New Zealand (NZ) has high rates of colorectal cancer but low rates of early diagnosis. Due to a lack of understanding of the pre-diagnostic experience from the patient’s perspective, it is necessary to investigate potential patient and health system factors that contribute to longer diagnostic intervals. Previous qualitative studies have discussed delays using The Model of Pathways to Treatment, but this has not been explored in the NZ context. This study aimed to understand the patient experience and perception of their general practitioner (GP) through the diagnostic process in the Waikato region of NZ. In particular, we sought to investigate potential barriers and facilitators that contribute to longer diagnostic intervals.Ethical approval for this study was granted by the New Zealand Health and Disability Ethics Committee. Twenty-eight participants, diagnosed with colorectal cancer, were interviewed about their experience. Semi-structured interviews were audio recorded, transcribed verbatim and analysed thematically using The Model of Pathways to Treatment framework .Participant appraisal of symptoms was a barrier to prompt diagnosis, particularly if symptoms were normalised, intermittent, or isolated in occurrence. Successful self-management techniques also resulted in delayed help-seeking. However if symptoms worsened, disruption to work and daily routines were important facilitators to seeking a GP consultation. Participants positively appraised GPs if they showed good technical competence and were proactive in investigating symptoms. Negative GP appraisals were associated with a lack of physical examinations and misdiagnosis, and left participants feeling dehumanised during the diagnostic process. However high levels of GP interpersonal competence could override poor technical competence, resulting in an overall positive experience, even if the cancer was diagnosed at an advanced stage. Māori participants often appraised symptoms inclusive of their sociocultural environment and considered the impact of their symptoms in relation to family.The findings of this study highlight the importance of tailored colorectal cancer symptom communication in health campaigns, and indicate the significance of the interpersonal competence aspect of GP-patient interactions. These findings suggest that interpersonal competence be overtly displayed in all GP interactions to ensure a higher likelihood of a positive experience for the patient. New Zealand (NZ) has one of the highest rates of colorectal cancer (CRC) in the world. CRC is NZs second most common cause of cancer mortality with over 1200 deaths per annum from around 3000 registered cases . HoweverAside from bowel screening, which began gradual regional implementation from 2017 but at the point of this writing has not yet been fully implemented nationwide, improving timely diagnosis is the most important step in ensuring that CRC patients have a better chance at survival . PreviouInternational studies have indicated that patient, physician and health system delays are key factors associated with late stage diagnosis of CRC. A qualitative study of 20 men in Australia, for example, found delays were associated with patient misinterpretation of symptoms, a failure to attribute symptoms to cancer, and subsequent delays in consulting a health care professional . Other sDue to the high mortality rates of CRC in NZ and a lack of understanding of the pre-diagnostic experience from the patient’s perspective, it is necessary to investigate the potential barriers and facilitators of CRC diagnosis. Previous qualitative studies have discussed patient and system related delays to diagnosis using The Model of Pathways to Treatment (MPT) , 12, 13 The 28 participants in this study were previously surveyed as part of a broader quantitative study and had indicated their willingness to take part in an interview. All participants had been diagnosed with CRC within the previous year (study period from 2016 to 2019). They were recruited either through mail out or referral from a CRC cancer nurse specialist at one of the regional district health boards (DHBs) involved in the study .n = 3) or other  were not included in delay interval calculations. Participants resided in the midland region of NZ. Ethical approval for this study was granted by the New Zealand Health and Disability Ethics Committee . Three delay intervals were calculated, guided by the Aarhus statement - a guideline for reporting time intervals in cancer-diagnosis research , and a ptee Ref: /NTB/156.Potential participants were initially contacted via telephone and invited to take part in the qualitative phase of the study. A convenient time and day were arranged to meet for interview. Interviews were usually carried out at the participant’s home and were held from May–December 2019. Written and verbal consent had already been obtained from the earlier quantitative study, but additional verbal consent was also obtained and recorded via audio device immediately prior to commencement of the interview.Interviews were semi-structured. Before the interview commenced, the objective of the study was restated and study information was read, with an emphasis on the participants’ rights and confidentiality. Māori participants had the option of opening the interview with prayer (karakia), and a culturally driven process of building rapport between the interviewer and participants was followed (whanaungatanga). Participants were thanked for agreeing to participate and compensated with a $30 travel voucher for their time. All interviews were conducted by the same female interviewer (KN) and directed by an interview guide see .During the interview, participants were invited to speak about their experience of being diagnosed with CRC. A particular focus of the interview was to hear their experiences of symptoms, the timeline from first symptom recognition to diagnosis, their experiences with their GP and their awareness of CRC symptoms prior to diagnosis. All participants were invited to speak about any other information significant to their experience. No time limits were placed on interview duration. Interview data were recorded via audio device, and recordings were transcribed verbatim by the interviewer. All participants were offered the opportunity to review or amend their interview transcripts, however, no participants undertook a review.The MPT  was usedFindings are presented as an overall summary of the participants who experienced delay and those who experienced no delay, followed by rich data within each of the MPT phases and their subthemes. In the appraisal interval the subthemes were self-appraisal and self-management, symptoms worsen was a subtheme in the help-seeking interval, the diagnostic interval subthemes were other diagnoses and patient appraisal of GP. Table The first theme identified was self-appraisal. All symptomatic participants engaged in a period of symptom self-appraisal, which determined whether or not they consulted a GP. Self-appraisal typically began upon first symptom recognition, whereby the severity of that symptom was appraised and perceived either as ‘normal’  or abnormal . If symptoms were normalised, participants typically felt unalarmed, and a GP was less likely to be consulted. One participant normalised their tiredness due to a vegetarian diet, and decided that a GP was not warranted:But I’ve been vegetarian for about 15 years, and I’ve always had a naturally low blood iron level. I have always had a funny guts for, you know years, and years and years … before that I’d actually had a stomach ulcer. So I thought, oh probably something like that. .I brushed my diarrhoea off to a large extent, because I knew how my stomach reacts to, tension and stress. A GP was also not consulted if a symptom was perceived as an isolated case  or if participants attributed symptoms to a benign health issue. For example, if symptoms could be explained by factors such as recent dietary change, changes in exercise routine, stress, lack of fitness, diverticulitis, haemorrhoids, stomach ulcers or emotional tension, a GP was often not consulted immediately. One participant attributed food intake as being responsible for the blood in her stool:Often, I used to, when I wipe my behind, I often used to look at it and think, mmm- is there a sign of red in that? But then it was persimmons season, and it was summer we‘d been eating a lot of salads. Is it the beetroot, is it the tomatoes, is it the persimmons? I always found another excuse. In contrast, when participants perceived their symptoms as abnormal , a GP was more likely to be consulted. One participant assessed bleeding as a stark contrast to their usual bowel habits, which facilitated immediate help-seeking:It was just blood, everywhere, and the water just turned bright red … So I went up to the hospital. The emergency department. Others attributed COBH to previous experiences of stomach ulcers or psychological conditions:I kind of put my head down on my desk and my work colleague he walked past and he says, hey you! You better get to the doctors. You look terrible he says. You look like crap! I said thanks for that! Sometimes when I was at work, I couldn’t make it [to the toilet] and um, you sort of um, dirty underwear sort of thing. So changed my underwear every, twice a day, as it got really embarrassing you know? You are too frightened to sit down and have a smoko with the rest of the mates. And you know, they whether they could smell you, I don’t know, but- For all the participants, symptoms such as abdominal pain, unexplained weight loss and nausea were perceived as abnormal, and so facilitated a faster GP consultation than other symptoms.Many of the Māori participants included the impact of their symptoms on their sociocultural environment in their self-appraisal. In particular, symptoms were perceived as less concerning if they could stay private, but once the symptoms became obvious to others around them, they decided to seek advice.Self-management was a second theme identified in the appraisal interval. Once symptoms had been appraised, participants employed various self-management techniques. Self-management was usually informed by the type of symptom experienced, the participant’s perception of their own level of health literacy and their previous experience of self-managing symptoms. Self-management ranged from