Search Results (3,089)

Background and objectives: Duloxetine is widely used for the treatment of major depressive disorder (MDD), generalized anxiety disorder (GAD), and various types of neuropathic pain. While its efficacy is well documented in clinical trials, less is known about how it is perceived and utilized in routine psychiatric practice. To address this knowledge gap, we conducted a cross-sectional observational study involving 80 psychiatrists from Spain to assess real-world clinical attitudes toward duloxetine. Methods: Participants completed a 20-item multiple-choice questionnaire that examined familiarity, perceived efficacy in multiple conditions (MDD, GAD, neuropathic pain, somatization, and quality of life), and perspectives on tolerability, safety, adherence, and overall satisfaction. Results: Survey results indicated that a large majority of psychiatrists frequently prescribe duloxetine, particularly for patients with MDD and comorbid chronic pain. Notably, 94% rated it as either “more effective” or “much more effective” for diabetic peripheral neuropathic pain. Psychiatrists reported a high perceived efficacy of duloxetine: 94% rated it as “more effective” or “much more effective” for diabetic peripheral neuropathy, and 93% gave similarly positive ratings for general neuropathic pain. For somatization, 70% found it “effective” or “very effective”, and 83% observed improvements in quality of life for many of their patients. Psychiatrists generally reported favorable perceptions of duloxetine’s tolerability profile: 97.5% rated it as the antidepressant associated with the least weight gain, and 82.5% perceived fewer sexual side effects compared to other options. Sedation and gastrointestinal side effects were generally considered mild or less severe. In terms of treatment adherence, 69% rated it as “better” or “much better” than other antidepressants, and 80% found its combination with other antidepressants to be “favorable” or “very favorable”. Overall satisfaction was high, with 99% of psychiatrists reporting being either “satisfied” or “very satisfied” with its use. The side effect profile was generally viewed as manageable, with low perceived rates of weight gain, sedation, and sexual dysfunction. Furthermore, 96% of respondents expressed a willingness to recommend duloxetine to their colleagues. Conclusions: Psychiatrists reported highly favorable attitudes toward duloxetine, viewing it as a flexible treatment option in routine care. However, these findings reflect clinicians’ subjective perceptions rather than objective clinical outcomes and should be interpreted accordingly. Full article

Background: Hypotension following epidural labor analgesia (ELA) is its most common complication, affecting approximately 20% of patients and posing risks to both maternal and fetal health. As digital tools and predictive analytics increasingly shape perioperative and obstetric anesthesia practices, real-world implementation data are needed to guide their integration into clinical care. Current monitoring practices rely on intermittent non-invasive blood pressure (NIBP) measurements, which may delay recognition and treatment of hypotension. The Hypotension Prediction Index (HPI) algorithm uses continuous arterial waveform monitoring to predict hypotension for potentially earlier intervention. This clinical trial evaluated the feasibility, acceptability, and efficacy of continuous HPI-guided treatment in reducing time-to-treatment for ELA-associated hypotension and improving maternal hemodynamics. Methods: This was a prospective randomized controlled trial design involving healthy pregnant individuals receiving ELA. Participants were randomized into two groups: Group CM (conventional monitoring with NIBP) and Group HPI (continuous noninvasive blood pressure monitoring). In Group HPI, hypotension treatment was guided by HPI output; in Group CM, treatment was based on NIBP readings. Feasibility, appropriateness, and acceptability outcomes were assessed among subjects and their bedside nurse using the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM) instruments. The primary efficacy outcome was time-to-treatment of hypotension, defined as the duration between onset of hypotension and administration of a vasopressor or fluid therapy. This outcome was chosen to evaluate the clinical responsiveness enabled by HPI monitoring. Hypotension is defined as a mean arterial pressure (MAP) < 65 mmHg for more than 1 min in Group CM and an HPI threshold < 75 for more than 1 min in Group HPI. Secondary outcomes included total time in hypotension, vasopressor doses, and hemodynamic parameters. Results: There were 30 patients (Group HPI, n = 16; Group CM, n = 14) included in the final analysis. Subjects and clinicians alike rated the acceptability, appropriateness, and feasibility of the continuous monitoring device highly, with median scores ≥ 4 across all domains, indicating favorable perceptions of the intervention. The cumulative probability of time-to-treatment of hypotension was lower by 75 min after ELA initiation in Group HPI (65%) than Group CM (71%), although this difference was not statistically significant (log-rank p = 0.66). Mixed models indicated trends that Group HPI had higher cardiac output (β = 0.58, 95% confidence interval −0.18 to 1.34, p = 0.13) and lower systemic vascular resistance (β = −97.22, 95% confidence interval −200.84 to 6.40, p = 0.07) throughout the monitoring period. No differences were found in total vasopressor use or intravenous fluid administration. Conclusions: Continuous monitoring and precision hypotension treatment is feasible, appropriate, and acceptable to both patients and clinicians in a labor and delivery setting. These hypothesis-generating results support that HPI-guided treatment may be associated with hemodynamic trends that warrant further investigation to determine definitive efficacy in labor analgesia contexts. Full article

