Mycobacterium tuberculosis infection that is likely to progress to active disease in the absence of treatment, but without clinical signs, symptoms, radiographic or microbiological evidence of disease. Biomarker‐based tests to diagnose incipient TB hold promise for better prediction and, through TB preventive therapy, prevention of disease. This study explored current and future framing and prioritisation of ITB.Incipient Tuberculosis (ITB) refers to Twenty‐two interviews across eight countries were conducted. A modified Shiffman & Smith Framework, containing four categories—Ideas, Issue Characteristics, Actor Power, and Political Contexts—was used to analyse the current landscape and potential for prioritisation of diagnosis and treatment of ITB.Latent TB policy implementation has been slow due to technical, logistical and financial challenges, and because it has been framed in a manner non‐conducive to gaining political priority. Framing ITB testing as ‘early detection’ rather than ‘prediction’, and its management as ‘treatment’ rather than ‘preventive therapy’, may help raise its importance in policies, and its acceptance among actors.Consensus surrounding the framing of ITB will be crucial for the successful adoption of ITB diagnostics and treatment. When designing ITB tools and policies, it will be important to address challenges that pertain to latent TB policies. Mycobacterium tuberculosis, yet only an estimated 10% of those infected develop tuberculosis (TB) during their lifetime [M. tuberculosis infection can be treated with preventive therapy (TPT). Drug combinations such as isoniazid‐rifampicin or isoniazid‐rifapentine for 3 months or less have demonstrated promising efficacy and cost‐effectiveness [M. tuberculosis replication without evidence of TB‐related pathology [M. tuberculosis infection that is likely to progress to active disease in the absence of treatment but without clinical signs, symptoms, radiographic or microbiological evidence of disease [Nearly one‐quarter of the world's population is thought to be infected with tiveness , 3, 4. Otiveness , whereasathology  ITB is a disease . It is t disease .The ability to detect and treat ITB would be beneficial‐ to scale up contact tracing, as it requires fewer people to be offered TPT, and to prevent further transmission, disease and suffering. Although several biomarkers have been identified that can predict progression to active TB, primarily reflecting inflammatory responses, there are currently no commercially available tools to diagnose ITB , 11, 12.ITB is an emerging topic that has yet to receive widespread political attention, while the related issue of LTBI has suffered from challenges in prioritisation. To avoid similar challenges, it is important to understand how ITB is framed by those involved in research, advocacy, and policymaking, and with what implications for both proposed solutions, for example, screening programmes, diagnostics, treatment solutions, and other forms of support, and their likely prioritisation in the face of other pressing concerns.For the first time in history, WHO is advocating for global investment in the early detection of TB in high‐risk groups globally , 14. ManLatent TB infection diagnostics, the tuberculin skin test (TST) or interferon‐gamma release assays (IGRAs), have limited value in predicting progression to active TB, meaning that mass screening for LTBI is neither practical nor cost‐effective , 22. A rThe purpose of this study was to explore how the concept of ITB, including its definition, and proposed screening, diagnosis, management and follow‐up, is being framed by TB researchers, policymakers and healthcare providers, to inform future policies, and to evaluate its potential for political prioritisation in comparison to that of LTBI. We explored future opportunities and challenges that ITB tools may encounter once brought to market, by applying a policy analysis framework to interviews conducted with those knowledgeable of ITB.We used qualitative methods to study the framing of ITB in policy and research. Semi‐structured interviews were conducted with a global variety of ITB experts Table  such as Due to the COVID‐19 pandemic, interviews took place via Zoom lasting on average between 40 and 60 min. All interviews were carried out by the primary investigator. An exploratory interview guide of open‐ended questions based on the study framework, background literature review, and expert opinion was used. The guide was kept broad to avoid investigator bias and was adapted for each respondent based on their area of expertise. The interview questions revolved around four main domains: challenges pertaining to LTBI and TPT, how the spectrum of TB is understood, the prioritisation of asymptomatic TB in policies, and considerations for future ITB policies. All interviews were audio‐recorded using a portable offline device and were transcribed verbatim.The Shiffman & Smith Framework  Table 22 was appThe transcripts were read in entirety by the first author and uploaded to Atlas.ti 8.0 software for inductive and deductive coding. Using thematic analysis, a code list was developed based on the study framework. The four domains did not fit well into the framework—and were thus coded separately. The arising themes of these domains were refined and sorted into a scheme of 46 code groups and 30 subcodes Table . The finEthical approval was obtained from Maastricht University's Faculty of Global Health ethical review board for the Global Health Masters programme. Prior to the interviews, respondents were required to read a participant information sheet and sign a consent form, including optional consent to be audio recorded.A total of 22 semi‐structured interviews were conducted between May and August 2020. Respondents had 2–35 years' experience with TB and resided in eight countries spanning Asia, Africa, Europe and North America Table .Overall, results indicated that the TB community has yet to fully understand and define the full spectrum of TB infection. Current challenges surrounding TPT implementation, including cost and accessibility of diagnostics and treatment, lack of designated human resources and low treatment adherence rates should be considered for the future development of ITB policies and implementation. Framing ITB as early detection and treatment rather than as prevention could be conducive to gaining political prioritisation. Furthermore, for ITB diagnostics to be successful, policies should be adaptable to context, considering local prevalence, cultural norms and resources. Table M. tuberculosis resides, whether an IGRA response would be positive, whether chest radiography has any role if biomarkers have been validated, and whether individuals could progress or regress along the spectrum of disease.Respondents agreed that a test to predict progression of TB infection is widely desired, as such an advancement would be transformational to scaling‐up TPT and meeting the WHO's End‐TB Strategy's targets , by beinDifferences in opinions existed between researchers, clinicians and policymakers interviewed. In particular, those who were not involved in test development had assumptions that accurate tests would soon be available and were more concerned regarding their future implementation. Scientists involved with ITB research were more hesitant to assume a test of progression would meet the TPP criteria anytime soon and may require different biomarkers for different groups. Some respondents viewed future ITB diagnostics under the realm of ‘personalised medicine,’ where different host responses based on local epidemiology and genetics equate to different biomarkers, therefore requiring different tests for different settings and individuals. Respondents stressed the importance of defining the appropriate application of ITB tests based on the setting, health system structure, and prevalence of TB infection. For example, people living with HIV in high‐burden settings would be eligible for TPT without the need for testing . A commoTPT or isoniazid preventive treatment will have to be adjusted for future ITB management. A policy advisor highlighted how framing LTBI treatment as a ‘cure’, rather than as commonly termed, ‘preventive therapy’, helps to convince policymakers that it is worth investing in.Most respondents agreed that to date, awareness of the spectrum of TB among the public is largely lacking. Many TB infections are asymptomatic, thus invisible to policymakers, healthcare providers, and the general public. Many patients are unaware of the concept of LTBI, why treatment and contact tracing are important, and what factors are involved with the risk of progression, for example . RespondRespondents agreed that the media and civil society have an important role to play in the way ITB is understood and perceived by the public. Because ITB is asymptomatic, respondents were skeptical that the public would take interest in such a condition if they are unable to see the direct effects of its burden and acknowledged their vital role in advocating for equitable access to new diagnostics and treatments and spreading information about the symptoms of TB to promote early detection and decrease stigma.M. tuberculosis [The burden of ITB is unknown, as validated biomarkers to detect ITB are not yet used in practice. For this reason, credible indicators and effective interventions do not yet exist. Hence, this aspect of the framework was largely absent. However, all respondents recognised the high global prevalence of LTBI, with many alluding to modelling projections that an estimated one‐quarter to one‐third of the global population is infected with rculosis , 44. As rculosis . Cost‐efLeadership was found to be important at all levels—from WHO and other multilateral organisations to community‐level healthcare providers. The NDWG, comprised of academics and supported by the WHO TB programme, was perceived by respondents as influential in terms of shaping the global ITB research agenda and the WHO TPPs. Furthermore, some respondents remarked it will be important to apply lessons learnt from Unitaid and the Global Fund to fight AIDS, Tuberculosis and Malaria, which were largely responsible for reducing the price of GeneXpert and TB drugs, to ensure equitable access to ITB diagnostics. For example, Unitaid, in conjunction with the Clinton Health Access Initiative, recently succeeded in scaling‐up short‐course preventive treatment, dramatically cutting the price of rifapentine by partnering with an Indian pharmaceutical company , 48. TheIn the current landscape, the