over the counter medication , to dietary or exercise routine changes, to simply waiting for psychological stress to abate:I have some diarrhoea tablets to stop the diarrhoea. It was bad diarrhoea. But, um, with the excitement of booking all our holiday and everything I just thought ‘oh its excitement, it will disappear once all that’s done’. .Self-management and self-appraisal were closely related behaviours. While self-managing, self-appraisal was commonly revisited as participants monitored the progress of the self-management strategies they were employing. Self-management, if successful, resulted in delayed help-seeking if participants felt symptoms had subsided to a more manageable level and therefore did not require professional medical help.During the help-seeking interval, the worsening of symptoms was an example of how severe symptoms had to get before a GP was consulted, so was an important facilitator to help-seeking. Self-management was often a temporary strategy, as participants not only reported the return of symptoms, but also usually experienced a pronounced increase in severity whereby symptoms became hard to manage :My symptoms weren’t improving in fact I think … just made it worse, you know, so I noticed a lot more. For some participants, it was an increase in the number of additional symptoms that warranted cause for concern and facilitated a GP consultation. One participant reported beginning with manageable symptoms that did not cause alarm, such as loss of appetite, however, as time progressed, additional symptoms presented and became unmanageable, prompting a GP consultation:In November, a year previously, I, um started having, weight loss and loss of appetite. [Then a while later] either constipation or diarrhoea [so I] went to my local doctor. For another participant, the smell associated with bloody stools prompted him to see his GP:The smell is the one that probably sticks out the most because it, it just, just lingers aye. It just sits on your tongue like ‘ugggh’. Some participants also recognised that symptoms had become unmanageable in their daily routine, as indicated by a change in their physical ability to perform usual household tasks, jobs or manage holidays. One participant reported a lack of energy for any non-work areas of life and another participant outlined the disruption a lack of control over bowel movements caused to a working holiday:My life consisted of going to work and coming home and getting my nightie on and going straight to bed. Every night. While I was over there, the pressures like going to the toilet, um was, chronic, and sometimes I’d go, and, and I’d go back to class and then, you know, 15 minutes later I think ‘Oh god I gotta go again!’ One participant reported that he was managing his symptoms initially, however once symptoms worsened, he was unable to complete his work efficiently and had to be close to a toilet throughout the day:I was going to the toilet around about 10 times a day then, and then um, it got worse. I was going 30 / 40 times a day … It was a nuisance. Like, I’d be up on the bloody roof  Oh sh**! Down the ladder, into the portaloo – you know? In this interval the Māori participants were more likely to consider the impact of their symptoms in relation to their families. This included overcoming their concerns about needing to accept help:You know in the mirror and you’re like that’s me, because I want to feel positive aye and I want to have pride aye. You know. I have a two year old daughter that um, man I want her to look up to me like, yeah ‘churr my dad’ she would like that. I don’t want to wait until later and write down, and go through all those emotions. Um, when I am meant to be strong for my children … I want to be there for that. Disruption to work and inability to manage a daily routine were important facilitators to seeking help for both Māori and non-Māori participants, and was an indicator that self-management options were exhausted/no longer effective and that their health was in a more serious state than initially thought.A prominent theme identified in the diagnostic interval was the participants’ perception that their symptoms had been misdiagnosed, either once or multiple times. Common misdiagnoses included haemorrhoids, menopause, diverticulitis, vitamin B12 deficiency, low iron, diabetes, stress, anxiety, irritable bowel syndrome, kidney stones and food poisoning, with GPs typically prescribing medication for these.Symptoms probably were, around about 10 months prior, um, to finally being diagnosed, and I’d been to my GP quite a few times of that 10 months period with my concerns, and his first comment was, you know ‘it’s probably just piles, you’ve probably just got piles.’ And I said ‘look, I’ve had them before, I know what pile bleeding is’ … I said, ‘This is quite a lot of blood’. I went back to the doctor and I said I’m a little bit concerned you know I’ve got this weight loss and I can’t understand it. I’m still eating. Although I don’t have a great appetite. But um, I’m noticing there’s blood in my stools. And he said to me ‘oh, do you think you might have piles?’ He [doctor] just thought I had irritable bowel syndrome and gave me medication for that which actually made me sick. Other diagnoses were reported more often by participants who experienced linger diagnostic intervals  and therefore was an important barrier to prompt diagnosis.Participants typically appraised their GPs performance throughout the diagnostic interval. If they perceived a high level of technical competence  a positive diagnostic experience was reported, but if participants perceived a poor level of technical competence, then they were more likely to report a negative diagnostic experience.Participants universally reported a positive experience if their GP investigated symptoms proactively, leading to a prompt diagnosis. For example, some participants praised GPs for having a high level of CRC knowledge (recognising symptoms) and taking the initiative in providing healthcare . One person perceived a high level of technical competence from their GP:I did go to my GP. And um, she did some blood tests and I was extra low in iron. So she gave me some iron. Um which made me feel a whole lot better. But in, in between times, she had already written to have a colonoscopy for me to have at [hospital]. Yeah so it’s, she obviously suspected something wasn’t quite right, you know, for losing all that iron out of my body so, yeah. So she then, got things cracking and she really did. And I was sent home because she said I had constipation … no scan, no nothing. He seemed to think I had piles, although he didn’t check. He never once, he never once examined me at all. Which I thought was really odd. But, I- in some ways, I think my doctor did fail, yeah, by lack of checking...he could have checked for haemorrhoids. In addition to the perception of technical competence, participants also assessed their GPs level of interpersonal competence based on their experiences of feeling respected, informed and cared about. Participants who reported having an overall positive diagnostic experience also perceived their GP to have a high level of interpersonal competence. Interestingly, interpersonal competence could often override perceptions about technical competence and a longer interval to diagnosis, and could still lead to a positive diagnostic experience:And in the interim again [waiting for non-urgent colonoscopy] we tried to- still tried to identify triggers and we tried to get another anti-nausea thing, that type of thing. Yeah so the on-going care, was, was happening, but not effective … So then, J*** who’s my GP, said okay well let’s try some, we will do some more blood tests etc and this time they did, an iron test … I’ve got the same GP I’ve been seeing for years, yeah, very, very good. He [doctor] said ‘you are under my care’. And that made a big difference, because it showed that somebody actually did care. I wasn’t just a number. In contrast, a failure to demonstrate interpersonal competence generated a negative diagnostic experience:He just didn’t really care, wasn’t interested and just, look-looked me up and down and just kept typing on his, on the computer. For one person, despite having received five earlier non-cancer diagnoses, experiencing a longer interval to diagnosis and cancer progression, it was the perceived lack of interpersonal competence that had the most negative impact:I stood at the reception and I, was actually treated quite disrespectfully, through this whole journey. Even by the receptionist because I think, I think they thought I was a hypochondriac … [So I said tell the doctor] I won’t be in for my B12 shot next week because I, I’m, I don’t have B12 deficiency. I have cancer. And I’ve never heard from them. Not an apology. Not a letter. Nope, nothing … and I just feel sorry for anybody else that’s been treated by him because we were just. We were just, I, you know I, I really feel that. Um, that particular company, just, get you in and out. Here’s some drugs, bugger off. We really don’t care. You know? And so all through this, I actually started seeing, I went and got counselling. While many of the participants described GP delays as frustrating or worrying, their more emotional descriptions of poor care tended to include incidences where they felt dismissed, ignored or disrespected.While the perception of a technically competent GP was associated with prompt diagnosis, a perceived lack of technical competence was an important barrier to diagnosis. For example, a lack of technical competence was perceived if GPs failed to perform appropriate medical examinations before offering a diagnosis. Several participants reported a lack of scans or rectal examinations:This study sheds light on the barriers and facilitators experienced by CRC patients who either did or did not experience a longer interval to diagnosis. For all the non-Māori symptomatic participants, the perception of an abnormal or previously unexperienced CRC symptom acted as a key facilitator to help-seeking behaviours. However, there was a barrier for some Māori participants who appraised their symptoms according to whether they were perceptible to their work colleagues or family. For all participants, self-managing and normalising symptoms acted as a barrier as no alarm was experienced. Symptoms worsening and an increasing