The aim of this paper is to analyze how young people in Slovakia perceive individual attributes of quality of life and to highlight the positive correlation with ethical values acquired primarily through family upbringing and, significantly, through the national education system. Quality of life is understood as a multidimensional concept encompassing opportunities, fulfillment of human needs, and subjective well-being, including dimensions such as happiness and life satisfaction. These aspects are strongly influenced by ethical values, which are particularly shaped by compulsory ethics or religious education provided to children aged 6–15 within the Slovak national curriculum. To explore the link between ethically grounded education and perceived quality of life among youth, a questionnaire-based survey was conducted. The findings reveal significant correlations between ethical or religious education and various quality of life indicators, emphasizing the importance of ethical education in shaping socially responsible and value-oriented young citizens. This study contributes to understanding the cultural and educational context influencing youth perceptions of quality of life in Slovakia. Full article

Urban parks are an important component of public urban spaces, which directly impact the living experiences of residents and the urban image. High-quality urban parks are crucial for enhancing the well-being of residents. This study selected Fukuoka, Japan, as the study site. Five urban parks were chosen to evaluate landscape visual quality by using the Scenic Beauty Estimation (SBE) method. The Semantic Differential (SD) method was used to get sample subjective landscape features. Meanwhile, sample objective landscape features were obtained by using semantic segmentation techniques in deep learning and combined with spatial analysis to understand their distribution. A regression model was established, which used the SBE values as the dependent variable and subjective landscape features as the independent variables to analyze the relationship between urban park landscape visual quality and subjective landscape features. The regression analysis revealed that sense of layering, harmony, interestingness, sense of order, and vitality were the core factors influencing visual quality. All five features had a significant positive impact on landscape visual quality. The sense of order was the most influential factor, which would be the key to enhancing the landscape perception experience. Moreover, the XGBoost model and SHAP value from machine learning were used to reveal the nonlinear relationships and significant threshold effects between urban park visual quality and five objective landscape features: openness, greenness, enclosure, vegetation diversity, and Shannon–Wiener diversity index. This study showed that when openness exceeded 0.27, the positive effect was significant. The optimal threshold for the greenness was 0.38. Vegetation diversity and enclosure had to be below 0.82 and 0.58, respectively, to have a positive impact. Meanwhile, the positive influence of the Shannon–Wiener diversity index reached its maximum at a value of 1.37. This study not only establishes a systematic method for diagnosing landscape problems and evaluating landscape visual quality but also provides both theoretical support and practical guidance for urban park landscape optimization. Full article

Although artificial intelligence technologies have significantly enhanced autonomous robots’ capabilities in perception, decision-making, and planning, their autonomy may still fail when faced with complex, dynamic, or unpredictable environments. Therefore, it is critical to enable users to take over robot control in real-time and efficiently through teleoperation. The lightweight, wearable myoelectric armband, due to its portability and environmental robustness, provides a natural human–robot gesture interaction interface. However, current myoelectric teleoperation gesture control faces two major challenges: (1) poor intuitiveness due to visual-motor misalignment; and (2) low efficiency from discrete, single-degree-of-freedom control modes. To address these challenges, this study proposes an integrated myoelectric teleoperation interface. The interface integrates the following: (1) a novel hybrid reference frame aimed at effectively mitigating visual-motor misalignment; and (2) a finite state machine (FSM)-based control logic designed to enhance control efficiency and smoothness. Four experimental tasks were designed using different end-effectors (gripper/dexterous hand) and camera viewpoints (front/side view). Compared to benchmark methods, the proposed interface demonstrates significant advantages in task completion time, movement path efficiency, and subjective workload. This work demonstrates the potential of the proposed interface to significantly advance the practical application of wearable myoelectric sensors in human–robot interaction. Full article