only policy community cohesion around ITB stems from the NDWG. However, the ambitious elimination targets set by the WHO's End‐TB Strategy , the UN Our findings reveal important gaps in research, policy, and practical guidance that should be addressed before accurate, cost‐effective, and acceptable ITB diagnostic and treatment protocols can be rolled out. Framing, that is, how something is portrayed or conceptualised, of a newly defined global health issue can dictate how it is prioritised , 52, 53.M. tuberculosis infection exists [Only recently there is a wide understanding among experts that a broad spectrum of n exists  Preventin exists . Incipien exists . It was n exists . As of nn exists . This isn exists , 61, 62.This study found that terminology is important, not only for defining the spectrum among the scientific community to enhance research and development (R&D) efforts but also for determining how ITB is portrayed to the public and policymakers. External framing is important at a policy level, for priority setting, and securing access to medicines and diagnostics, while at a user level, it is important for encouraging health‐seeking behaviour and adherence to treatment. Civil society, including the media, also plays an important role here in generating support and demand toward eliminating TB, and should be conscious of the way they frame early infection. Framing ITB diagnosis as ‘early detection’, and its subsequent management as ‘treatment’, rather than ‘prevention’ may be vital in securing support. Although the terminology is important, especially once ITB tools become publicly available, a consensus on terms will require further understanding of the spectrum of TB. Further, the implications of potentially reframing treatment of ITB as ‘cure’ rather than ‘prevention’ merits further field research. This, however, should not delay the prioritisation of research and development for ITB tools. At present, the NDWG is leading the ITB research and development dialogue. The importance of allowing civil society to engage in the development of policy guidance was stressed by many respondents.Most respondents emphasised the importance of learning from LTBI programme successes and challenges to maximise the future success of ITB diagnostic roll‐out. To address high‐level barriers, it will be important to increase political commitment and investment to attain country‐specific targets, public‐private collaboration, and continued investment in R&D for new and improved diagnostics and treatment , 63. TheThe framework was useful in identifying certain research gaps, based on aspects of the categories that were left unclear from the interview data, such as the severity of the issue in comparison to other issues, and effective interventions. However, there are several limitations to this study. The framework we used focused on the political prioritisation of ITB, as this has previously not been investigated. More exploratory studies are warranted, to uncover further challenges and perspectives surrounding the disease state. Furthermore, it was challenging to apply the framework prospectively—anticipating future as well as current needs, differentiating political priority from healthcare priority, and distinguishing between the four actor categories. There may be selection bias of the respondents, as purposeful rather than random sampling was used. Only people who identify as experts in latent or incipient TB were approached to be interviewed. Few respondents were based in high incidence, low‐income settings. Furthermore, allied health professionals, people with TB, and the public were not included in this study. Finally, due to the online virtual format and limited time of the interviews, there is a chance that important details were missed, or were subject to observer bias , 65.It will be important to avoid challenges that pertain to LTBI policy implementation, by learning from programmatic experiences and conducting field research with diverse populations, including healthcare providers and TB survivors, in a variety of setting, to better understand their experiences and potential concerns. It is also critical to consider how ITB will be framed to increase the likelihood that future policies and programmes are implemented and received successfully. We caution to be mindful of the ramifications of labelling people with a disease. Social scientists should be involved in future ITB trials to uncover challenges and risks that may arise from diagnosing people with a new stage of infection—as a diagnosis can ‘vindicate and blame, can legitimise or stigmatise, can facilitate access to resources just as it can restrict opportunities. A diagnosis can be welcomed or eschewed’ . While dTable S1‐S2Click here for additional data file.


It is like the fire of a torch: If hundreds or thousands of people would come each with a torch to ignite by that flame, each torch they have ignited from the original one could be used to cook meals and keep a dark house bright, and yet the original torch would stay as bright as it used to be.”—Shakyamuni Buddha, “The Sutra of Forty-two Chapters”“There is growing appreciation of information sharing in science, because it allows reproducibility and boosts usability, thus benefiting the community and helping to advance knowledge . NeverthAiming to solve those issues and improve the reproducibility and usability of primary scientific research, general guidelines have been proposed in the light of the open science culture . ExampleThose existent guidelines and extensions are crucial as many ecologists rely on primary data for synthesis. However, despite those new roadmaps and tools, issues in reproducibility and usability are still common in ecological studies. We notice them all the time, as our research group specializes in synthesis. Our main topic of interest is ecological interactions between organisms of different species (a.k.a. species interactions), such as pollination and zoonosis. We have struggled to extract information from primary sources when compiling primary interaction data, conducting meta-analysis, reanalyzing processed data, and interpreting model results. Our syntheses strongly depend on you, who collect data on species interactions in the field or lab. Most importantly, we agree that sharing your data collected with so much effort without receiving proper rewards is not fair . Anyway,Aiming to tie those loose ends and improve the communication between data producers and users, and by harnessing the framework created by the previously mentioned guidelines, we propose 10 simple rules for reporting information related to data collection methods, raw data, processed data, and model results from studies on species interactions. Our objective is to go beyond merely pointing out problems, as we also suggest practical solutions to solve them. Although some of our rules apply to researchers who use primary information for secondary studies, they are addressed primarily to you and all colleagues who produce primary information on species interactions. Because our rules can significantly improve the reproducibility and usability of methods, data, and results, by following them you can improve the citations of your primary studies  as well A good study begins with an exciting problem begging to be solved. From the problem come your questions and expectations, and from them follow the methods used to describe new phenomena or contrast expectations against reality. Adequate methods lead to reliable results, allowing robust interpretations and paving the way for discoveries. Nevertheless, all this fine-tuning might not be helpful for yourself and your community if every step taken along the way is not clearly explained. You cannot bake a tasty cake without a nice recipe. Likewise, the reader cannot assess your study’s reliability and originality if its methods, data, and results are not thoroughly reported. Therefore, if you follow all rules proposed here, the reader will be able to use your ideas , reuse your data, and make synthesis with your results. In addition, you can use our rules as guidelines to design your study from scratch, as many people do in the case of systematic reviews and meta-analyses carried out in the light of PRISMA, because all these rules and guidelines are connected to one another .We are sure you have also faced this problem when checking a data sheet. Several studies lack clarity about the scope of the sampling units, especially in terms of the ecological level of organization assessed . When samples are taken from wild organisms, some methods capture or collect individuals, while others only allow direct or indirect observation. Those differences also need to be addressed in the statistical analysis. In addition, be clear about recording interactions between individuals or groups of individuals. For example, if samples were taken from individuals that were subsequently released without being marked or collected, they should be quantified as “number of captures” rather than “number of individuals.” If samples were taken from direct or indirect observation, they should be quantified as “number of visits” rather than “number of individuals.” These simple changes can improve statistical analysis and communication with your peers.Not all primary studies allow us to reproduce their data collection unequivocally. Naive assumptions must be made when we lack information about study design, which leads to biases . TherefoIn addition to being clear about the sampling sites, informing the size of the team of data collectors, as well as how the team was divided across sites and treatments, can help the readers to understand sampling effort and potential biases. Understanding those key points can prevent serious biases as, for example, the number of nodes and links in an ecological network tends to increase with sampling effort. This trend can induce a potential bias toward a core of highly connected species, underestimating the presence of lowly connected species, which results in flawed assessments of network topology ,15. DiagFinally, report interaction attributes that allow telling apart positive and negative interaction events  and explicitly state if your data set has only positive, negative, or both types of interactions. This way, you can avoid misinterpretations and clarify potential limitations of your data set. Moreover, remember to explain what the interaction weights mean in your study . Due to the difficulty in comparing interaction strength  betweenUnfortunately, critical information about your study area