The Autonomous Sensory Meridian Response (ASMR) is a tingling sensation across the scalp that occur in response to specific triggering audio and visual stimuli, connected with the Default Mode Network. Our study (N = 76) aimed to test the neurophysiology of ASMR by examining pupil diameter and brain activity. Assuming the idiosyncratic nature of ASMR, we expected results detecting opposite physiological outcomes considering pupil diameter and brain activation. We used a battery of self-reports to investigate psychological dimensions; for the physiological measures, we used two instruments: PupilCore and NeuroSky MindWave Mobile 2. The results showed an augmented pupillary diameter during the ASMR video, regardless of the perception of tingles. On the other hand, the arousal level during the ASMR video was lower than the other conditions. The difference between the two neurophysiological measures appeared as peculiar and can be considered as the promoting phenomenon for ASMR psychological outcomes. The autonomous sensory meridian response (ASMR) is a sensory phenomenon typically characterized by tingling across the scalp, following the line of the spine downward, extending to the arms and further depending on the intensity of the response . AssuminRegarding eye tracking, the first study about pupillometry and ASMR was conducted by Valtakari et al. ; they foSeveral arousal studies used pupillary diameter measurement ,22, findHypothesis 1 (H1).People during the viewing of an ASMR video will have a larger pupil diameter compared to the viewing of other videos.Hypothesis 2 (H2).People during the viewing of an ASMR video will have a general reduction in arousal, measured by Neurosky brain waves, compared to the viewing of other videos.Hypothesis 3 (H3).ASMR experiencers will have different scores in psychological dimensions compared to Non-ASMR experiencers.Hypothesis 4 (H4).People with high values in ASMR-15 will have a higher brain activation.M = 24.96 SD = 4.867). The participation was completely voluntary, and anyone who wanted to be involved as an experimental subject had to sign an informed consent statement.A total of 76 participants were recruited for the experiment . Participants were invited to take part in the experiment with e-mails and private messages. The sample was composed by young adults , but the NeuroSky Agency has chosen to refer to the unit of measure as ASIC-EEG-POWER units, as you can read on the website [NEUROSKY MINDWAVE MOBILE 2: this device is a wireless electroencephalogram that allows one to trace an EEG in which different brain waves , the number of blinks, and three composite measures called “ website : “MindWa website . The EEG website . The cho website ,27.PUPILCORE: The PupilCore is a monocular eye-tracking device from Pupil Labs, featuring an open-source software suite and a wearable headset .It has two cameras, one tracking the subject’s pupil and one framing their vision of the ‘world’; the support is light and adjustable, based on the characteristics of the user’s face. Both cameras connect to a laptop platform via USB. The camera outputs are read through Pupil Capture software for real-time pupil detection, gaze mapping, recording, and other functions. The data acquisition program (Pupil Player) has an interface that presents various options for customizing the recording, as well as calibrating the subject’s field of vision.We selected as stimuli for the present study 5 videos with different contents. The ASMR video and the Control video with a duration of 30 s were selected from another study about the ASMR phenomenon . Videos We chose ASMR and Control videos from Cash et al.  researchLikewise, we chose High-Arousal and Low-Arousal videos from Li et al.’s  databaseThe procedure of the experiment included filling out different questionnaires in order to investigate various psychological aspects of the sample.Socio-demographic survey, which included age and gender.Interpersonal Reactivity Index (IRI) [α: PT = 0.75, EC = 0.80, PD = 0.76, FS = 0.79).ex (IRI) : a test Telepresence Scale [α 0.78). Telepresence is defined as a person’s perception of being in a specified or understood virtual place [ce Scale : a self-al place . Even ifTo investigate the ASMR phenomenon, we chose 3 different surveys submitted post-video session:ASMR Experience [perience : a singlASMR-15 [α 0.78).ASMR-15 : a questASMR POST [SMR POST : an inteThe experiment took place in a laboratory of the Department of Psychology of the University of Florence. The procedure was divided into 3 experimental phases, and included PRE-self-report administration, eye-tracking, and Neurosky brain waves detection for the duration of each video, and POST-Self report administration. The order of the video presentation was balanced to eliminate possible priming effects; in particular, we alternated the order of the ASMR