Objectives: Tinnitus, defined as the perception of sound without an external stimulus, is a complex condition with unclear etiology. Emerging evidence suggests a link between vascular dysfunction, particularly arterial stiffness, and tinnitus. This study aimed to evaluate vertebral artery stiffness in patients with idiopathic subjective tinnitus and assess the utility of Doppler ultrasonography as a non-invasive diagnostic tool. Materials and Methods: In this prospective study, 31 patients with idiopathic tinnitus (11 males, 20 females; mean age: 50.42 ± 9.64 years) and 24 healthy controls (12 males, 12 females; mean age: 39.67 ± 10.63 years) underwent comprehensive clinical evaluations, including pure tone audiometry, blood tests, and vertebrobasilar Doppler ultrasonography. Vertebral artery stiffness index (VAS), resistive index (RI), and pulsatility index (PI) were measured bilaterally. Results: A total of 31 patients with idiopathic subjective tinnitus and 24 healthy controls were evaluated. The mean age was significantly higher in the tinnitus group compared to controls (50.42 ± 9.64 vs. 39.67 ± 10.63 years, p < 0.001). Lipid profile analysis revealed significantly higher levels of total cholesterol (193.6 ± 47.28 vs. 167.5 ± 28.99 mg/dL, p = 0.021), LDL (149.4 ± 37.9 vs. 106.1 ± 10.7 mg/dL, p < 0.005), and triglycerides (202.2 ± 83.5 vs. 148.6 ± 26.4 mg/dL, p < 0.005) in tinnitus patients. Doppler ultrasonography demonstrated significantly higher vertebral artery stiffness values in the tinnitus group (left: 2.87 ± 0.72 vs. 2.12 ± 0.22; right: 2.99 ± 0.77 vs. 2.14 ± 0.5; both p < 0.005). Similarly, pulsatility index (PI) was significantly elevated in patients compared to controls (left: 2.45 ± 1.2 vs. 1.2 ± 0.43; right: 2.49 ± 1.02 vs. 1.19 ± 0.42; both p < 0.005). No significant differences were observed in resistive index (RI) or vertebral artery diameters between groups. Among tinnitus patients, PI and VAS were significantly higher on the side corresponding to reported tinnitus symptoms (p < 0.05), suggesting a lateralized vascular contribution. Conclusions: The findings suggested a potential relationship between idiopathic subjective tinnitus and vertebral artery stiffness. We demonstrated the utility of Doppler ultrasonography, a cost-effective and non-invasive imaging modality, for evaluating vascular parameters in tinnitus patients, paving the way for broader clinical applications. By uncovering a significant association between vertebral artery stiffness and tinnitus, our findings suggest that vascular health assessments could enhance diagnostic and therapeutic strategies for tinnitus management. Full article

In the present era, achieving sustainability requires the development of planning strategies to develop a safer urban infrastructure. This study examines the realistic aspects of cyclist safety by analysing cyclists’ fields of view, using Geographic Information Systems (GIS) and spatial data analysis. The research introduces novel geoprocessing tools-based GIS techniques that mathematically simulate cyclists’ angles of view and the distances to nearby environmental features. It provides precise insights into some potential hazards and infrastructure challenges encountered while cycling. This research focuses on managing and analysing the data collected, utilising OpenStreetMap (OSM) as vector-based supporting data. It integrates cyclists’ behavioural data with the urban environmental features encountered, such as intersections, road design, and traffic controls. The analysis is categorised into specific classes to evaluate the impacts of these aspects of the environment on cyclists’ behaviours. The current investigation highlights the importance of integrating the objective environmental elements surrounding the route with subjective perceptions and then determining the influence of these environmental elements on cyclists’ behaviours. Unlike previous studies that ignore cyclists’ visual perspectives in the context of real-world data, this work integrates objective GIS data with cyclists’ field of view-based modelling to identify high-risk areas and highlight the need for enhanced safety measures. The proposed approach equips urban planners and designers with data-informed strategies for creating safer cycling infrastructure, fostering sustainable mobility, and mitigating urban congestion. Full article