inability to perform routine daily activities was identified as a key facilitator for the majority of symptomatic participants. This was particularly the case for Māori participants, who focused on their desire to involve their children as they made the decision to seek medical help. Other diagnoses being offered before clinical investigations, and a patient-appraised lack of GP technical competence acted as barriers to a prompt CRC diagnosis, whilst in contrast, a perceived high level of technical competence was found to be a facilitator to diagnosis. The perception of interpersonal competence was found to be a key facilitator to diagnosis and dictated the overall positive or negative GP-patient experience.The symptoms experienced by participants align with the current international literature  however,Failure to examine the patient was found to be a significant barrier to CRC diagnosis, and generated a negative overall experience. Participants perceived the absence of physical examinations (commonly for haemorrhoids) as a demonstration of a lack of technical competence in their GPs. This was further evidenced by the participant receiving a diagnosis of ‘piles’ along with prescribed medication, both of which contributed to a longer diagnostic interval. A combination of GP professional processes of diagnosing  with the way in which symptoms of CRC are commonly found to be present with other benign bowel diseases could offer a potential explanation as to why non-cancer diagnoses were offered. The appraisal of GP competence is a complex finding, nonetheless, further investigation, and improved access to diagnostic procedures such as colonoscopy for GPs is needed, especially considering the suggestion that NZ GPs have generally more limited access compared to other countries .Interpersonal competence was significant in all patient narratives and dictated whether participants had a positive or negative diagnostic experience. Interestingly, a GP displaying high levels of interpersonal competence could override poor technical competence in producing an overall positive diagnostic experience, even when the cancer was advanced. This finding indicates that interpersonal competence is more important to the patient than technical competence during the diagnostic process. However, the GP-patient relationship was significantly weakened if the GP was appraised as being technically incompetent in addition to not communicating that they cared about the patient.This study supports previous literature which indicates that barriers to CRC diagnosis are influenced by the nature of CRC symptoms and the individualised symptom experience , 18, 20 Facilitators to GP consultation and CRC diagnosis identified in this study also support previous literature. Normalising of symptoms by participants acted as a barrier and delayed help-seeking . SymptomOverall, the findings from this research hold broader implications relating to the health promotion, health campaign, and CRC symptom education contexts in NZ. Tailoring CRC health messages and information to the non-clinical and culturally diverse audience is crucial for CRC symptoms to be recognised and diagnosed quicker, as recommended by previous literature , 29. ThiIn addition, a key message is the importance of interpersonal and technical competence. Minimising the perception of a lack of technical or interpersonal competence could strengthen GP-patient relationships. Consequently, this could reduce the amount of reported complaints to the Health Commissioner about GPs failure to examine or adequately perform GP duties in the future.A major strength of this study was that the patient was enabled the space to speak about their diagnostic experience from their perspective, with Māori participants able to contribute their stories in a culturally safe manner. Whilst this is a qualitative study and findings cannot be generalised, the findings support the broader quantitative research project by providing a more comprehensive understanding of the appraisal, help-seeking and diagnostic intervals that lead to CRC diagnosis. Another strength was the range of participants included in this project, including age, gender, cancer stage and geographical location across the Waikato. Future directions could include a more focussed investigation into (1) the differences in CRC symptom discourse between clinical and non-clinical perspectives and (2) the experiences and processes employed for self-treatment by individuals, as this research identified these two contexts to be significant in the CRC diagnosis experience.The findings of this study help to understand the lived experience of the CRC diagnosis in the NZ population as well as identify barriers and facilitators present in the diagnostic experience. These findings indicate a significance of tailored CRC symptom communication in any future health campaigns, as well as indicating the significance of the interpersonal competence aspect of GP-patient interaction, which can generate a positive diagnostic experience despite delays in diagnosis and repeated misdiagnosis. These findings suggest that interpersonal competence be overtly displayed in all GP interactions to ensure a higher likelihood of a positive GP experience for the patient.Additional file 1. Supplementary material. COREQ Checklist. Completed COREQ checklist.Additional file 2. Supplementary material. Interview guide. Interview guide used.


Catharus guttatus) as an example, I discuss how the song of a single species has been described by writers from a variety of disciplines, including music, literature, and the sciences, as well as how we can contextualise these varied perspectives in terms of broader cultural thought trends. I end with discussion of how combining approaches from multiple fields can help us to figure out new questions to ask, can help us identify how our own cultural biases may affect how we hear birdsong, and ultimately can help us develop richer and more nuanced understandings of the songs themselves.Birdsong is widely analysed and discussed by people coming from both musical and scientific backgrounds. Both approaches provide valuable insight, but I argue that it is only through combining musical and scientific points of view, as well as perspectives from more tangentially related fields, that we can obtain the best possible understanding of birdsong. In this paper, I discuss how my own training as a musician, and in particular as a composer, affects how I listen to and parse birdsong. I identify nine areas of overlap between human music and birdsong, which may serve as starting points both for musical and scientific analysis, as well as for interdisciplinary analysis as practiced in the developing field of “zoomusicology.” Using the hermit thrush ( Catharus guttatus) as an example, I discuss how the song of a single species can be understood from a variety of perspectives, including musical, poetic, naturalistic, and scientific, as well as how we can contextualise these perspectives in terms of broader cultural thought trends. I end with discussion of how combining approaches from multiple fields can help us to figure out new questions to ask, can help us identify how our own cultural biases may affect how we hear birdsong, and ultimately can help us develop richer and more nuanced understandings of the songs themselves.Musicians and ornithologists alike have a long history of listening closely to, analysing, and writing about birdsong, but they typically do so in very different ways. Musicians are more likely to focus on the subjective or visceral experience of hearing the song, or to look for points of comparison with human music. Scientists, on the other hand, tend to focus on objective description, gathering quantifiable data, and finding functional explanations for song structure and singing behaviour. Both approaches provide valuable insight, but I argue that it is only through combining musical and scientific points of view, as well as perspectives from more tangentially related fields, that we can obtain the best possible understanding of birdsong. In this paper, I discuss how my own training as a musician, and in particular as a composer, affects the way I listen to and interpret the songs of birds and other non-human animals. I identify nine areas of potential overlap between human music and birdsong, which can be used as starting points for both musical and scientific analysis, as well as for interdisciplinary analysis, as practiced in the developing field of “zoomusicology.” Finally, using the hermit thrush (Turdus merula) for the first time, shortly after I had moved from Canada to the Netherlands to study music composition. I was fascinated by the way small bits of what it sang sounded a lot like human music – clear, pure notes, repeated phrases, scale‐ and arpeggio-like passages, and so on – even though the structure of its song as a whole was very different than any of the human musical forms I was aware of. I decided to explore blackbird song through writing a piece of music based on a series of blackbird motifs (short sequences of sounds): I would arrange these motifs first in a blackbird-like way, and then gradually transform their organisation into something more typical of the human music I knew. I began by transcribing the song of the blackbird outside my window into musical notation and making a list of the differences between the ways, I thought the blackbird and a human might arrange the same collection of motifs. Here are a few , was influenced by the songs of birds native to Ustilug (Ukraine), where he spent his summers  that still makes up the bulk of a classical music education, there are many kinds of music that do sound like birdsong  younger blackbird with a simpler, more repetitive song that would not have been at all suitable for my piece. To finish it, I had to transcribe the song of the blackbird in a friend’s garden instead. That song was just as interesting as, but completely different from, the song of the original blackbird. I had not known that the songs of different birds of the same species could vary so much. I started reading ornithological literature and learned about vocal learning, imitation, and dialects in songbirds . Though the sound and motivic structure of Eurasian blackbird song is what had initially piqued my musical interest, it turned out there were behavioural and