might go unnoticed, despite being essential to make your paper reproducible and usable. Therefore, describing the study area in detail is particularly important when analyzing spatial and temporal patterns of species interactions. Whenever possible, take a professional GPS to the field so that you can georeference your sampling sites, plots, transects, and trails. Afterwards, it is worth reporting all coordinates in decimal degrees using the proper datum, preferably the World Geodetic System 1984 (datum WGS 84). If you do not have a professional GPS, download a geotracking app to your smartphone, as modern models contain GPS receivers with good accuracy in open areas. You can also use indirect approaches, such as identifying site landmarks on Google Maps or Google Earth and extracting their coordinates. Explain the georeferencing in detail as each technique implicates different accuracy levels.When reporting the seasons sampled, consider universal seasons, such as summer/winter and spring/fall, and local seasons that affect the interactions studied, such as rainy/dry. You can also report microclimatic information, such as temperature, moisture, and rainfall. Next, illustrate the environment, describe its elevation, types of vegetation, average tree height, water sources, and any other information that helps assess the context of the interactions. Finally, explain the land-use regimes of the studied landscape. If possible, include a map in the supplement.Identifying organisms to the species is no easy task. In addition, many studies do not name species correctly, with mistakes varying from misspelling to outdated names. Those 2 problems combined create severe limitations for interpreting and reusing interaction data. Scientific names are not a mere formality, but they are key to unlocking a trove of biological knowledge acquired over generations. Access to this knowledge is crucial to correctly interpret the conditions and resources required by the species involved in the interactions. Furthermore, this knowledge is crucial to tell apart closely related types of interactions, such as seed dispersal and seed destruction, based on their potential outcome .Therefore, whenever possible, provide additional information about unidentified species, such as photos, sketches, DNA/RNA sequences, and ultrasound calls, in the supplement so that other scientists can at least tell different morphospecies apart. Thus, when dealing with unidentified species, rather than grouping them all together per higher taxon, it is better to number them individually for each study site. Remember that morphospecies 1 found at site A is not necessarily the same as morphospecies 1 found at site B, especially if the sites are far away from one another.https://www.mammaldiversity.org/) and Plants of the World Online (http://powo.science.kew.org/), and others with broad taxonomic scope such as Catalogue of Life  and Encyclopedia of Life (https://eol.org/). There are also some awesome tools for taxonomic harmonization )P values or cherry-pick the results that support the working hypothesis [Do not spare any details when reporting your model results after all this work to make your study reproducible and reusable. Many ecological studies report only pothesis . Missingpothesis . Biases In addition, fraud is more easily prevented by transparency. When reporting results from tests or models, go beyond significance values by including relevant descriptive statistics, scores of the calculated statistics, sample sizes, degrees of freedom, effect sizes, and statistical powers . If a rThis last rule might sound trivial but pay close attention to it. All your hard work is lost if people do not find your paper, so choose your keywords wisely. Keywords not only help people interested in the same scientific problem find your paper, but they are also crucial for people who carry out systematic reviews, meta-analyses, and all kinds of synthesis. Unfortunately, several studies on species interactions are overlooked in advanced searches due to poor keyword choice.Therefore, first, we strongly recommend that you include at least one of the following general keywords, even if they are already contained in the title: “ecological associations,” “interspecific interactions,” or “species interactions.” Second, add keywords related to the expected outcome and intimacy of the interactions, such as “amensalism,” “antagonism,” “commensalism,” “mutualism,” or “symbiosis.” Third, include some keywords specific to the studied interaction type, such as “blood parasitism,” “cleaning symbiosis,” “ectoparasitism,” “endoparasitism,” “extrafloral nectaries,” “folivory,” “florivory,” “frugivory,” “infection,” “nectarivory,” “nectar robbery,” “oil collection,” “pollination,” “pollinivory,” “seed dispersal,” “trophobiosis,” “zoonosis,” or whatever fits your study best.By choosing your keywords wisely, your work will gain visibility and will more likely be found, read, cited, and used in synthesis.The reproducibility crisis in global science is also worrisome in the small world of species interactions. Transparency and clarity are crucial to solving this crisis. Furthermore, scientists who collect primary interaction data in the field or lab can significantly benefit from improving the reproducibility and usability of their studies. Like a torch, whose brightness is not diminished by igniting other torches, the reuse of primary data and the synthesis of primary results broaden the scope of your primary studies by multiplying their potential uses, boosting their citations, and creating new opportunities for collaboration and coauthorship. To achieve this promising scenario of mutual benefits, improving communication between data producers and users is of paramount importance. The 10 simple rules suggested here can help us reach this goal.


Introduction: Patients with cancer as a life-threatening illness have needs in various dimensions. One of the most crucial dimension is spiritually. The present study was conducted to elucidate the spiritual needs of patients with cancer.A qualitative approach involving face to face semi-structured interviews conducted in Arak city, Iran. In total, 24 participants were recruited through purposive sampling. All interviews were recorded and transcribed verbatim. The data were analyzed using content analysis.Patients' experiences of spirituality were classified into four themes, including spiritual needs , strategies to address spiritual needs  and pray, reading the religious book and texts, making vows, paying attention to and loving others), reasons for not using spiritual resources , and impacts of spiritual beliefs .Exploring the experiences, perceptions, and spiritual needs of cancer patients is of great importance in providing spiritual care as one of the critical aspects of holistic care. Nurses should be educated for assessing spiritual needs of patients to provide spiritual care. Spirituality has been regarded as the essence of human existence. The World Health Organization (WHO) defines health in four dimensions: “Health is a dynamic state of complete physical, mental, spiritual and social well-being and not merely the absence of disease or infirmity” . PhysiciThey also want health-care professionals consider their spiritual concerns and to be treated and cared as a human with all dimensions of their health . StudiesSpiritual tendencies lead to understanding, cherishing, giving meaning, hope, serenity, compassion, diminishing loneliness, enhancing self-esteem, communication skills, psychological competence, and holism . While, Patients with cancer in particular are at a greater risk of spiritual distress when confronted with illness or end-of-life difficulties . Such spSpirituality is rooted in individuals cultural and the historical background . DefininA qualitative approach using content analysis was employed to facilitate a rich exploration of participant spiritual needs. After obtaining approval from the Ethics Committee of Arak Medical Sciences University, the potential participants were provided with study-related information and the confidentiality of their information. All the participants were joined voluntarily and they completed the informed consent. Participants also were made aware that findings to be made available to them at the end of study. Participants were assured that their information would be kept confidential and that the findings of the study would be reported in groups and anonymously.Semi-structured and in-depth face to face interviews were conducted with 24 participants who were recruited from the tertiary cancer hospital in Arak city, Iran. The interviews were held in hospital by one of researchers in the present study. The interviews ranged from 45 to 90 minutes. All interviews were recorded digitally and transcribed verbatim. The transcripts were checked to ensure participants' expressions and responses were accurately recorded by another researcher. Participants were asked to answer the following questions: “What are your needs at the moment?”, “What are your concerns?”, and “What relieves your tension?”