Objective: This study aims to investigate the feasibility of an online music therapy protocol for individuals previously diagnosed with COVID-19, focusing on their perceptions of their respiratory symptoms and the intervention’s impact on psychosocial measures. Methods: A within-subject experimental design was applied to examine an eight-week weekly online music therapy protocol, including singing, wind instrument playing, and music visualizations. All self-report data were collected bi-weekly throughout the 16-weeks study period, including baseline and post-tests. The measures for respiratory symptoms included the Medical Research Council’s Dyspnea Scale (MRC Dyspnea), Chronic Respiratory Questionnaire-Mastery Scores (CRQ Mastery), and Visual Analogue Scale for breathlessness. The measures for the secondary psychosocial outcomes were the Beck Depression Inventory-Short Form, the Generalized Anxiety Disorder 7-item, the Hospital Anxiety and Depression Scale, the Fatigue Severity Scale, the Epworth Sleepiness Scale, the EuroQol 5-Dimension 5-Level, and the Connor-Davidson Resilience Scale. Results: Twenty-four participants were enrolled. The participants perceived a reduction in respiratory symptoms, and shortness of breath (MRC Dyspnea). Planned comparisons showed significant decreases in MRC from baseline to post-treatment (p = 0.008). The mixed-effects model, including pre-baseline and post-treatment, was significant (p < 0.001). Significant changes in Breathing VAS were consistent with improvements in MRC Dyspnea, showing a significant baseline-to-post difference (p = 0.01). The CRQ Mastery showed significant improvements from baseline to Week 12 (p < 0.001). No significant changes were observed in other secondary measures. Conclusions: Our preliminary findings suggest that this protocol is feasible, and as a result, may help individuals previously diagnosed with COVID-19 to cope with lasting respiratory symptoms and improve their perception of shortness of breath. Live music-making, including playing accessible wind instruments and singing, may contribute to an increase sense of control over breathing. As this was a feasibility study, we conducted multiple uncorrected statistical comparisons to explore potential effects. While this approach may increase the risk of Type I error, the findings are intended to inform hypotheses for future confirmatory studies rather than to draw definitive conclusions. Full article

Against the backdrop of evolving global climate patterns, the frequency and intensity of extreme weather events have increased significantly, posing unprecedented threats to agricultural production. This change has particularly profound impacts on agricultural systems in developing countries, making the enhancement of farmers’ capacity to withstand extreme weather events a crucial component for achieving sustainable agricultural development. As an essential safeguard for agricultural production, agricultural insurance plays an indispensable role in risk management. However, a pronounced gap persists between policy aspirations and actual adoption rates among farmers in developing economies. This study employs the integrated theory of planned behavior (TPB) and protection motivation theory (PMT) to construct an analytical framework incorporating psychological, socio-cultural, and risk-perception factors. Using Jiangsu Province—a representative high-risk agricultural region in China—as a case study, we administered 608 structured questionnaires to farmers. Structural equation modeling was applied to identify determinants influencing insurance adoption decisions. The findings reveal that farmers’ agricultural insurance purchase decisions are influenced by multiple factors. At the individual level, risk perception promotes purchase intention by activating protection motivation, while cost–benefit assessment enables farmers to make rational evaluations. At the social level, subjective norms can significantly enhance farmers’ purchase intention. Further analysis indicates that perceived severity indirectly enhances purchase intention by positively influencing attitude, while response costs negatively affect purchase intention by weakening perceived behavior control. Although challenges such as cognitive gaps and product mismatch exist in the intention-behavior transition, institutional trust can effectively mitigate these issues. It not only strengthens the positive impact of psychological factors on purchase intention, but also significantly facilitates the transformation of purchase intention into actual behavior. To promote targeted policy interventions for agricultural insurance, we propose corresponding policy recommendations from the perspective of public intervention based on the research findings. Full article