cognitive similarities between music and birdsong too. Birdsong, like my own composing, was a cultural activity .Catherpes mexicanus) are frequently described as singing “in the chromatic scale” , typically defined as the study of the “aesthetic use of sound communication among animals” , and of animal musicality in general; Megaptera novaeangliae) song. Introductions to zoomusicology as a field include texts and online resources by The term “zoomusicology”  from other humans. Vocally learning birds [songbirds (oscine passerines), parrots, and hummingbirds; b. Culture: Vocally learning species learn the music/vocalisations of conspecifics around them, rather than of their genetic ancestors. For example, just as humans learn the music they hear or are taught, songbirds of the same species in different regions may sing different versions of their songs, called “dialects” , timbres, durations, and other sound elements to create recognisable motifs or phrases, which may recur within or between pieces/songs, or may be varied throughout the piece/song  sing in repeated four-part form (ABCD), with males singing the A and C parts and females the B and D parts , continually order and reorder a fixed or variable set of motifs, more akin to improvisatory forms of human music  supports the idea that some non-human species, too, may sing in part for “intrinsic reward” . Each song-type consists of a long “introductory whistle,” followed by one or two phrases of cascading shorter notes. The song may also contain some trills, multi-pitches, and noise sounds, but clear notes with a measurable pitch (“steady-pitch notes”) predominate  North American songbird with a song that is widely considered beautiful . They lic, d, e;. Song-tyd, e, g;c, d;Hylocichla mustelina; a, b;a, d, and e). Further research is needed to determine whether or not there are adaptive reasons for the divergent song characteristics between eastern and western populations, and whether these differences are perpetuated genetically or culturally (f).Song-types are presented with immediate variety in a semi-fixed, semi-unpredictable order, reminiscent of a second order Markov chain d, e, g;, with solturally . If thesNaturalists, musicians, poets, and scientists have all written extensively about the hermit thrush since the early 1800sCatskills-born naturalist John Burroughs (1835-1927), whose seminal “nature essays” were formative in the developing American conception of nature and the wild , p. 278,This song appeals to the sentiment of the beautiful in me, and suggests a serene religious beatitude as no other sound in nature does. “O spheral, spheral!” he seems to say; “O holy, holy! O clear away, clear away! O clear up, clear up!” interspersed with the finest trills and the most delicate preludes. It is not a proud, gorgeous strain. Suggests no passion or emotion, – nothing personal, – but seems to be the voice of that calm, sweet solemnity one attains to in his best moments. It realises a peace and a deep, solemn joy that only the finest souls may know. Listening to this strain on the lone mountain, with the full moon just rounded from the horizon, the pomp of your cities and the pride of your civilisation seemed trivial and cheap , p. 51.In this, as well as in many similar passages published between then and his death in 1921, Burroughs emphasised the hermit thrush’s reclusive nature (“on the lone mountain”), the music-like beauty of its song (“the finest trills and the most delicate preludes”), and the song as a potential conduit to the holy .When Lilacs Last in the Dooryard Bloom’d (1866) and Starting from Paumanok (as published in the 1867 version of Leaves of Grass), using imagery borrowed directly from Burroughs. The bird is solitary: “The hermit withdrawn to himself, avoiding the settlements”  in 1865, and shared with him his enthusiasm for the hermit thrush. Whitman made prominent reference to hermit thrush song in his poems lements” , p. 4. Ilements” , p. 11. lements” , p. 16. lements” .Wood Notes Wild, musician-turned-naturalist Field Book of Wild Birds and Their Music, believed that the hermit thrush had a sense of harmonic progression. “Not content with a single key, he deliberately chose several in major and minor relationship….” He went on to compare hermit thrush song to Beethoven’s Moonlight Sonata, as well as to passages from Wagner and Strauss (240–244). Biologist Late 19th and early 20th century poetic and naturalist writing about the hermit thrush were thus deeply intertwined. But while poets typically stuck to emotive and symbolic representation of hermit thrush song, those writing nature essays and guides often attempted to record and communicate the sound of the song itself. For this, they turned to musical terminology, in what might retroactively be seen as some early essays into zoomusicology. In From today’s vantage point, most would agree that although a birdsong might sound like human music – and might even be its own kind of music – it is vanishingly unlikely that it would be organised according to the principles of Western classical music, or indeed the music of any specific human culture , p. 24. Field Book of Wild Birds and their Music provide clear evidence of how belief informed the supposedly objective finding of pentatonic scales in hermit thrush song. Whereas in the 1904 version of Field Book Mathews enthusiastically described the song in terms of the major and minor scales of Western classical music (see above), in the preface to the 1921 version he stepped back from his earlier analysis. “It may seem rather extravagant praise to sum up the song of the Hermit Thrush in the unqualified terms I have used on pages 256–257…” , two use three pitches, and one was un-notable, leaving only one that actually uses five notes. The idea that hermit thrush song was based on the pentatonic scale comes not from observation, but from ideology. As ornithologist The Nature of Music and the Music of Nature, was published in the prestigious and widely read journal Science, lending new credibility and visibility to the myth of the hermit thrush pentatonic scale. Subsequent writings such as articles by Natalie A book preface from 1921 or a one-off paper from 1951, which misinterpret hermit thrush song would be little more than a historical curiosity, had they not somehow captured the imagination of not only the general public, but also of numerous subsequent researchers. To give just a few examples, A. A. Hopkins repeated Mathew’s belief that hermit thrushes sing pentatonic scales in a 1922 Scientific American article, claiming that “The hermit thrush has the distinction, above all other birds, of having developed the Scotch, or pentatonic scale… the musical mode instinctively adopted by primitive man,” and Wing’s research was cited in work by It is not surprising that European and North American writers before the mid-20th century used Western classical music theory as a framework for understanding birdsong. Lack of recording equipment meant they had to make on-the-spot analyses based on one-time hearings of the songs, and an anthropocentric and Eurocentric worldview was so deeply ingrained as to be invisible to its adherents. Those who understood the world from a non-Eurocentric point of view would have had less access to publishing, especially in a scientific or scholarly context. These early naturalists mapped what they heard on to what they knew, and described the song as accurately as they could with the limited set of tools and contextual knowledge available to them. But as mid-century technological advances began to allow repeated listening, listening to the song in smaller sections and at reduced speed, visualisations of sound, and more objective measurement, and as researchers began to understand that a Western outlook was not the only one possible, the belief that hermit thrush song should be based on either Western classical music or its imaginary other, “primitive” music, became increasingly untenable.Perhaps in an effort to avoid the now-glaring errors of anthropomorphism and Eurocentrism made by earlier writers, recent scientific writing about hermit thrush song has tended to avoid substantive musical comparisons (though the timbre is sometimes referred to as “flutey” or “flute-like”). The following descriptions are typical:Each song began with the characteristic introductory whistle, followed by a distinctive, complex series of fluty warbles , p. 468.Their song frequency band was 1.4–8.6 kHz… The song begins with an introductory note… followed by a series of flute-like body notes. Many songs also contain structures like the upsweeps. The bird… had an 11-song repertoire that contained about 350 notes and structures , such that introductory note frequencies were not normally distributed throughout their range .more than just facts. Metaphor is language’s essential anchor, and thin language distances us from animals, impoverishes our understanding of animal abilities, and disguises how songbirds serve the human imagination.”The Singing Life of Birds, published after his retirement from academia, but this kind of musical comparison never makes it in to his scientific publications.These descriptions are objectively true, but are also less evocative of the sound and structure of the song than the earlier descriptions which fit it into a human musical framework. They also serve to distance us from our emotional, visceral, and aesthetic reactions to hearing birdsong and from our sense of connection to other species. As Abandoning inappropriate frameworks for understanding birdsong is essential if we wish to understand the songs on their own terms. But to ignore entirely our subjective apprehension of the songs is to discard one of the most important tools, we have for making sense of the world around us. We can never know exactly how a bird thinks about or hears its own songs, but as living beings with the ability to make and interpret our own complex vocalisations, we may be able to bring insight that is lacking in purely objective analyses. Indeed, automated categorisation of sounds is still calibrated against human aural and visual categorisation as a measure of accuracy . Though In 2008, I embarked on a collaborative research project with evolutionary and cognitive biologist (and accomplished amateur musician) Tecumseh Fitch, music theorist, and cognitive biologist Bruno Gingras, and