. Participants were asked to describe the meaning of the spirituality and talk about their spiritual needs. Exploratory questions, such as “Could you explain more?” or “What do you mean?” were also asked in the interview. The interviews continued based on the needs of the study until data saturation.To analyze the data, MaxQDA 2018 was used for the data encoding and classification process. The deductive directed approach to content analysis based on Hsieh and Shannon (2005) was used . The steEthical considerations: The present research is the result of a research project approved by the Research Ethics committee of Arak University of Medical Sciences with the following ethics code: IR.Arakmu.Rec.1399.33. After acquiring the legal permits and acquainting the participants with the goals and significance of the research, their conscious written consent was attained. Participants were assured that their information would be kept confidential and that the findings of the study would be reported in groups and anonymously.The majority of the participants (n=15) were female, aged from 23 to 70 years and undergoing chemotherapy . Data anSpiritual NeedsThe main theme consisted of four sub themes. The need to be in nature, the need to communicate with others, the need to perform religious practices, and the need for solitude, reflection, and need to trust and security.Need to be in nature: Participants remarked leisure and nature trips as incredibly considerable factors influencing the human spirit in the battle against cancer: “...Mountaineering gives me peace of mind” (p3). “...I wish our house was in the country or suburbs with lots of green spaces where I could feel uplifted and distracted” (p1).Need to communicate with others: Interacting and communicating with others was described as a source of comfort by many participants: “...Communication with my companion, family, friends, and children make me happy” (p9). “...Talking to my family members gives me peace” (p5). “...I like to talk to my best friends, it gives me peace” (p2).Need to perform religious practices: Participants explained that religious practices are incredibly important to cope with their illness, psychological distress and feel relaxed: “...I love attending religious ceremonies” (p4). “...Ever since I was diagnosed with cancer, I've been attending morning prayers every day” (p5).Need for solitude and reflection: The statements of the participants demonstrate their desire for silence and peace. They need sometimes to be isolated and alone with themselves to think about their true wishes, goals, feelings and interests: “...Solitude and silence calm me down” (p7), “... when I'm alone, I comfort myself ” (p8).Need to trust and security: Participants stated that after being diagnosed with cancer, their need for having trust in God increased because they believed that God is the ultimate creator of human existence: “...When I realized I had cancer, I thought on the first night of the grave, I clung to God with both hands” (p6), “...Facing cancer underscores the need to trust in God in patients” (p9).Strategies To Address Spiritual NeedsPhysical activity, achieving inner peace, communicating with the nurse and physician, doing dhikr(Zikr) and pray, reading religious books or texts, making vows, and paying attention to and loving others are categorized as solutions to meet spiritual-religious needs.Physical activity: Participants stated that exercising had a significant impact on reducing complications and accelerated their recovery process: “... Physical activity, yoga and swimming have reduced the symptoms and complications of my disease.” (p8).Achieving inner peace: Participants believed that a person who faced with daily challenges and stresses seeks ways to relax and achieve inner peace: “...I forgive others, so that God will forgive me” (p6), “...My earlier life was nice. I did not appreciate it enough and God did this to me, now I should thank god a lot and I know that God will heal me ” (p10).Communication with the nurse or physician: Most participants, described that communication with the medical staff and their bedside manner in dealing with patients helps them to cope with the cancer and its symptoms and complications. “...Talking to medical staff, such as a nurse or doctor, reduce my pain greatly” (p10), “...For a patient, the doctor's manner is remarkably impactful, even more than medication” (p12). “...The greatest and best treatment for a cancer patient is nurse or physician empathy with patients ” (p4).Doing dhikr (zikr) and pray: Participants stated that praying plays a significant role in their recovery and healing, especially prayers of others: “...I believe the pray of others are more helpful and I pray for others too” (p13), “...I say Zikr and call God to cure me through praying” (p17), “... I pray for others and ask others to pray for me” (p15).Reading the religious book and texts: Participants explained that they read the Holy Qur'an and text because they considered the Qur'an as a spiritual miracle to find peace: “...Reading the Qur'an inspires me, and I always have a prayer book with me and read it” (p18), “... Whenever I am worried about my illness, I write the names of Allah(God) and the verses of Quran that I recite on a small piece of paper. ” (p2).Making vows: In Iranian society, people make various vows to fulfill their wishes. Some participants also stated that they vow to solve their problems and regain their health. “... I decided to spend money for Imam Hussein's shrine if I recover from cancer ” (p19).Paying attention to and loving others: The participants stated that if someone wants to be forgiven by God for sins, must forgive others: ”...I forgive those who hurt me, .... then hope Khoda(Persian word for God) forgive me. (p21).Reasons For Not Using Spiritual ResourcesThe findings of this study indicated that not believing in praying, and believing in a better life after death are reasons for not using spiritual and religious resources.Lack of belief in the healing powers of praying: Some participants stated that they do not pray and do not ask others to pray for them: ”...I don't need others' praying and I believe that praying will not help me” (p. 16), “...I feel that praying have no effect on my situation. It is a misconception that the power of praying can save me without any medical treatment” (p17).Believing in a better life after death: Some participants stated that they had no spiritual needs, never thought about their problems, and were unafraid of death since they considered it a step towards better life: “...I have no spiritual needs and I do not worry about my future. If I die, I'm sure I'll be more comfortable in a nicer place” p22), “...I have no impressions or fears of death. I believe in life after death” (p24), “... I'd rather not turn to Khoda and beg Him not to let me die, ... I welcome death because I am going to in a better place” (p26).Impacts of Spiritual BeliefsThe study findings demonstrated that hope of life, belief in divine destiny (the divine will and decree), trusting in God's support and accepting divine test can be considered the impacts of spiritual beliefs.Hope of life: From the participants' point of view, illness enhances hope of life and efforts to achieve aspirations: ”...ever since I became ill, my hope of life has increased” (p2), “...no matter how difficult is the circumstances, I don't lose my hope, and I remind myself that for at the end of the dark night, there is light” (p. 22)Belief in divine destiny: Some participants stated that God determines the destiny of each person and we should accept it. “... Whatever God wills, will be. God wanted me to get cancer” (p. 8), “I believe in divine destiny...so I try to give meaning to my illness” (p. 21).Trusting in God's support: Some participants stated that God is a powerful source of support for them “...I always tell God that I have entrusted myself to Him” (p. 10), “I am not worried... I am in the arms of God “ (p. 14) “... I feel that I am not alone, God is inside me and walks with me” (p. 17).Accepting the divine test: Some participants believed that illness is a divine test and passing this test is a source of pride: “...sickness and suffering is a divine test for me... I hope that I will pass this test” (p. 23) ), “...I know that none of God's decisions are without a reason, he tests me” (p. 30).The present study explored the spiritual dimension in patients with cancer in four areas of religious needs, strategies to address religious needs, reasons for not using spiritual resources, and impacts of spiritual beliefs. Consistent with the findings of the present study, the results of the other studies showed worshipping and rituals, seeking safety, reflecting and reasoning, as well as communication with and closeness to God ,24,25, aThis impression helps the patient in the face of unfortunate life events, such as loss or illness, and give him hope for a better life. Following religious practices, a sense of serenity is accomplished, the need for interpersonal relationships is fulfilled, and hope is maintained . ReflectAnother finding of the study was the strategies to fulfill spiritual-religious needs, including physical activity, achieving inner peace, communication with the medical staff, performing dhikr (Zikr) and prayers, reading religious books and text, making vows, and paying attention and loving others. In other studies, relationships with important people in life, sources of support, prayer and religious rituals, concentration, and exercise have been recognized as important factors in cancer patients' hopefulness ,33,34. TPatients' religious beliefs can offer support at times of disease, praying, performing rituals, reading religious books, and believing in vows create a positive spiritual feeling for them. By repeating these practices, patients' attitudes change . In sociThe reasons for not using spiritual resources were another theme with two sub-themes of lack of belief in the healing powers of praying and believing in a better life after death. To explain this stance, it can be stated that spiritual needs and spirituality are formed by the accepted practices and beliefs of a particular culture. Since each patient possesses unique individual characteristics and different subcultures and backgrounds, it is anticipated that some of them might not need to resort to higher and superhuman forces and then prayers for healing. Due to the differences among individuals, religion practices could build comfort and peace for a person while doing nothing for another. Studies in this field have confirmed the results , 42. AddThe last theme of this study was the impact of spiritual beliefs. The theme was manifested in four forms, including hope of life, belief in divine destiny, trusting in God's support and accepting the divine test. The findings of the other studies were consistent with the results of the present study ,40,43. HThe present study was conducted on patients with cancer in a city of Iran with Persian ethnicity and Islam religion. Therefore, further research is suggested in other life threatening disease and in other communities with different religions and cultures.Exploring the experiences, perceptions, and spiritual needs of cancer patients is of great importance in providing spiritual care. Therefore, nurses should be educated to assess spiritual-religious beliefs and needs of patients in their region to provide and promote holistic care. The findings of the present study, were explored four themes including the spiritual-religious needs, strategies to address spiritual needs, reasons for not using spiritual resources, and the impacts of spiritual beliefs. These findings can help healthcare professionals, especially nurses for effective interaction and communication with patients to address their spiritual needs and accelerate the healing process of patients. However, the findings cannot be generalized in different communities and there is need to conduct more research due to cultural and spiritual/religious differences.