video and CONTROL video, as well as the HIGH- and LOW-AROUSAL video. Each video was separated by the viewing of a REST video. The setting was arranged to promote the isolation of the subject: the person was alone in a quiet room with the computer used to follow the procedure, wore earphones, and was assigned an experimental ID to keep the participants anonymous. We registered a 6% sampling mortality rate between acceptance to participate and real participation. The criteria for inclusion in this study were: to have the ability to give consent in the experiment participation, to have the ability to correctly understand and fluently speak Italian, and to be able to watch a computer display at a distance of 54 cm without the use of glasses.All distracting elements were removed from the room. The setting was maintained quiet for the entire duration of the experimental session. The setting of the experiment was standardized; in particular, the distance of the subject from the PC, the audio of the device, and the luminance were controlled: the luminance of the room was 50 lux, the computer screen brightness was set to 100%; the computer audio was set to 80%; the distance of the subject from the screen was 54 cm. There were two computers connected by a Google ChromeCast, one out of the room for the researchers, where they could follow the subjects filling out the report, and one in the room for the subjects, where the experimental procedure took place.All the videos, and consequently the vectors considered to compute the average brain and pupil activity, had an identical duration  of 30 s. The researchers monitored in real time the subject through the use of internal cameras, and the Google ChromeCast, leaving the subject in a condition of physical isolation. The researchers reported the absolute time of beginning and end of any phases of the “trial” as triggers to be compared subsequently with the synchronized absolute time detailing the PupilCore and NeuroSky data stream. Finally, we decided to not renormalize the signals on their baseline conditions, but to consider such baselines in the data analysis as reference conditions. The experimental sessions always had a total duration of 30 min.t statistics to explore the experimental hypotheses.As the first step of the analysis, we codified and cleaned the datasets coming from the NeuroSky and the PupilCore. The signal preprocessing was composed by three steps: (i) we cut the 30′′ temporal windows  for all the signals according to the experimental protocol; (ii) we cleaned the technological artefacts, removing 5% of extreme values ; (iii) we substituted the missing value  with a regression method interpolating the signal with the weighted moving average method (WMA). As the second step, analyses of frequencies, central tendencies, and dispersion indicators were carried out using the IBM Statistical Package for Social Sciences (SPSS 27.0) . Before First, we cover the sociodemographic and descriptive outcomes. Secondly, we show the inferential statistics starting with the comparison between pupil diameter and brain waves frequencies among different video contents. Finally, we discuss the outcomes.M = 24.96, SD = 4.867) and gender . No statistically significant difference can be found with regard to sex and age.A total of 76 participants  were recruited for the study. The sociodemographic information included age  [ex (IRI) .M = 27, SD = 4.7), Fantasy Scale , Empathic-Concern Scale , Personal Distress Scale .The test has four subscales: Perspective-Taking Scale , Not being present in the mediated environment .ce Scale  after thSD, skewness, and kurtosis. ASMR determined the higher pupil diameter  compared to the other videos . The data obtained from the differences between the conditions of Low Arousal, High Arousal, and Control videos were not significant.We investigated pupil diameter and brain waves for each video that was submitted to the sample. For pupil diameter, we report in SD, skewness, and kurtosis of the ASMR video. As the EEG variables did not distribute normally, they were log-transformed before correlation calculation. mean, skewness, and kurtosis refer to the 30 s frequency band measurement time window of each video. Even if it is not a standard way of presenting data, it was sufficient for the level of detail we were interested in.For frequency bands results, we report in For the measurement of ASMR experience, we used ASMR-Experience  and ASMRASMR-Experience is composed of the item “How frequently did you experience tingling sensations during the video?”, rated on a Likert scale from 1 (none of the time) to 7 . The results showed a mean of 1.97 (SD = 1.29).ASMR 15 has four subscales: Altered Consciousness , Sensation , Relaxation , Affect . Results are reported in H1: Pupil dilation during ASMR video compared to other conditions.H2: Brain activation