computational psychologist Domink Endres . We wantc, d, and e;We began our research by listening to hermit thrush songs as we would listen to music, searching for any patterns or processes that might give insight into the structure of the songs. After first listening to hermit thrush recordings at full speed, we slowed them by a factor of four (using the software Raven Pro) to bring them into a more comfortable frequency range and tempo for human auditory processing. We heard immediately that most of the song-types seemed to follow the overtone (or harmonic) series . The birds never sang the fundamental of the series (which would be too low for a bird of that size to produce), but for each overtone-based song-type, all the pitches in the song (except the introductory whistle) were drawn from harmonics three through 12 above an unvoiced fundamental . And just as importantly, the overtone theory is plausible. While many cultures have some music which uses only five pitches, there is no culturally independent “pentatonic scale”: each culture that uses five note scales constructs, conceptualises, and/or uses them very differently. In other words, while there may be multiple kinds of pentatonic scale, there is no such thing as “the pentatonic scale.” The overtone series, on the other hand, is a physical phenomenon, present in many kinds of pitched sound, both natural and human-made. Many human musical cultures derive scales, melodies, or harmonies from the overtone series , and the pitches used follow a harmonic rather than scalar distribution – that is, the intervals sound closer together as they get higher, rather than being fairly equally distributed across an octave and repeated at each octave  and regionally varied (b); it uses a limited selection of pitched and non-pitched elements to create individually distinctive songs , which are presented in a species-characteristic, semi-unpredictable order (d and g), primarily during breeding season (h). We do not yet know if the hermit thrush enjoys its song (i), but research on other songbirds . This expanded and updated version appears here with permission of the original publisher.This paper is based in part on an earlier essay, entitled The author confirms being the sole contributor of this work and has approved it for publication.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The world has been affected by an outbreak of the novel coronavirus (COVID-19). Health care workers are among those most at risk of contracting the virus. In the fight against the coronavirus, nurses play a critical role. Still, most social media platforms demonstrate that nurses fear that their health is not being prioritized. The purpose of this study is to investigate nurses’ experiences through analyzing the main themes shared on Instagram by nurses during the COVID-19 pandemic. In contrast with highly structured research, the current paper highlights nurses’ natural language use in describing their experiences during the first months of the outbreak in their workplace. Instagram captions were utilized as a data source. Leximancer was utilized for the content analysis of nurses’ narratives towards their coronavirus experience. We sought to accomplish three research objectives: the first was to identify the main themes in the descriptions of nurses’ experiences shared via their social media, specifically Instagram; then, to determine the relationships among concepts, and finally, to give useful implications based on the findings. The current study uses a qualitative  approach to analyze the main components of the nurses’ experiences during the pandemic. The Leximancer software analysis revealed nine major textual themes and the relationships among these themes. In order of the relative importance, the themes were “patients”, “coronavirus”, “exhaustion”, “family”, “hospital”, “personal protective equipment” (PPE), “shift”, “fear”, and “uncertainty”. The results offer practical implications based on the social media information regarding nurses’ overall experiences. In the early months of 2020, a novel virus, coronavirus COVID-19), became an international issue 9, became. This inIn every country, nurses are being praised for their efforts, and countless encouraging messages are relayed to medical workers through social media platforms. Nurses play an important role in COVID-19 prevention and response efforts. The nursing profession is a leading profession internationally, with approximately 3.8 million nurses in the United States (US) and over 20 million nurses worldwide.Nurses assumed the closest contact with COVID-19 patients during this period. Therefore, nurses have undertaken the most important tasks in rescuing critically ill patients and curing infected patients in the COVID-19 period . While tNurses experience mental stress and may feel isolated and abandoned in the face of health fears and burdens from the high-intensity work triggered by this type of public health tragedy . EarlierResearch has revealed that the occurrence of depression, insomnia, and post-traumatic stress among nurses involved in the treatment of SARS patients was 38.5%, 37%, and 33%, respectively . In an iIt is disgusting”, one nurse wrote. More than 1200 nurses shared a private online document to share their stories of combatting the COVID-19 pandemic on the front lines. In their profiles, they stated that the outbreak had turned US hospitals into “war zones.” They stated that they were frightened to go to work and worried that they will become ill. They complained about the top management of hospitals who seem careless towards their difficulty [Several nurses have shared their experiences via their social media accounts, which was reflected in newspapers. For example, a nurse in the United States (US) used a social media platform to show the poor working settings that might put ill people at jeopardy. “fficulty .Another nurse in Italy shared a picture through her Instagram account saying that “I afraid to go to work” during the pandemic, but she continued to do so since she “honored” and respected her profession. She also added that “I am frightened since the personal protection equipment didn’t provided enough”. She also added that she was mentally exhausted. On her Instagram account, she stated that “the lab coat makes me sweat,” and that, once she is dressed, she is not allowed to “go to the restroom or drink for seven hours” in order to diminish any possible virus spread. Her post was liked over 800,000 times, and followers shared supportive and appreciative comments for all nurses in this post . As seenUnderstanding nurses’ experiences is essential to ensure that appropriate support is given to enable labor retention and high-quality clinical practice at a time when society’s health necessities are extraordinary. However, academically, inadequate research has been published regarding the experiences of nurses during a pandemic ,19. The To our knowledge, there are no previous studies analyzing user-generated content from social media regarding nurses’ experiences. The current study uses the social media platform Instagram and emic material as a window to process the assessment of nurses’ experiences during the COVID-19 pandemic. By incorporating the nurses’ reviews shared on Instagram, we attempted to ascertain the dominant concepts used by nurses when reporting their experiences during the COVID-19 outbreak.The current study contributes to nursing literature at least in three ways: first, we crystalize the main themes during the outbreak of COVID-19 as expressed by nurses on the social media platform Instagram. Second, we explore the inter-relationships among concepts expressed within Instagram captions shared by nurses during coronavirus. Third, we suggest important managerial insights for hospital administrations. Therefore, the aim of this paper was to determine the prominent themes shared on Instagram by nurses during the COVID-19 pandemic.All subjects gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of Cyprus West University (project identification code 2020/01–22). The Ethics Committee of Cyprus West University decided that the current research did not meet the definition of human subject research. This was on the basis that the current research was a review of publicly available social media posts and did not involve interactions with human subjects. All social media posts utilized in this research were publicly available and viewable to any website visitor ,27. WithThe source for the captions analyzed in the present study was Instagram, which is considered one of the world’s largest social media platforms . The InsSocial media has become ubiquitous in modern life and provides a large and readily available platform through which the public may receive information about nursing . One wayIn this research, two of our specialist authors were included in the data collection process. The data collection and analysis respected the reviewers’ anonymity . PhotogrIn order to include eligible nurses in the dataset of the study, the nurses had to meet a number of inclusion criteria: (1) being a nurse and having posted a photo with scrubs; (2) posts should include a caption; (3) captions should be written in English. During searching for nurses’ profiles, some key hashtags were used to reach a high volume of nurses. The most popular hashtags were entered, including #nurse, #nursing, #nurselife, #nursepractitioner, #instanursing, #nurseproblems, #nursesrock, and #nurselife. The selected hashtags were those most-used among nurses according to recent data .The data collected from Instagram were the nurses’ sex, residency, tags they used, and caption text. Data collection period started from May to June. According to the data collected, 444 Instagram captions were written by female nurses (88.8%) and 56 by male nurses (11.2%). Around a third or 32% of the captions were posted by European nurses, 56.4% by nurses from the United States, 4.2% by United Kingdom nurses, and 7.4% from other regions.Content analysis has earned popularity as an essential technique to understand the fast-growing form of communication on the web . ContentContent analysis can, thus, be achieved with structured quantitative or unstructured qualitative approaches . These iIn the current study, there were four steps to determine the concept map as illustrated in Figure 4 below. To be able to