Background: Factors related to the desire of receiving psychological help in cancer patients are not well known. The aim of this study is to assess the prevalence of patients who would ask for psychological assistance in the first weeks following diagnosis, and to identify their psychosocial and disease-related profile. Method: This cross-sectional study assessed 229 consecutive cancer outpatients at a visit with their oncologist to be informed about the treatment they will receive. Disease-related and medical characteristics were assessed, and patients were asked about their mood states, levels of self-efficacy, and difficulties coping with the disease. Finally, patients were asked about their desire to receive psychological assistance. Results: Only 20% of patients expressed a desire for psychological help. These patients were lower in age and had previous history of mood disorders and reported higher discouragement and coping difficulties. These variables explained 30.6% of variance. Conclusions: Although psycho-oncologists can provide helpful interventions, the percentage of patients interested in receiving psychological assistance in this study is low. Although further studies are needed, results from this study suggest methods that could easily be used by oncologists and nurses to identify patients who would like to receive psychological support. Health problems can be produced by biological  or psychological  reasons and can evolve as an acute or a chronic process. Whatever the case, many non-pharmacological interventions (NPIs) can help patients to improve their quality of life if these problems appear. Furthermore, NPIs can be used not only to treat health problems once they appear, but also to prevent them. Thus, NPIs’ efficacy can be enhanced if they are applied both to reduce risk factors before the illness appears and to provide help at the first stages of a disease, when a diagnosis is given to the patient. When a person knows that they have a serious disease with an uncertain prognosis, the patient’s life is threatened and emotional distress appears. Psychological interventions are useful NPIs to enable patients to cope with this emotional distress and to prevent psychopathology. Thus, psychological support should be provided early to patients suffering serious illnesses. Cancer belongs to this group of diseases; it is diagnosed in millions of people each year, and it is estimated that its incidence will increase. Public health policies should take into account this situation and should plan interventions providing psychological support to patients in order to reduce emotional distress and, hence, years lived with a disability. This psychological support should be provided as soon as the disease has been diagnosed, since a cancer diagnosis produces emotional distress in patients and their families ,2,3,4,5.Cancer patients could benefit from psycho-oncological support, which is useful in reducing anxiety, depression, and distress in cancer patients ,10,11. HIn addition, some studies have found a relationship between levels of distress and desire for help ,23, but In this sense, younger patients seem more likely to accept psychological support, Refs. ,27,28,29Finally, it has been found that the type of psychological support offered is also related to the desire for psychological help. Studies that offered patients a chance to engage in psychosocial support groups had rates of participation between 21% and 66% ,26,29,30Thus, further research is needed to know which patients would ask for psychological assistance as well as the prevalence of these patients. This knowledge might help to optimize psycho-oncological services, since it would provide physicians and nurses with a guide to identify patients who need psychological support.In this context, the aim of this study is to assess the prevalence of patients who would ask for psychological assistance after a cancer diagnosis, and to identify their psychosocial and disease-related profile.This study was developed at the medical-oncology department at the Cancer Center of Hospital de Terrassa and was approved by its Ethics Committee. Outpatients who met the inclusion criteria (patients had to be at least 18 years old and free of any cognitive impairment) and were receiving their second visit with their oncologist, to be informed about their oncological treatment, were included in the study. These patients were aware of their diagnoses from a previous visit no more than two-three weeks prior. During this second visit, patients were informed about the study and its voluntary nature, that the data would only be used for research purposes, and that all information collected was anonymous. They did not start completing it without having first given explicit consent. A sample of 355 patients was recruited.The oncologists completed a separate sheet registering sociodemographic  and clinical data for each patient (kind and stage of tumor and presence of mood disorders across the life span).The oncologist asked the patients six questions, and they answered them using a categorial scale of four points . Four questions were addressed to assess how the patient’s mood state was during the last week . The other two questions asked about: (a) the actual levels of self-efficacy to cope with the situation, and (b) difficulties to cope with the situation.In order to develop a logistic regression analysis , answers were recorded in two categories: “YES” (when patients stated “much” or “very much”) and “NO” . Thus, it was considered that a patient has discouragement (YES) if they answered “much” or “very much.” If they answered “not at all” or “not so much,” it was considered that the patient did not have discouragement (NO). The same procedure was applied for nervousness, fear, anger, self-efficacy, and coping difficulties. Finally, the oncologist asked the patient if they would want to receive psychological assistance. Patients answered this question by saying “yes,” “no,” or “I do not know.”p = 0.663), living alone (p = 0.100), cancer site (p = 0.155), nor presence of metastatic disease (p = 0.141) had a relationship with the desire to receive psychological help.On the final sample of 229 patients (see Participants section), a univariate analysis of the relationship between patients’ desire for psychological help, education, living alone, cancer site, and presence of metastatic disease was developed using a chi-squared test. Neither education  were entered in the regression model.Thus, a regression logistic procedure  was developed to assess the relationship between age, gender, mood states , self-efficacy, coping difficulties, and previous history of mood disorders. All variables with a univariate Logistic Regression Analyses see  showed tThe present study shows that an important number of patients (35.4% of the sample) do not know if they want to receive psychological support. These patients do not offer a clear different profile from patients who answered “yes” or “no.” Although this subsample included more breast cancer patients and less lung cancer patients than those observed in the other subsamples, in other features these patients were similar to those who answered “no,” such as mean age, level of education, and living alone. As discussed below, perhaps patients answered “I do not know” because the type of psychological support suggested was not specified.On the other hand, the results of this research show that only 20% of patients of the whole sample of 355 participants were clearly interested in receiving psychological support. Previous studies have shown different prevalences to those found in our study, with higher rates which range from a 66% in a Norwegian breast cancer sample  and loweSome arguments could explain these differences in rates of interest for receiving psychological support, as well as account for the relatively low rate observed in the present study. Firstly, it could be the type of psychological assistance offered. Perhaps some strategies  might be preferred by some patients, but not by others. In our study, when patients were asked if they wanted psychological support, the type of psychological help they would receive was not specified. This can lead to a confusion about what “psychological intervention” or “psychological support” means . This maSecondly, it seems that lower rates of interest are observed when mixed cancer samples are used or when samples include only men, which is the case with prostate cancer patients. Some studies ,30,31 haIn our sample, patients who would ask for psychological support were those with high levels of discouragement and coping difficulties, as well as those with previous history of mood disorders. Discouragement can be considered as a global measure of emotional distress that includes the other negative mood states assessed in this study . In this sense, emotional distress has also been related to a desire for receiving psychological support in previous studies using samples with mixed cancers and which did not specify the schedule of psychological treatment to be provided ,24,25,30Variance of a desire for psychological support explained by our model (30%) does not reach the 52% found in melanoma patients  but is hOne of the limitations of this study could be that data were obtained using simple questions and not standardized procedures or questionnaires. However, we think that single questions provide valid information about patients’ feelings if one keeps in mind the time limitations that oncologists have in their visits, as well as the fact that some questionnaires require a previous knowledge to be correctly applied, which is hardly available to the physicians. On the other hand, single questions or Likert scales have been used in previous studies with cancer patients to assess the desire for psychological assistance or other psychological variables ,35. FinaFurther studies are needed to clarify when and why men and women differ in their preferences for scheduling psychological assistance, or which barriers perceived by patients and health professionals preclude the delivery of psychosocial care services ,38. Ther


Urbanization has exposed people to extreme sound levels. Although researchers have investigated the ability of people to listen, analyze, and distinguish sound, the concept of noise has not been clearly articulated from a human perspective. The lack of knowledge on how people perceive noise limits our capacity to control it in a targeted manner. This study aimed to interpret the definition of noise from the public perspective based on a grounded theory approach. Seventy-eight participants were interviewed about noise, and four categories of perceived understanding of noise were identified: challenges, definitions of noise, opportunities, and action. As one of the challenges, urbanization is associated with increased noise levels around the human environment. In terms of definition, perceiving sound as noise is considered to be a result of the complex and dynamic process that includes sound, the environment, and humans. Sound and humans interact with the environment. In terms of opportunities, noise may have positive roles on certain occasions, dispelling the misconception that noise is exclusively negative. In addition, we found that noise perception has gradually shifted from noise control to noise utilization. In terms of action, noise can be controlled at the sound sources, susceptible target groups, susceptible behaviors and states, locations, and times where noise is perceived with high frequency. In this study, we investigated several aspects of noise, ranging from noise control, soundscape definition, and ‘soundscape indices’ (SSID) integration and application. Our findings provide an additional basis for developing better definitions, control, and utilization strategies of noise in the future, thereby improving the quality of the sound environment. The Soundscape: Our Sonic Environment and the Tuning of the World , which severely disrupted people’s sleep. Besides, the industrial revolution introduced industrial machinery noise, and the rapid growth of many cities around the Second World War enhanced noise problems. In addition, the concept of the soundscape was reported Schafer, . It