CDS and ED, particularly through non-shared environmental influences, research in this area remains limited and conceptually fragmented. The review identifies critical knowledge gaps, including the lack of longitudinal studies, inconsistent definitions of ED, and limited exploration of developmental trajectories. We argue that future twin studies are essential for clarifying these unresolved issues. Nonetheless, limitations include the scarcity of twin-based studies directly examining the CDS–ED association and methodological inconsistencies across the existing literature. Full article

In the twentieth century and into the present one, scholars working in the field of Christian pastoral care have concentrated their efforts in both well-established and emerging areas. Traditionally, thinking about pastoral care has been oriented to the person suffering from an existential, developmental, spiritual, or moral crisis (or a combination of these). With the emergence of the psychotherapeutic psychology of Freud, Jung, Erikson, Kohut, Berne, Perls, and others, a new focus on pastoral psychotherapy emerged. Taking things in a very different direction, a host of pastoral theologians issued a call to not only care for the individual, but also for the socio-political world that is oppressive and exclusionary for many. Still others promoted pastoral care and counseling as a ministry of the Christian Church. Finally, those animated by the ancient tradition of cura animarum accented pastoral care as spiritual formation. It is to these latter two themes that this article is addressed. What is proposed is a practical prompt card approach to spiritual formation in the congregation that is holistic and runs in the first instance over six to eight weeks. The four areas covered are spiritual practices, spiritual character (fruits of the Spirit), moral character, and positive psychology. Full article