generate the conceptual map, a number of steps were performed. First, the data we collected from Instagram were copied to an Excel file. Then, we added the Excel file into the software. As can be seen in As mentioned earlier, concepts are collections of correlated words that encompass a central theme. Once these lists of words were identified for each concept, the concept map was generated to illustrate the relationships between the concepts in the text. The thesaurus displays a list of concepts, the number of iterations performed by the thesaurus learning system, while generalizing from the seed words to the concepts, and producing a ranked list of the thesaurus words that define and describe each concept . The theAs in earlier research utilizing Leximancer ,37,50,51The content analyses revealed the existence of nine themes in the nurses’ descriptions of their experiences during the outbreak of COVID-19 : “patienAs seen in We collected 500 Instagram captions shared by nurses (reviews) from the social media platform, Instagram. The dataset included 50,992 words in total. The nine themes were found to be the essential aspects and the most-mentioned themes among nurses who worked during the pandemic. Twenty-five concepts were recognized as a result of the analysis. The more the concepts were located within a theme, the more the sense of the theme was articulated. A preliminary understanding of In this study, nurses shared narratives in their captions regarding some of the difficulties they faced during the pandemic. Long working hours, a lack of protective equipment, daily increased exhaustion, personal health, and the risk of loved ones facing outbreaks are just some of them. Looking at it historically, nurses have always been at the forefront of combating health-threatening outbreaks worldwide, and in the future, they will also continue to do so. This research was especially focused on nurses’ experiences during the coronavirus period.In contrast to previous research, this study stressed the nurses’ natural language use in describing their experiences during the outbreak in their hospitals. Instagram captions were used as research materials. Leximancer 4.5 was utilized to analyze nurses’ Instagram captions during the coronavirus. The current research sought to accomplish three research objectives, the first of which was to identify the main themes in the descriptions of nurses’ experiences shared via the social media platform Instagram and then to find the relationship among concepts.The study also analyzed the main components of the nurses’ experiences during a pandemic. Leximancer 4.5 was applied and identified nine major textual themes and the relationships among these themes. In order of relative importance, the themes were “patients”, “coronavirus”, “exhaustion”, “family”, “hospital”, “personal protective equipment” (PPE), “shift”, “fear”, and “uncertainty”.The use of Leximancer delivered a more inclusive framework of the nurses’ experiences during the coronavirus outbreak by providing a visual concept map with philological conceptions. These approaches are different from other content analyses, which simply present word occurrences and links. The results from Leximancer noticeably demonstrate the examination of blog texts and make it stress-free to trace back to the essential lexical concepts.The purpose of this study was to investigate nurses’ experiences through analysing the main themes shared on Instagram by nurses during the COVID-19 pandemic. In the current research, patient and care concepts had a high likelihood percentage, which shows that although nurses were under challenging conditions, they paid great attention to patient care, which is their first and foremost duty. In their Instagram captions, nurses shared positive narratives regarding patient care. Consistent with our findings, one study found that nurses during their interviews emphasized their patients’ goodwill, respect, active cooperation, and gratitude during the COVID-19 pandemic .Although nurses as a health ambassadors have to deliver health services for patients consistent with their major duties and ethical values , there wPositive attitudes towards patients infected with transmissible diseases represent an essential element in the appropriate care of patients . Nurses In addition, one study demonstrated that nurses facing virus catastrophes displayed a clash between their roles as healthcare workers and feeling self-sacrificing, professionally accountable, fearful, and guilty regarding possibly transmitting the virus to their wife/husband, mother/father, or daughter/son at the same time . AnotherThe second striking theme in the study was “coronavirus”. Coronavirus themes included concepts, such as fight, motivation, and proud. In the narratives of nurses that were shared on Instagram, the nurses shared narratives around “proud”, where they reflected on the coronavirus pandemic and they revealed that they were proud of their work. Nurses mentioned the theme of “fight” in their narratives towards coronavirus, which shows their dedication to helping fight the pandemic. Nurses shared stories using the concept of “motivation” during the coronavirus phase.According to Min and colleagues , nurses In the study, the theme of exhaustion appeared as another main theme. The theme of exhaustion had a strong relationship with several concepts. Most of the exhaustion themes were linked to exhaustion, marks (due to PPE), shifts, and life. Exhaustion was a concept for nurses to express their thoughts and impressions during coronavirus in this current research study. Nurse exhaustion is a “work-related situation that ranges from severe to long-lasting in nature and can generate an overwhelming sense of tiredness, reduced dynamism, as well as tiredness resulting in impaired physical functioning, cognitive functioning, or both” .The nurses caring for COVID-19 patients felt extreme physical exhaustion and pain triggered by the virus, heavy work circumstances, long shifts, a high volume of patients, and inadequate personal protective equipment, which was parallel with the past and present research on the outbreak of MERS-CoV  and EbolAnother study investigating the link between burnout, anxiety, and stress disorders during the COVID-19 pandemic showed that nurses experienced high levels of mental health problems, including emotional exhaustion . A qualiIn our study, the theme of “family” was used in different senses in the narratives shared by nurses on their Instagram accounts. In their narratives, some nurses called on people to stay home in order to prevent endangering their families with the possibility of coronavirus infection. Some nurses shared narratives of having coronavirus and transmitting the virus to their loved ones and families. The family theme was linked with concepts, such as family (20%), patients (18%), challenging (18%), and risk (14%).Nurses, in general, face challenges in balancing work and family . ResearcIn our study, “uncertainty” was another mentioned theme. In line with our research, uncertainty was observed during the SARS period on nurses . One stuAnother theme that appeared in this study was “fear”, which shows the nurses shared narratives that included the theme of “fear” towards coronavirus. Nurses’ fears regarding an unknown infectious disease could quickly be intensified to higher levels. Although nurses make a promise to practice professionally, they can still feel fear and even experience worries regarding contagious diseases . The resConsistent with our results, research has displayed that nurses often experience psychological problems, for instance depression, nervousness, sleeplessness, and strain, and those at the frontline of combating coronavirus have more severe psychological problems ,77. A reThe analyses of this research reveal that personal protective equipment (PPE) is the critical issue that nurses share narratives on. Concepts, such as “necessary” and “marks” (left on their faces), were used together with PPE in the narrative of nurses. The perceived absence of PPE was a factor in nurses’ distress and worries regarding working during pandemics . ProtectIn addition to a deficiency of PPE causing fear and distress among nurses, skin reactions from the gloves, gowns, or face shields that were also worn by nurses for long hours during the existing pandemic discouraged nurses from using them . The weaThe aim of this study was to find the main themes shared on Instagram by nurses during the COVID-19 pandemic. Leximancer 4.5 was applied and used to identify nine major textual themes and the association among these themes. In order of the relative importance, the themes were “patients”, “coronavirus”, “exhaustion”, “family”, “hospital”, “personal protective equipment” (PPE), “shift”, “fear”, and “uncertainty”. The use of Leximancer portrayed a more inclusive framework of the nurses’ experiences during the coronavirus outbreak by providing a visual concept map. These approaches are different from other content analyses that simply present the word occurrences.Findings from this research show that the coronavirus substantially affected the psychological state, workload, health provisions, and safety concerns of nurses. The mentioned factors also have the potential to impact the quality of care given by nurses. This study provides nurse leaders and policymakers with nurse-oriented evidence to comprehensively plan and better optimize the allocation of nursing resources in line with the aims and objectives of healthcare centers during the COVID-19 pandemic.This research offers insights into understanding the perception of nurses during the coronavirus pandemic, based on the narratives these nurses shared online. Leximancer’s analytical tools enabled the identification of the main themes in nurses’ overall experiences during a pandemic with minimal intervention from the researchers. There have been a few studies that have analyzed the COVID-19 experiences of nurses using quantitative methods [Nurses’ sense of duty, commitment to patient care, personal sacrifice, and professional teamwork increased during the COVID-19 pandemic. Although nurses shared narratives on fears, family welfare, and panic, as well as defenselessness, their positive narratives and hashtags also demonstrated care for their patients and how much they love their job. Almost all nurses shared narratives