This review provides a comprehensive analysis of recent advancements in lower limb exoskeleton systems, focusing on applications, control strategies, hardware architecture, sensing modalities, human-robot interaction, evaluation methods, and technical innovations. The study spans systems developed for gait rehabilitation, mobility assistance, terrain adaptation, pediatric use, and industrial support. Applications range from sit-to-stand transitions and post-stroke therapy to balance support and real-world navigation. Control approaches vary from traditional impedance and fuzzy logic models to advanced data-driven frameworks, including reinforcement learning, recurrent neural networks, and digital twin-based optimization. These controllers support personalized and adaptive interaction, enabling real-time intent recognition, torque modulation, and gait phase synchronization across different users and tasks. Hardware platforms include powered multi-degree-of-freedom exoskeletons, passive assistive devices, compliant joint systems, and pediatric-specific configurations. Innovations in actuator design, modular architecture, and lightweight materials support increased usability and energy efficiency. Sensor systems integrate EMG, EEG, IMU, vision, and force feedback, supporting multimodal perception for motion prediction, terrain classification, and user monitoring. Human–robot interaction strategies emphasize safe, intuitive, and cooperative engagement. Controllers are increasingly user-specific, leveraging biosignals and gait metrics to tailor assistance. Evaluation methodologies include simulation, phantom testing, and human–subject trials across clinical and real-world environments, with performance measured through joint tracking accuracy, stability indices, and functional mobility scores. Overall, the review highlights the field’s evolution toward intelligent, adaptable, and user-centered systems, offering promising solutions for rehabilitation, mobility enhancement, and assistive autonomy in diverse populations. Following a detailed review of current developments, strategic recommendations are made to enhance and evolve existing exoskeleton technologies. Full article

With the rapid expansion of Internet of Things (IoT) and edge computing applications, efficient video transmission under constrained bandwidth and limited computational resources has become increasingly critical. In such environments, perception-based video coding plays a vital role in maintaining acceptable visual quality while minimizing bit rate and processing overhead. Although newer video coding standards have emerged, H.264/AVC remains the dominant compression format in many deployed systems, particularly in commercial CCTV surveillance, due to its compatibility, stability, and widespread hardware support. Motivated by these practical demands, this paper proposes a perception-based video coding algorithm specifically tailored for low-bit-rate H.264/AVC applications. By targeting regions most relevant to the human visual system, the proposed method enhances perceptual quality while optimizing resource usage, making it particularly suitable for embedded systems and bandwidth-limited communication channels. In general, regions containing human faces and those exhibiting significant motion are of primary importance for human perception and should receive higher bit allocation to preserve visual quality. To this end, macroblocks (MBs) containing human faces are detected using the Viola–Jones algorithm, which leverages AdaBoost for feature selection and a cascade of classifiers for fast and accurate detection. This approach is favored over deep learning-based models due to its low computational complexity and real-time capability, making it ideal for latency- and resource-constrained IoT and edge environments. Motion-intensive macroblocks were identified by comparing their motion intensity against the average motion level of preceding reference frames. Based on these criteria, a dynamic quantization parameter (QP) adjustment strategy was applied to assign finer quantization to perceptually important regions of interest (ROIs) in low-bit-rate scenarios. The experimental results show that the proposed method achieves superior subjective visual quality and objective Peak Signal-to-Noise Ratio (PSNR) compared to the standard JM software and other state-of-the-art algorithms under the same bit rate constraints. Moreover, the approach introduces only a marginal increase in computational complexity, highlighting its efficiency. Overall, the proposed algorithm offers an effective balance between visual quality and computational performance, making it well suited for video transmission in bandwidth-constrained, resource-limited IoT and edge computing environments. Full article

Background: Subjective socioeconomic status (SES) is a powerful determinant of health and well-being, capturing individuals’ perceptions of their material conditions and security. While higher perceived financial and basic needs security are generally linked to better health outcomes, little is known about how these associations differ across global contexts. Drawing on data from 23 countries, this study tests whether these relationships are systematically weaker in Global South countries. Methods: Cross-sectional data from Wave 1 of the Global Flourishing Study (n = 207,000) were used to examine associations between subjective SES indicators—financial security and security in basic needs (food, housing, safety)—and two outcomes: self-rated physical health and mental health. All variables were measured on 0–10 scales. Linear regression models were estimated separately by Global South and Global North country status, adjusting for age and sex. Global South classification was based on standard development and geopolitical frameworks. Results: In both global regions, individuals with higher perceived financial and basic needs security reported significantly better mental and physical health. However, the strength of these associations was consistently weaker in Global South countries. Interaction terms confirmed that Global South status moderated the association between subjective SES and health outcomes. Conclusions: These findings suggest global-scale “diminished returns” of subjective SES on health, echoing patterns previously observed within countries. Structural inequalities, weaker public systems, and contextual adversity may dilute the health benefits of perceived security in Global South settings. Global health equity efforts must therefore move beyond individual-level interventions to address the broader systems that constrain the translation of socioeconomic resources into health. Full article