between ASMR and other contents.t-test for the EEG delta between the ASMR video and other videos. Delta values during the ASMR video were lower than during the High-Arousal , Low-Arousal , and Control videos . Theta values during the ASMR video were lower than during the Low-Arousal  and Control videos . Low Alpha differed only during the Low-Arousal video experience, being higher than during the ASMR video . High Alpha Delta appeared lower during the ASMR video than during the Low-Arousal  and Control videos . Low Beta values were lower during the ASMR video than during the High-Arousal, Low-Arousal, and Control videos, respectively, with t = −2.64, p < 0.01; t = −2.38, p < 0.05; and t = 2.02, p < 0.05. High Beta values did not present significant differences between the conditions, while Low Gamma  and Mid Gamma values  during ASMR were lower than during the Control video. Interestingly, from the brain activity point of view, the ASMR video did not show any differences with the Rest video.H3: Psychological measures in ASMR experiencers and Non-ASMR experiencers. We found differences only in the correlation between brain wave dimensions; to investigate the predictors of ASMR experience , we took into account as a dependent variable the answers provided to the question “How frequently did you experience tingling sensations during the video?” Due to the non-Gaussian distribution of the answers, we first eliminated those participants who answered “never” (n = 39), in order to investigate only those participants who reported an ASMR experience to any degree. Further, in order to respect the inferential analysis preconditions, we discretized the variable within two levels, defining two balanced subsamples, respectively, labeled as “Few” and “Many” tingles perceived. The “Few” subsample was composed by those participants that reported tingles only a “Few times” (n = 17), while the “Many” subsample was composed by those who reported tingles “Sometimes” (n = 10), “Half the time” (n = 4), “Quite frequently” (n = 5), and “Frequently” (n = 1).t test. Regarding IRI, higher scores in the subscale Empathic Concern appeared to determine higher tingles perception , but they reported lower scores in the subscale Personal Distress . The subscales “Perspective-Taking” and “Fantasy” were not statistically significant.The differences between the subsample reporting more tingles experiences (“Many”) and the subsample that reported few tingles (“Few”) are summarized in t = −2.03, p < 0.05).Of the Telepresence Scale, lower scores in the subscale “Being Present in the Mediated Environment” appeared to be associated with higher tingles receivers (H4: Higher brain activation with tingles experiences is shown by the ASMR-15 results.Autonomous Sensory Meridian Response (ASMR) is a phenomenon still to be explored, but a large amount of research has analyzed its characteristics. For our study, to perform a multi-dimensional analysis, we chose to investigate ASMR through an eye-tracking device (PupilCore) and a wireless electroencephalogram (NeuroSky), concurrently with the submission of some self-report measures . The sensitivity to the phenomenon could be linked to different psychological characteristics, including greater sensory suggestibility .For our study, we chose to investigate the influence of empathy levels through the Interpersonal Reactivity Index (IRI) , previouNeurophysiological parameters are also involved in the ASMR phenomenon: for example, Poerio et al.  claimed Regarding the measurement of arousal, today, thanks to new technologies, arousal can be investigated by using different tools: first, the detection of skin conductance (biofeedback). This index is very sensitive to minimal fluctuations in arousal, measured without any time difference. Another measurement method often used is the detection of the heart rate . By thesAnother point of view we considered to examine the ASMR phenomenon was the brain activity. A lot of research has been reported; for example, Fredborg et al.  and Lee As a lot of research has supported, ASMR could be a complex emotional experience that comprises feelings of both relaxation and excitement; paradoxical physiological responses to ASMR showed decreased heart rate and increased skin conductance levels . It was Similarly, also with the results derived from ASMR 15 , it is nIn conclusion, it is clear that people use ASMR videos to relax, induce sleep, and reduce anxiety, but despite the relaxing state in which people affirm to be, physiological data also suggest an activation component. Our data can be a starting point to understanding the general framework regarding the mechanisms underlying the ASMR; because of the complex nature of the phenomenon, it is necessary to understand how this activation is consciously perceived by individuals, and also, how, and when, this idiosyncrasy occurs.