supporting a willingness to accept the jeopardies of their duty during the COVID-19 pandemic. The important effect of nurses’ experiences highlights a need for strategies around self-care and ongoing support to ensure that the health of nurses is maintained.Hence, a method of increasing the quality of patient care might be an attempt to set or improve the best-fit bundle of human resource practices and provide sufficient resources in the implementation of high performance work practices (HPWP). Recent studies have shown that HPWS improved patient care quality among nurses ,86. HighWork related fatigue includes not only physiological aspects but also emotional, cognitive, and sensory elements that result from a high workload and insufficient time for energy recovery . In the To minimize nurse exhaustion during the coronavirus period and the associated adverse nurse and patient consequences, additional useful or achievable characteristics of work structures should be reformed . Hospitals might reflect shorter working hours, systematic rest periods, and rotating shifts for those working in high-risk areas if possible . A novelIn the study, the narratives shared by nurses repeated the theme of “personal protective equipment” (PPE). The results of the analysis show that the PPE theme was associated with the concept of “necessary” as well as “risk”. Undoubtedly, the necessity of PPE created a problem of immense distress and intensified the risk and anxiety for nurses. Therefore, PPE should be utilized according to the risk of experience  and the contamination dynamics of the pathogen . The excessive utilization of PPE will have an extra effect on stock deficiencies. Therefore, the “rational use of personal protective equipment (PPE) for COVID-19” prepared by World Health Organization  should bAnother theme that appeared in this study was “uncertainty”. Previous research has stated that uncertainty occurs in a situation where an event or a disease cannot be adequately defined or categorized, or the outcome predicted . In the The current research cannot be generalized as it has certain limitations. The first limitation is the sample that was used in our research. We collected our data from Instagram. It would be interesting to conduct this research with more participants. The second limitation of this research is the cross-sectional time span used in this study. Due to this, there is potential causality and reciprocal associations between components . This stOur study collected data from a single social media platform—Instagram. Further studies could compare the user-generated content of nurses from different social media platforms  to analyze the relevance in comparison with this paper’s findings. Different research methods will be useful, for instance, surveys and interviews with nurses who have encountered coronavirus. These further studies may focus on the intention to care, COVID-19 patients, psychological distress among nurses, and uncertainty and its effects on nurses. Future research may expand the range of available data and provide comparisons among different countries-of-origin and different cultural groups to expand the knowledge regarding nurses’ experiences during the pandemic.


Big, beautiful organisms are useful for biological education, increasing evolution literacy, and biodiversity conservation. But if educators gloss over the ubiquity of streamlined and miniaturized organisms, they unwittingly leave students and the public vulnerable to the idea that the primary evolutionary plot of every metazoan lineage is “progressive” and "favors" complexity. We show that simple, small, and intriguingly repulsive invertebrate animals provide a counterpoint to misconceptions about evolution. Our examples can be immediately deployed in biology courses and outreach. This context emphasizes that chordates are not the pinnacle of evolution. Rather, in the evolution of animals, miniaturization, trait loss, and lack of perfection are at least as frequent as their opposites. Teaching about invertebrate animals in a “tree thinking” context uproots evolution misconceptions , provides a mental scaffold for understanding all animals, and helps to cultivate future ambassadors and experts on these little‐known, weird, and fascinating taxa. There are many twists and turns in the tree of life. In this paper, we urge biology educators to include examples of evolution that remind students that evolution does not always result in organisms that are bigger, smarter, and/or more beautiful. There is grandeur in this view of life, with its several powers, having been originally breathed into a few forms or into one; and that, whilst this planet has gone cycling on according to the fixed law of gravity, from so simple a beginning endless forms most beautiful and most wonderful have been, and are being, evolved” Darwin, .Understanding evolution is a cornerstone of scientific literacy Allmon,  that invscala naturae or Linnaeus's classification of animals, are still common in modern textbooks  teaches invertebrate zoology at SUNY‐ESF, so she has used many of these examples in the classroom. Both JCM and RJR have taught the general evolution course at SUNY‐ESF, and we find at least some mention of the themes discussed below is important as a conceptual counterpoint when talking about sexual selection, or the evolution of whales or hominins. We certainly think that traditional, charismatic systems are still useful in the classroom  appeared in the fossil record around the same time, 541–520 Ma  have only 68 neurons  lived to be 507 years old , but they share a phylum (Mollusca) with many tiny organisms such as Ammonicera and Condylonucula, a snail and a clam genus, respectively, that each contain at least one species that never gets larger than a half a millimeter. In North America, Europe, and New Zealand, the land snail fauna tends to be composed of 40% to nearly 100% of taxa that are 5 mm or less  is killed are parasitoid relationships: more lethal than some forms of parasitism and more prolonged than regular predation. There are probably more than 100,000 insects that are parasitoids, mostly in the hymenopteran superfamily Chalcidoidea , and the blanket octopus Tremoctopus violaceus (Mollusca) , mentioned earlier: The male is only 50 µm, and so is one of the smallest animals known. Arguably, the most extreme is what are almost unicellular males in the scale insect Icerya purchasi (Arthropoda). This species, and perhaps others related to it, have unipotent sperm present in all observed females. These sperm can undergo cell division and fertilize the female's eggs inside her body. During or immediately after fertilization, other sperm associate with the egg before oviposition and live commensally in the developing female. There does seem to be loosely organized spermatogenic tissue in the female, but it seems to be descended from a line of sperm that can persist in the female's body, then fertilize her eggs, and be passed down transovarially .Cope's rule has a long history in paleontology as an appealing hypothesis to test Newell, . Recentl–6 mm3 by the present. This is actually close to the body size of the smallest animals: The smallest gastrotrich likely has a biovolume of ~6.67 × 10–6  predicted by the model Heim et al. designed to simulate Cope's rule style of evolution have evolved in at least 5 animal phyla: the Gastrotricha, Rotifera, Nematoda, Annelida, and Arthropoda  or exapStanley, .5Many evolutionary biologists have emphasized that very beautiful organisms can evolve, but we think it is important to emphasize that evolution does not always lead to forms that the average person might immediately think are elegant or esthetically appealing. Thus far, we have focused on reversals and evolutionary lability, but certain groups may be ancestrally restricted in the ways they can develop: They are subject to constraint. This can sometimes result in strange, imperfect solutions to adaptive problems that other organisms have solved in seemingly more elegant ways Figure ,c. For eJust as most humans have an instinctive aversion to the thought of feces near their heads, many have an aversion to parasites. Parasitism has been discussed earlier as a means by which “regressive” evolution has occurred, often concurrently with the origination of evolutionary novelties: Cestode platyhelminths (tapeworms) possess interesting morphological innovations such as an anterior scolex that securely fastens them to the tissues of their interiorly facing home Figure , and somHarpactea sadistica, the male actually seems to envenomate the female first and then punctures her abdomen (or opisthosoma) with his accessory genitalia  to inject sperm into her, often 6 or more times  and allowing for ~40‐ to 70‐hr copulatory sessions , which essentially fling themselves toward the females' chelicerae during or after mating. Although both traumatic insemination and sexual cannibalism have likely been driven by sexual selection , invigorated the study of members of the newly erected phylum Xenacoelomorpha  . The examples discussed above: The evolution of simplification in placozoans and orthonectids; the spectacular miniaturization of interstitial meiofauna and insect egg‐parasitoid wasps; the strange and icky mating behaviors of bedbugs and flatworms; the steadfast efficiency of suspension feeders; and the myriad bizarre morphologies of endoparasites, along with the records of stasis and random walks from the fossil record, are evidence of macroevolutionary directions that would not be obvious from a cursory study of the evolution of whales, humans, and peacocks. There is grandeur in this view of metazoans, with their many traits, having evolved through a variety of evolutionary trajectories. While this planet has gone cycling on according to the laws of physics, endless forms most stupid, icky, and small have been, and are being, evolved.None declared.Jesse Emrys Czekanski‐Moir: Conceptualization ; investigation ; visualization (lead); writing–original draft ; writing–review and editing . Rebecca Janine Rundell: Conceptualization ; data curation ; investigation ; supervision (lead); writing–original draft ; writing–review and editing .Figure S1Click here for additional data file.Appendix S2Click here for additional data file.Appendix S1Click here for additional data file.Appendix S3Click here for additional data file.