is iSchafer, , “StartiSchafer, . AlthougSchafer, . Noise iSchafer, . Thus, tSchafer, . Since pSchafer, . TherefoSchafer, , 2021b. A bibliometric approach based on VOSviewer (v.1.6.17) and CiteSpace (v.5.7 R5) analysis were adopted in this study. Bibliometric analysis monitors changes in specific research areas from a quantitative perspective thereby revealing emerging trends and research progress in specific areas. Bibliometric analysis is often performed in conjunction with visualization using charts created through VOSviewer and CiteSpace. These charts allow for a clear and effective presentation of data. A title search was conducted on the Web of Science using the keyword ‘noise’ to identify studies published between 2010 and 2022. A total of 20,072 studies were obtained. The studies were collected and analyzed using data mining visualization software VOSviewer and CiteSpace to identify research hotspots and co-category networks.In Fig. In summary, research on noise covers various aspects including noise , the relationship between noise and humans, noise classified according to different environments, noise prediction and control , and noise control design at the technological level. Research hotspots appear to be in highly sophisticated fields such as aerospace and medicine    was 12.72)  demographic information, such as age, gender, occupation, and education level of the respondent and (2) the perception and opinion of people on noise, which was captured in questions such as what do you consider as noise in your understanding? Can you describe it? Can you discuss noise from the perspective of your daily life?A total of 78 interviews, each lasting 30–60 min were conducted. With the consent of the interviewees, each interview was recorded and transcribed by the researcher, producing approximately 36,000 words of interview transcripts.The data analysis was performed by a team of two researchers who have worked in the field of soundscape and are familiar with qualitative research  is a user-centered approach to the systematic analysis of qualitative data  The interview text was collated and analyzed according to the aforementioned steps, resulting in 894 labeled data points a1), 527 conceptualized data points (aa1), 67 categorized data points (a1), and four categorized data points (aa1). The specific results are shown in Table , 527 conThe above-mentioned grounded theory process yielded four main categories Table : challenThe main category AA1 challenges were divided into three perspectives: sound, human, and environment.Noise is always present, as stated in aa1. “Noise is always present with humans. We are familiar with the word noise, which is ever present in our daily lives. Noise is often overlooked, yet it is present in every second of our daily lives…”Noise is ubiquitous, as stated in recording aa2. “Noise is everywhere, but to put it in another way, having noise in empty, silent places is pointless. In our daily lives, noise is practically ubiquitous…”Noise is inescapable. An interviewee in recording aa3 observed that “the world has two sides, and so does sound. I hate noise, yet I know I cannot escape it because I live in such a noisy environment. God has given us the sense of hearing, which is both a gift and a test. What should I do? I believe that noise is inevitable in today’s environment…”People who raise their voices in inappropriate scenarios should promote a sense of morality and public spirit. In recording aa7, an interviewee mentioned, “I believe that most of the noise is caused by a lack of public spirit. …they do not care about the health and feelings of others.”Humans are creators and victims of noise. “I was once surprised to find that I had gone from being the one who hated noise to being a noisemaker. I had subconsciously become an emitter of noise.” As recorded in aa12.Noise level increase as urbanization progresses. In recording aa13, an interviewee stated that “With the progress of society, cities are developing. Industrial production, transportation, people’s daily lives, and various recreational activities in cities have all expanded, and environmental noise has become increasingly serious.”Noise is often associated with life. “Noisy environments are actually quite common in life. Therefore, noise is always with us, and it is relevant to our lives” (aa14 and aa15).The definition of noise AA2 is the core category and is divided into four parts: (1) the ontology of noise concept, (2) the concept of noise from the environment, (3) the concept of noise from objectivity (sound), and (4) the concept of noise from subjectivity (human). Perceiving sound as noise is a result of the complex interactions among several factors including sound, environment, and humans. See below for a detailed analysis.Noise exists both in the plural and singular forms. As described in the interviews, “The definition of a noisy environment is multifaceted. Noise is a very broad concept…Sources of noise are relatively diverse. When we think of noise, we first think of broad-defined sounds, which is a slightly one-sided definition. If only the abrupt and obvious are referred to as noise, then this is only the tip of the iceberg floating on the surface of the water” (aa16–aa19).Noise is a mixture of absolute and relative. As the interviewee in recordings, aa20 and aa21 suggested, “I think of noise as relative, rather than the usual sounds that are considered bad. No sound is absolute noise, and no sound is ever noise. In my opinion, noise can be divided into relative and absolute noise.”Noise is subjective and objective. As stated by the interviewee in recordings aa23 and aa24, “Noise is the product of a combination of the subjective and the objective. However, noise has multiple meanings, both physical and psychological.”Noise is a mixture of simplicity and richness. When asked what noise is, an interviewee was recorded (aa25) saying, “This is an interesting question, and each definition of noise has unique characteristics. The word noise is simple but extremely rich in meaning”. Noise is both obvious and evasive  stated, “If a faint sound that is not noticeable during the day is heard before going to sleep, it is amplified many times …” In particular, the interviewee (recording aa36) added, “During holidays, there is a lot of activity in crowded pedestrian streets, shopping malls, and restaurants, and having a lively atmosphere is acceptable.”The perception of noise is influenced by the space factor in the environment. As described by the interviewee in recording aa42, “There is always Russian music playing on Central Avenue… enhancing the experience of visiting the city. By contrast, if Russian-inspired music is played in the study rooms, there is no doubt that even the most beautiful music becomes noise.” The concept of space can be defined as what an individual perceives and interacts with objectively through the connection that he or she forms with the area; each of the above showed specific responses to space based on their own and potential entrants  are present in a space at the same time for the person hearing the sound”. Pitch strength. The aa64 recording that: “Noise is… uncommon frequency sounds that are unattractive background sounds that are chaotic and floating. What I think of as noise is, on the one hand, a very unstable sound, with highs and lows”. For loudness, the interviewee (recording aa65) stated that, “People still accept sounds at different decibel levels to a similar degree, with sounds above 70 dB(A) generally considered to be noise”. As noise exposure increases (via longer exposure and/or higher sound levels), the risk for cochlear injury and hearing loss increases  perception: psycho-acoustic parameters of sound, noise as defined by the physical discipline, duration of the sound, and sound information content. Perceiving sound as noise is a result of a complex, dynamic process that includes sound.As described through the interviews (aa86), the perception of noise is related to a person’s age; most people felt that the older they got, the less they accepted noise and the more strongly they felt it. “I feel that as I get older, I become more resistant to noise, the interviewer says. Before I treated noise as just a bit annoying, but it was acceptable. Now I get very angry when I hear noise…My grandparents, for example, are older and prefer a quieter environment…” This is because ageing is associated with increased sensitivity to noise Du, .The perception of noise is related to a person’s occupation. Different professions pay different attention to and have different feelings about noise, as described in (aa88): “Concern about noise is higher than the general population due to occupational attributes (relevant researchers)”. “Those who work in quiet indoor offices, such as programmers, are prone to the effects of harsh sounds and may be more sensitive to noise.” Noise interferes with attention and affects performance on cognitive tasks , “When I drag my mother to rock concerts, she complains about the noise. It’s loud and she doesn’t like it. For me, it’s superb and I really like it”. Soundscape evaluation is part of the study of sensory esthetics, and all esthetic issues involve preference. Esthetics also includes the ability to discern or judge. People evaluate the same environment differently and react differently as a result of their individual preferences  it was stated that “Some people are taught not to make noise when they eat and grow up with an aversion to the sound of their mouths, which is obviously noise to them, but for other groups who believe that the sound of eating means I am eating well, the sound of their mouths during eating is physically and emotionally pleasing”.The perception of noise is related to a person’s behavior. As stated in the interview (aa135), “The sensitivity to noise varies with what we are doing, and the definition of noise should be different for different behaviors”. For example, interview (aa170) mentions that “when we are studying or resting, all sounds that can be clearly heard, whether they are pleasant or not, are considered noise… while when we are exercising, we often find the natural ambient sound not loud enough, or even like to play some punk rock music with strong drums and dense rhythms at a high volume”.The perception of noise is related to a person’s mental state. As described in the interview (aa173), “It has been observed that people tend to ignore distracting noises when they are concentrating on a certain state… When a person is initially in an office state, he can easily feel annoyed and dissatisfied because of the distracting noises around him, and as he gradually immerses himself in his work, he can no longer easily feel the presence of these noises.”The perception of noise is related to a person’s environmental integration. The environment is highly integrated and less influenced by noise. When one is involved in the current environment, he/she ignores the surrounding noise, whereas one is not involved in the current environment, the opposite feeling arises. For example, as described in the interview (aa199 and aa214): “In a public space, a group of people talking to each other and a person doing their own thing, to the person talking their conversation is nothing, to the other person doing their own thing their conversation is noise. When I am interacting with my friends, I don’t find the noise of people talking and laughing with me at all”. We are both the emitter and the victim of noise. Being the source of noise ourselves, we often ignore the noise we produce. However, we are disturbed by the noise produced by others.The perception of noise has been linked to a person’s psychological state. Noise and psychology interact, and when psychological conditions are poor, one becomes more critical of sound and more sensitive to noise. For example, “when I am irritable and unhappy, I am more critical of my surroundings and even sounds that I would not normally pay much attention to become noise… In everyday life…whether it is judged as noise or not often depends on the subjective state of mind” (aa130 and aa132). Noise and psychology interact and may form a vicious circle. As described in the interview (aa134), “these sounds that become