This project aimed to review the medical cover available to an Old Age Psychiatry inpatient ward.2. To discuss with ward staff their view for potential improvements and areas of clinical development.3. To review the potential of a Full Time Nurse Practitioner role on the ward.One junior doctor  was allocated to cover the ward whilst balancing their other training needs and clinical commitments. The inpatient ward was based in a community hospital with no onsite medical team. The patients mostly had complex medical needs and multiple comorbidities.The Junior Doctor's timetable and the time allocated to the ward was reviewed. Questionnaires were conducted with nursing staff to assess their views on the support of physical health cover. The patient notes were analysed for the time taken to review patients after falls over a one month period.There were 14.5hours allocated to ward cover. An additional 4 hours was provided by another visiting junior doctor totalling 18.5hours per week- 11% of the time. This figure does not account for annual leave, on call commitments or study days whereby there was no additional cover.They rated medical cover of physical health needs on ward 7 as 1.3.They found contacting a Doctor to discuss a physical problem as 1.7- with particular concern for OOH.It was rated to be extremely difficult for a same day review of physical health problems- 1.7It was rated extremely difficult to get a physical review following a fall on ward 7- 1.4Continuity of care for the patients on ward 7 was rated as 1.6.The patient case files reviewed over a one month period showed x8 falls. These took on average 14 hours before having a review.A short survey completed by ward staff showed- (1 = Very Poor/Difficult 5 = Excellent/Easy)Medical cover for the old age psychiatry inpatient ward was inconsistent and a challenge for a single trainee to manage alongside their other clinical commitments and training needs. A case was proposed to management with an SBAR for a Full Time Advanced Nurse Practitioner which has been approved. This role should provide patients with appropriate cover of their physical health needs. It will allow the junior doctor to work alongside them on the ward supporting each other to provide optimal care for the inpatients.


The COVID-19 pandemic necessitated stringent visitor restrictions in critical care departments worldwide, creating challenges in keeping family members connected to patients and clinical staff. Previous studies have examined how hospitals addressed this challenge by repurposing existing tele-ICU systems or by using personal smartphones as a workaround and have analyzed clinical and family feedback. This case report addresses the experience of rapidly implementing a video-call system in the critical care department of a tertiary referral hospital that had no prior video-call system in place, detailing the key requirements in that setting. The 24 requirements were identified via interviews and surveys to both clinical and technical professionals. The top requirements identified were sound and video quality, usability for clinical staff, call control by staff, and patient privacy. From tailoring a video-call solution for this setting, we learned that video-endpoint selection is a key design decision. The initial proposal was to use wireless tablets, but the selection of a large wired video-endpoint allowed us to better address the requirements in the critical care setting. This was based on several characteristics of the large wired video-endpoint, including: high-fidelity video and sound, with directional noise-cancelling; large touch-screen setup for minimal-click navigation; wired as well as wireless connectivity. The critical care department accepted complex patients with COVID-19 from the West and Northwest of Ireland, which have a combined population of ∼750 000. The department has 27 beds, in a mix of “open bays”  and isolation rooms. Prior to March 2020, the critical care department had no formal video-conferencing system used for the purposes of “tele-ICU” or for facilitated video calls with patients’ families.An interdisciplinary team was quickly assembled, spanning clinical, academic, and technical-industry partners. The 7-person core team included critical care expertise , partnering with medical innovation researchers , and 3 team members from Technology partners . The small core team had sufficient expertise to proceed rapidly, with minimal communications overhead, but with wider support to enlist additional expertise as required.Similar to other telehealth projects that were implemented at the onset of the pandemic, a rapid, iterative, and highly collaborative approach was taken.Initially two different types of video-endpoint were considered—a wireless tablet and a large wired video-endpoint. Testing of both was conducted onsite, and one was chosen based on staff feedback.Hands-on training was provided for existing staff, and training videos were provided for onboarding of additional staff. During the rollout phase, pertinent network and video-call performance metrics were proactively monitored.The key requirements of a video-call system suitable for a critical care setting were identified, considering the requirements identified prior to and during iterative