Although consumption is a key engine of economic growth, it is also one of the main drivers of environmental degradation. In this context, a deeper understanding of consumers’ perceptions and behavior regarding sustainable products is essential for promoting a more sustainable future, with behavioral change being crucial to achieving it. This research study explores consumer behavior regarding sustainable egg consumption, a sector where production is frequently associated with environmental and ethical concerns such as animal welfare and intensive resource use. Based on a sample of 197 valid responses from Portuguese egg consumers collected through an online survey distributed between 27 February and 17 March, of the year 2025, and applying the Theory of Planned Behavior (TPB) framework through a structural equation modeling (SEM) approach, this study finds that consumers’ intention to consume sustainable eggs is influenced by their attitudes and subjective norms. Furthermore, actual consumption behavior is driven by both the intention to consume sustainable eggs and perceived behavioral control. By providing an in-depth analysis of consumer behavior related to sustainable egg consumption, this study contributes to the advancement of the scientific literature on the subject. It also aims to support policymakers and other stakeholders in designing and implementing more effective strategies to promote environmentally responsible consumption practices. Full article

Background: Despite losing weight, the majority of subjects retained an obese view of themselves. The aim of the study was to evaluate the usefulness of a 3D modeling tool in improving the body image of patients who have undergone bariatric surgery. Methods: Morbidly obese subjects involved in a medico-surgical obesity management program and having undergone a Roux en Y Gastric Bypass (RYGB) or a sleeve gastrectomy (SG) were prospectively included during their usual postoperative medical follow-up. The figure rating scale (FRS), body image questionnaire, and Hospital Anxiety Depression Scale test were performed. The FRS was assessed before and after visualizing their body image using a 3D modeling tool. Distributions between the groups for gender (female vs. male) and type of surgery (gastric bypass vs. sleeve gastrectomy) were tested with a Pearson’s chi² independence test. The significance threshold was p < 0.05. Results: We included 140 adults with sleeve gastrectomy (72.9%; n = 102) or gastric bypass (27.1%; n = 38). The mean time from surgery was 308.3 ± 111.4 days (63–511). Participants were mostly female (77.9%; n = 109). Nearly half of the subjects who had undergone bariatric surgery almost one year before modified their body perception after visualizing their avatar thanks to a 3D modeling tool. One third reduced their FRS score (“perceived body”) after visualizing their avatar. FRS score and body mass index (BMI) following surgery (“real body”) were significantly correlated before and after visualizing the 3D avatar, with a stronger correlation after visualizing the 3D avatar. Conclusions: A 3D modeling tool may improve body perception after weight loss in subjects with bariatric surgery. Being simple, non-invasive, not expansive, and easy to use during a consultation and to understand for the patient, a regular use of this tool may be largely implemented in clinical practice. Its usefulness in improving body image, mood disorders, and eating disorders and the further success of the surgery should be further evaluated. Full article

Women disproportionately encounter negative affordances in urban environments—defined as features that severely restrict movement and impose harm. City venues are, thus, selectively permeable to women, though men face their own challenges, especially in intersectional contexts. The data in this study suggest that gender combines with ethnicity, socioeconomic status, and visible religious markers, making obstruction a shifting but nonetheless real phenomenon, much like a staircase genuinely impedes wheelchair access. Cultural context also matters: a Black woman may face one set of barriers in Paris, another in Seoul, with a Latin American woman encountering different ones in both. Building on these observations, the article argues that urban landscapes manifest gender-based political affordances—material configurations that reflect and reinforce social inequalities. As an affordance-based framework, the selective permeability model (1) draws on a well-supported theory of perception, where settings objectively present both favorable and hostile values relative to agents. The outlook (2) thereby challenges the stereotype that women’s spatial concerns are merely subjective. The position also (3) affirms that despite differences, people share bodily constraints and, hence, have largely overlapping values and experiences. The perspective accordingly avoids exaggerating divisions to the point of denying the mutual understanding that underlies empathetic norms. Full article