more emotionally distressing the more we care, lead to a more depressed mood and the more noise we hear, which then creates an emotionally vicious circle”. Emotion, a key psychological antecedent of cognition, can frequently influence or even overpower our right conclusions . When physiological conditions are poor, the perception of noise and discomfort increases. This may be because people are more vulnerable when they are physically uncomfortable which makes them more susceptible to noise disturbance compared to healthy individuals. Thus, there is a need to focus more on the physical discomfort and to actively avoid noise interference.The perception of noise is related to a person’s sound expectations. People expect more sound at certain times and occasions and when they are engaged in certain behaviors. As mentioned in the interviews (aa194–aa197), “when studying in the library and needing a quiet environment, the expectation at this time is that the sound is quiet, but the music that I normally enjoy listening to becomes noise because it does not match the environment I need at the moment”. Sound expectation is part of a framework of cognition and emotion when perceiving soundscape contexts. Expectation is related to an individual’s experiences and encompasses factors such as personal beliefs, perspective, ideals, values, emotions, and mental models. Expectations strongly influence perception.The perception of noise is related to a person’s needs, as described in the interview (aa146 and aa147), “When a sound does not satisfy my needs, I feel that the sound is noise. Like myself, I like to listen to songs when I am going to study. I do not really understand why I concentrate more when I am listening to a song when it is obviously louder than my classmates’ voices. Maybe it’s psychological, or maybe the songs are what I want subjectively”.The perception of noise is related to a person’s sensitivity, as described in the interview (aa182 and aa189), “I know people who are quite sensitive to sound and can’t sleep at the slightest noise, and others who can sleep even when thunder rolls through the sky. People’s sensitivity to noise also varies from person to person…”The perceived annoyance of noise has a great difference among individuals with different noise sensitivities : “I think everyone has a different level of tolerance and acceptance of noise, which I personally believe is inextricably linked to one’s occupation, physiological performance, living environment, habits and personality”. As stated in the interview (aa190), “noise should have different standards and tolerances for different people. I have a higher tolerance for the noise created by people I know and am close to, and a lower tolerance for people I don’t know or don’t like”.The perception of noise is associated with a person’s five senses. As described in the interview (aa152), “to be judged in conjunction with sight, taste, touch and smell, specific to the problem”. The assertion “we unknowingly can use all senses information to assess sounds” emphasizes the influence of other sense sensations on sound perception. In addition, ‘Audio–visual interaction can significantly influence the outcome of the definition of quiet areas : “noise is a concept for people. Only in human society does noise exist. However, despite this subjectivity, most people have a consistent definition of a noisy environment. Even if it is the same sound in the same environment, different people will have different answers as to whether it is noise or not”. Age, occupation, preferences, habits, behavior, status, environmental integration, psychology, sound expectations, needs, sensitivities, tolerances, and five senses have all been linked to defining noise. Therefore, perceiving sound as noise is the result of a complex, dynamic process that includes humans.The main category AA3 Opportunities was divided into three viewpoints, i.e., sound, human, and technological development.(1) Noise should be viewed in context: “Noise is not always harmful. I believe it should be viewed in a dialectical way. For instance, white noise, which is beneficial, should not be rejected, but tolerated” (aa216 and aa217). In general, noise is harmful since it renders organisms less flexible and potentially causes gene mutation. Nonetheless, accumulating evidence suggests that noise helps in stress response, metabolic activity, development, cell cycle, circadian rhythms, and aging, as well as regulates cellular functions  Background noise is a protective buffer: According to the interviews (aa299), “…just as we are unaccustomed to a 0 dB environment, it is frightening to be in a condition of absolute silence. If in a relatively quiet environment, a loud noise is suddenly generated… it is easy to be frightened when you are unprepared. This is when the noisy environment that we normally take for granted becomes a kind of protection for us again”. All the disturbing sounds in the environment can be muffled by monotonous sounds, including white noise, which is a combination of constant sound frequency variations within the environment  Noise induces sleep: As described in the interview (aa23), “…when the snow-plows were roaring in the winter evenings, I was undisturbed by the sounds because they were stable. On the contrary, it even helps me sleep very much.” This is because humans easily get used to steady noise or repetitive monotonous noise. Steady noise may induce sleep, whereas intermittent noise does not  Noise acts as a reminder and a warning: As described in interviews (aa233 and aa234), “…The air-raid siren on China’s September 18 anniversary was deliberately special, attention-grabbing, and slightly uncomfortable sound… aimed striking the heart of the people, awakening inner emotions, warning and spurring the present generation not to forget the war.” This shows that although noise evokes discomfort, it generates emotions within people.(5) Noise elicits fun: “Within reasonably normal limits, noise is interesting” (aa237). For example, the noise was used as an artistic and esthetic resource, a source of music, and to create new sound sensations in the 20th and 21st centuries  Noise reduces feelings of isolation: “…late at night…the sound of cars whizzing by on the road is the only reason I don’t feel alone…” (aa235 and aa236). Silent individuals feel uncomfortable. Thus, the concept of quiet zones, currently emphasized, warrants further exploration and refinement. This is because a good acoustic environment is not defined by the quiet standard alone.(7) Noise transports memories, warmth, and a sense of life: A soundscape positively or negatively affects the way of life. Soundscapes attempt to recreate historical scenes  Noise has an emotionally calming effect: Interviews (aa230 and aa231) revealed that white and pink noise from nature calms. The interviews were as follows: “Some white noise, which is the sound of nature, like the wind, rain, birdsong, and so on, is an ambient sound for us, and such sounds make us feel settled.”(1) People adjust to daily noise: As mentioned in the interview (aa238): “Noise pollution is a daily occurrence and most people do not see it as a problem; most of the noise we hear every day is related to everyday activities, so people are used to it.” Although most people are habitually exposed to noise, the habituation extent varies among individuals  People expect a quiet, natural, and beautiful environment: As stated in the interview: “The demands on the quality of the surrounding environment will also be more demanding… Nowadays, people are increasingly looking for “quiet”. There has always been a picture of birds and flowers, paths in the fields, two or three friends and a glass of wine…” (aa239–aa244). Similarly, people demand soundscapes having simple sound developments with messages of peace and joy  The concerns about noise are increasingly prominent: As the recording states: “The noise problem has become more and more serious in recent years and more and more people are paying attention to it. Noise pollution can be harmful and needs to be taken seriously” (aa247–aa249). There is a growing concern for environmental quality, specifically noise and air issues  From an environmental standpoint, technological developments have reduced noise pollution. Interview (aa250) states that “… I think noise can be dissipated. But the prerequisites for this would be very many. For example, it would require modern technology to develop to a point where invisible earplugs could be invented with 100% noise dissipation…” (2) Furthermore, active and widespread use of white noise provides new ideas for the rational use of noise. The interviews (aa251–aa253) state that “…white noise is noise whose power spectral density is constant throughout the frequency domain. For example, some learning apps have a ‘white noise background to help people focus better.” Several studies have investigated devices producing white noise to offset and minimize the effects of environmental noise in clinical and laboratory settings. Since white noise is actively used in everyday life, several studies have focused on the impact of white noise on humans. Consequently, the understanding of white noise in the physical sense and white noise by the general public is not similar. Therefore, there is a need to investigate a definition of white noise based on the general public.The main category AA4 Action was divided into three viewpoints, i.e., sound, human, and environment.(1) Noise classification should be specific: As stated in the interview (aa255), “I believe that the classification of noise should be more focused. The criteria for judging noise today are uncertain…” Despite being unpopular, noise should be classified and controlled from a qualitative perspective in the future Schafer, .den; by railway traffic below 54 dB Lde; by aircraft to below 45 dB Lden. Noise levels from wind turbines should be reduced to below 45 dB Lden, and the annual average noise from all recreational noise sources combined should be reduced to 70 dB LAeq,24h. Otherwise, it may have negative effects on health  The loudness of the sound can be controlled: As stated in the interview (aa254): “…after a certain dB(A), noise has an adverse effect on what we are doing…”. From a quantitative standpoint, controlling sound decibels is easy Schafer, . Based olth WHO, .(3) Noise can be converted into positive sound in the right environment: As stated in the interview (aa256), “The most beautiful sounds can be achieved if they occur in the right environment”. The design of the ambient sound improves the attractiveness of a venue. For instance, laughter in a library is an inappropriate negative sound, but laughter in an amusement park or at a party is a positive sound driving the atmosphere.