Do those who believe in conspiracy theories feel less happy and healthy than others? Do they believe the world is simply unjust? This study was concerned with how demographic factors, personal ratings of success, personal ideology  and Just World Beliefs are related to Conspiracy Theories. In total, 406 participants completed two questionnaires: Just World scale (Rubin & Peplau,  Those working in the area of Conspiracy Theories (CTs) and Just World Beliefs (JWBs) both argue for the functionality of both belief systems for individuals. They help to make sense of personal and global events and thus give a sense of control and predictability , agenticity ), confirmation bias  and hindsight bias .CTs, like Just World Beliefs, appear to be psychologically functional in that they help individuals attain or maintain a sense of meaning, control and personal security  as predictors of CTs. The JWB concept was identified over 30 years ago and concentrates on the tendency of people to blame victims of misfortunes for their own fate Lerner, . The idePeople are confronted with difficult social problems such as why some people get ill, are abused, descend into poverty etc. while others do not. They also have to make sense of their own misfortunes. The idea of the JWB is that it helps answer some of these very difficult moral, political and social questions. Many researchers have noted that classic JWB scales have both Just and Unjust items, but that when the two separate scales are combined the negative correlations are modest, and that they are usually quite differently related to other variables. Hence it is advisable to measure each individually. Further it is the Just World, but not Unjust World beliefs, that are adaptive and related to well-being: Unjust World views have the opposite correlates . That is, those who believe the world is Unjust the sense that “bad things happen to good people” are likely to believe in many CTs. The UJW belief reflects the unfairness of the world and a sense of powerlessness which is associated with CT beliefs. There should be no relationship to JW beliefs.Studies on CTs have examined many individual difference correlates. The data in this area suggests that more pessimistic people with low self-esteem are more likely to endorse CTs. In this study we asked a number of questions using self-ratings of happiness, health, success at work and wealth. We assumed that these would correlate highly and form a single well-being factor which would be related to CTs. The hypothesis, based on the literature, tested was that there would be a significant negative correlation between self-ratings representing well-being and positive self-regard, and endorsement of CTs (H2). That is, people who feel less successful and adapted search out possible explanations for their condition and CTs can function to do this.This paper also examined the usual demographic variables of age, sex, education, and also political beliefs. On the basis of many previous studies reviewed, we predicted that males more than females (H3), younger rather than older (H4), and politically right-rather than left-wing people (H5) would have higher CT scores. Many poorly educated young men feel alienated and disenfranchised and are attracted by both right-wing politics and CTs . In all, 26% had a high school certificate, 47% an undergraduate degree and 21% a postgraduate qualification. 50% claimed to be Christian and 35% Agnostic or atheist.There were 406 American participants, of which 161 were male. They ranged in age from 19 to 60 years (Belief in Conspiracy Theories Inventory (BCTI): This is a 15-item scale that measures an individual’s general conspiracist ideation. It was developed by Swami et al.  is high, they rated their physical attractiveness ; physical health ; current happiness ; wealth  and success at work .Ideology: They rated themselves on a 7-point religious scale   and simple one rating politics scale (1 = Very Left Wing to 7 = Very Right Wing) . This is a simple single judgment which has proved to be theoretically related to other factors  and “I believe alternative medicine works” (1 = Strongly Disagree to 7 = Strongly Agree) .They were asked to rate themselves on a 7-point scale for “I am an optimist” (1 = Strongly Disagree to 7 = Strongly Agree) , which has been used in many studies , which were ratings from 0 to 100 on how happy, happiness, healthy, wealthy, and successful at work they were as well as whether they were an optimist or pessimist. The Cronbach alpha for this variable labelled personal success was .76 which is judged acceptable as a measure of internal reliability. High scores indicate a measure of general self-worth, success and self-esteem.A number of the personal self-ratings were inter-correlated: See Table M = 57.08 (SD = 26.70) vs M = 49.60 (SD = 29.23); F = 6.96, p < .01; Effect Size (Cohen’s d = .26)). The CT score was correlated with Unjust  but not Just World Beliefs. This confirmed H1. It was also correlated with age  (confirming H4), political orientation  (confirming H5) and the success variable . The effect sizes for these correlations are however very low.There were no significant sex differences on any variable, though males scored significantly higher on CT beliefs compared to females  = 11.71, p < .001; AdjR2 = .14. Four of the six variables were significant: UJW beliefs ; political orientation ; sex  and age . This indicated that younger, more right-wing males with UJW beliefs were more likely to endorse CTs. The beta for JW beliefs  missed being significant at the accepted p < .05 level. These results thus confirmed H1, H3, H4 and H5.A regression was then run with CTs as the criterion variable and the above six variables  as the predictor variables: See Table This study confirmed results in some other studies which have found that sex, age and political beliefs are related to CTs Swami, . This stCertainly, CTs have the potential to sow discord, violence and public mistrust, which can divert attention from certain political issues and even undermine democratic debate. It would be interesting to have a more detailed measure of political beliefs, such as an interest in and knowledge about politics, party political preferences and political activism. This may indicate a more nuanced relationship between politics and CTs such that it is extremists beliefs on the left and the right that are associated with a belief in CTs (Furnham et al., Results showed that although, as predicted, self-rated success was correlated with CTs - that is, the more positive and successful the respondent thought they were, the less they endorsed CTs – this factor ceased to be significant in the regression. This suggests that self-ratings of esteem and success play less of a role in CTs than other factors like ideology and world views. This has been observed by other researchers in the CT area, namely that those who endorse CTs tend to be unhappy, marginalised and less objectively and subjectively successful people. However, it seems from the work of Walter and Drochon  that it In this study we used an aggregate measure of self-ratings and although we explored individual ratings and their relationship to CTs they did not differ significantly. Clearly this is an area for further exploration: what precise features and factors of self-assessment relate to the belief in CTs and more importantly do these beliefs function at all successfully to bolster self-beliefs? It may be that these self-ratings mediate the relationship between personal alienation and endorsement of CTs.The study examined whether Just and Unjust world beliefs are related to CTs. Many studies have shown that these beliefs are only weakly negatively correlated and associated with different variables Furnham, . This sthealthy coping mechanism rather than being the manifestation of anti-social beliefs and prejudice (Dalbert, Just World is clearly functional for the individual. On the other hand. it is clear that UJW are related to beliefs in CTs which are themselves related to numerous poor coping strategies, just as holding CTs.One development in the Just World literature has been to view the JWB as a Dalbert, . JWB hasThis study linked two literatures that have overlapping concepts concerned with people’s views of the world that are seen to be psychological functional. Nearly all of the CT literature has associated conspiracy beliefs with poor coping strategies and a negative world view. Similarly, the JWB literature views those who see the world as unjust tend to be less adapted and happy.Although most of the hypotheses were confirmed, it was apparent from the correlations that effect sizes were small: in this sense the variables we measured did not explain much of our variance in the major dependent variable: i.e. the belief in CTs. This is indeed a common finding in the literature which has driven researchers to seek out yet more individual difference or sociological variables that correlate more highly and explain more of the variance (Douglas et al., What are the theoretical and practical implications of this study? The first is that political and world views are, quite understandably, closely related to CTs which are indeed often themselves political world views, particularly among extremists. Researchers interested in both the origin of, and the best ways to reduce, CTs should concentrate on socio-political attitudes rather than classic personality and other individual difference factors. This involves a more nuanced understanding of an individual’s political beliefs and involvement (Furnham & Fenton-O’Creevy, This study was not without its limitations. We used a convenience sample and all data was self-report which is true of nearly all these studies in the literature . Also, t