(4) Sound sources easily identified as noise: The interview content (A56) of the main response noise sources was extracted and screened (Selection criteria are frequency ≥ 5 times) Table . Traffic(1) Shielding noise from the perspective of human vision: As stated in the interview (aa60), “…I find it easier to concentrate when I am visually invisible to the source of the noise… This has inspired me to design spaces in the future in such a way as to reduce the impact of noise on people by increasing visual concealment or adding partitions”. Acoustic and visual (and other) components interact in human perception  Controlling noise control from the perspective of policy: From the perspective of noise control, policies should be developed to control the loudness of sound, the time and place where the noise is emitted, and noise-generating behavior. As mentioned in the interviews , “The sound of car horns is prohibited. As well as limiting the working hours of construction sites. I think it is necessary to set strict noise control levels around specific buildings…to introduce regulations for this….set strict decibel levels…”(3) Limiting noise based on moral constraints: As shown in the recordings (aa401), “I think we should be more tolerant and also abide by the rules of public places”. Morality and its role in societal life have been critical to human thought history thought since its beginnings. It is ranked first in Aristotle’s hierarchy of virtues as a good to which every human being must aspire  On human self-regulation and protection, it is possible to shield oneself from the noise by negotiating with its source: For example, as stated in the interview (aa376): “negotiate with your neighbor to turn down the volume of the TV.” Protect your ears from noise through simple means, “Silicone earplugs are available and these are simple and practical means to provide warning and protection when noise is coming” (aa381). This is because noise discomfort triggers the body’s defense mechanisms, hence prompting people to adopt appropriate protective behaviors to resist additional harm from noise  Focus on vulnerable target groups and extract and screen interviews (A62) primarily responsive to them (Selection criteria are frequency ≥5 times): This is also aimed at determining the frequency of vulnerable behaviors in descending order: Older people (15 times); Students (14 times); Patients (11 times); People concentrating on their studies and work (11 times) High sensitive People (10 times); People with psycho-social problems (10 times); Researchers (9 times); People with a high demand for a quiet environment (9 times); People with Poor sleep quality (7 times); Infants and young children (7 times); People needing rest (5 times); Preoccupied people (5 times); Brain workers (5 times) Fig. . Thus, t(6) Vulnerable behavior: Focusing on these vulnerable behaviors, the interview content (A63), which primarily responds to the behavior, was extracted and screened (Selection criteria are frequency ≥5 times) to arrive at the most vulnerable behaviors in descending order of frequency: working (19 times), studying (14 times), resting (14 times), sleeping (8 times), thinking (8 times) and hearing sounds (8 times) Fig. . Locatio(7) Vulnerable states: The interview content (A64) primarily responding to the person’s state was extracted and screened (Selection criteria are frequency ≥5 times) to establish the susceptible states, i.e., in a bad mood (15 times) and during concentration (6 times) Fig. . Therefo(1) Reducing noise impact based on spatial planning and design: As demonstrated in the recording (aa483), “…For example, the location of hospital buildings, the layout of ward buildings, outpatient buildings and other departmental rooms, the design of doors and windows, the choice of interior and exterior building materials, and the planting of surrounding vegetation”.(2) Reducing noise impact according to the physical equipment and materials: As demonstrated in the recordings , “We need measures that prevent harmful noise, including retrofitting roads with soundproof panels. Measures to control these noises often include the installation of silencers on cars…” Car silencers reduce noise right at the source. Noise barriers, acoustic glass, and other sound-absorbing materials are passive methods using physical structures and affect sound waves before they enter the interior of the building. These are classical, simple, and easy-to-use methods  Locations with high noise perception frequencies: The interview content (A67) was extracted from locations primarily responding to noise perceptions and filtered (Selection criteria are frequency ≥5 times) to show exact locations with the highest frequency of noise perceptions in order: traffic streets (8 times), homes (7 times), factories (5 times), quiet places (5 times) and locations where renovation work is taking place (5 times) Fig. . This co(4) Time of day with high noise perception: The time points were extracted from the interview content (A68) mainly responding to the time of noise perception and filtered (Selection criteria are frequency ≥5 times) to establish the time of night (6 times) with the highest frequency of noise perception Fig. . This maWhat is the relationship between different categories?What is the impact of this study on human perception of noise?What is the source of inspiration for us in noise study from human perception?To understand our findings, three key points must be emphasized; the details are as follows:Challenges: The three components i.e., sound, human, and environment  demonstrate the importance of the noise problem and its challenges as an urgent issue that must be addressed. Notably, noise is present at all times, it is everywhere, and it cannot be avoided.Noise definition: The definition of noise includes four components, i.e., noise concept, noise from environment perception, noise from objectivity (sound) perception, and noise from subjectivity (human) perception. The overarching concept of noise acts on the three components i.e., human, sound, and environment. Sound and humans are in an interactive relationship; both exist in and interact with their surroundings.Opportunities: The advantages of noise based on current developments, as well as environmental changes caused by changes in human thinking and technology. Considering the positive effects of noise, noise should be viewed from the following perspective: noise carries memories and warmth, and a sense of life; background noise has a buffering effect to protect people from sudden loud sounds; noise has a calming effect on the emotions; steady noise helps people fall asleep; noise has a reminding and warning effect, noise reduces feelings of isolation; noise enhances the fun. The current social environment opportunities and technological developments enable noise abatement, as well as the active and widespread use of white noise in daily life.Action: Plans and measures for noise are proposed based on sound, human perception, and the environment, including controlling the loudness of the sounise transformation into positive sound in the right environment; shielding noise based on human self-regulation and protection; focusing on noise from based on vulnerable target groups, noise control from the perspective of policy rules; shielding noise according to human vision; limiting noise according to moral constraints; reducing noise impact based on spatial planning and design; reducing noise impact from according to the physical equipment and materials.The first topic is the relationship between different categories, as shown in Fig. As shown in Fig. Figure In conclusion, our findings expound on the definition of soundscape by refining the concept of noise at the level of human consciousness and providing a qualitative research direction to improve the ISO standard.The importance of studying noise from a human perception is that noise not only have a negative effect, but also a positive effect in some cases. Therefore, it is important not to completely remove it but exploit its positive effects in appropriate situations. This view coincides with the soundscape approach, which addresses issues related to the sound environment from a sound perspective, in which sound is not treated as waste but as a resource Kang, . This stNoise not only affects several of people’s lives in terms of psychological, physiological, and behavioral aspects in addition to studies, recreation, and rest. People’s subjective perception of sound is the soundscape, and perception contains both positive and negative components. Generally, the negative part of soundscape is considered noise, which is dependent on the listener’s experience of the sound and the environment. Schafer believed that the soundscape can demonstrate a society’s illness or well-being. A soundscape that is ordered and peaceful reflects a society that is ordered and harmonious, whereas a soundscape that is disordered and discordant causes social disorder and disharmony Schafer, . This stFour categories are identified in this study: Challenges, the definition of noise, opportunities and action. By analyzing the external factors of noise: challenges and opportunities, as well as internal factors: definitions of noise, action, an implementable strategy model for noise control was established from a public perspective.Challenges: As urbanization progresses, noise levels increase, and we are all creators and victims of noise. Noise is everywhere, every time and thus unavoidable. Therefore, it is important to understand how people perceive the noise to develop effective noise control strategies.Definition of noise: Perceiving sound as noise is a result of a complex and dynamic process which include sound, the environment, and humans. The environmental aspects include time, space, and context. The sound aspect includes duration of the sound, content of the sound message and other factors. On the other hand, the human aspect of noise includes factors such as age, occupation, tolerance, and five senses.Opportunities: Noise not only have negative effects, but also positive effects in specific situations, which are related to how people perceive sound in their environment. The positive effects of noise include carrying memories and warmth, providing a sense of life, providing a buffering effect that protects people from harmful effects of sudden loud sounds, calming emotions, reminding, and warning people, as well as reducing feelings of isolation. On the human side, although people are adapting to noise, they are more concerned about noise issues and aspire to a better life and a more beautiful environment. Recent technologies have shown good performance in reducing noise and white noise is now an active and widespread part of life. In recent years, focus has shifted from noise control to noise application.Action: Noise needs to be classified and its loudness needs to be controlled, which will turn it into a positive sound in the right environment. From the human side, noise can be shielded from human vision by focusing on susceptible behaviors such as working, studying, resting, sleeping, thinking, and listening to sound. Besides, this can be achieved by focusing on susceptible states, such as when in a bad mood, when concentrating, as well as on the vulnerable target groups such as older people, students, patients, researchers, people with poor sleep quality, infants, and young children. From the environmental aspect, the impact of noise can be reduced from the perspective of physical equipment and materials, and from the perspective of spatial planning and design. It is also important to focus on locations with high noise perception frequencies, such as traffic streets, homes, factories, quiet places, and places where renovation work is carried out. In addition, there should be focus on times of the day when noise perception is high, especially at night.The study studied the concept of noise from the human perception. Historical noise complaints were reviewed by analyzing studies on noise (VOSviewer) and relevant bills. Systematic qualitative analysis of user-centered noise and grounded theory interview methods were adopted. In addition, the basic understanding of noise from the perspective of the public was explored to uncover all possible understanding of noise from the user’s point of view. Our results present a comprehensive understanding of the noise environment, and highlights the importance of examining noise from the perspective of the public, which will ensure effective control of noise.This study addresses three components, i.e., human, sound, and environment. Sound and human form an interactive relationship in the environment. The soundscape approach together with its indices (SSID) is appropriate in achieving a better understanding of this process. Moreover, our study refines the concept of noise at the level of human consciousness. The current study investigated noise control, soundscape definition, integration, and SSID application. Findings from this study are expected to guide future improvement on the definition, control, and utilization of noise, moving from  noise control to modern design of acoustic environments, thereby increasing quality of the sound environment.Conventional perceptions may have led many people to believe that noise is negative. We have come up with the theory that “ Perceiving sound as noise is the result of a complex dynamic process that includes sound, the environment, and humans”. Given that noise has both positive and negative aspects, what should positive noise be called? What are personal preferences for terms and how are they defined? These are questions that deserve to be explored in future.