development, but also postrollout feedback related to those requirements. The data were collected from clinical staff via early-stage nonstructured staff interviews, a postrollout clinical survey, and a semistructured interview with a focus group of nurses. The data were collected from technical members of the solution team via a postrollout technical questionnaire.The data were synthesized and coded by the lead author, using NVivo,ad hoc virtual visits 24/7 without reliance on administrative staff , who was responsible for disseminating to other family members .A 23″ touch-screen video-endpoint that has wired (Ethernet) and wireless (Wi-Fi) connectivity, and high-fidelity audio and visual. It was customized with a menu of “virtual family rooms”, mirroring the existing departmental naming scheme for patient areas or patient rooms. It was also customized for low-touch video-call setup, requiring a minimal number of clicks. It has large “soft”-buttons for the main tasks, the camera has a physical lid and there is a physical mute button. It was mounted on a metal stand creating a freestanding, mobile unit .A commercial cloud video-conferencing platform was used, setup to provide “virtual family rooms”. It was configured to maximize video-call security and patient privacy, including disabling recording, sharing, and chat.Additional devices (9.7″ tablet devices) were provided to facilitate staff training and were used to simulate family-members joining a call. These were configured with a minimal set of applications and managed via a Mobile Device Management (MDM) tool.The technical details of the solution are available via whitepapers, including video-endpoint and video-call cloud service configuration and customization.The first call to a patient’s family took place <2 weeks after project inception, and the full system rollout was completed in <3 weeks.n = 17), the focus group consisted of four nurses, and the postrollout technical questionnaire was completed by all four technical members of the solution team.The postrollout clinical survey had 17 respondents  made audio communication more difficult.The system needed to allow a bed bound patient to easily see multiple family members at the same time. The system needed to provide a high-quality video feed for remote family members to see the hospital environment and the patient, and minimize the possibility of causing additional stress due to video quality issues. Some patients had limited ability to communicate, so it was particularly important to adequately convey facial expressions and other nonverbal communications.Staff needed the ability to move around the bedside and to conduct the video-call handsfree—to allow them to assist the patient or carry out other tasks, as necessary. The use of gloves made it harder to operate electronic devices. Staffs were under significant pressure preparing for a surge in COVID-19 cases, particularly with upskilling on new equipment and training of redeployed staff. Hence ease of use was even more important to ensure system adoption.Communication with patients’ families is always a key part of critical care and often includes sensitive discussions. Staff needed confidence that they could easily and reliably control the basics of the video-call for these communications, particularly starting and stopping the call and quickly turning the camera and audio on and off. Staff needed to be able to securely control the identification of family members, and their admission to the call at an appropriate time to ensure patient privacy.“Specifically for ICU [Intensive Care Unit], our patients can be sedated and ventilated, and I think families can experience a lack of control, as they have to trust people they have never met to care for their loved one”. After using the video-call solution for a few weeks, a staff nurse noted, “to physically see the person—it tells them [the family] so much more about how they [the patient] are than what we’ll say. Literally, they trust us a little better, they can back up what we’re telling them with physically seeing them themselves”.In addition to gathering data on the requirements, the interviews and surveys also gathered anecdotal feedback from staff on their overall experience of communicating with families of critical care patients while stringent visiting restrictions were in place. Prior to the introduction of the video-call system one staff nurse commented, The system has been successfully deployed and has been used frequently by staff during the pandemic and the department anticipate using it after the lifting of visiting restrictions, particularly for families abroad or at a distance. Careful selection of video-endpoints and adherence to local policies and regulations are particularly important in the critical care environment.The video-call solution comprised multiple components and each contributed toward addressing the requirements—the top 12 requirements were addressed by a combination of these solution components: video-endpoint, network, workflow integration, IT integration, documentation, and training. A mapping of these solution components to requirements is provided in Supplementary MaterialFor the video-endpoint, we chose a large wired video-endpoint in preference to a wireless tablet, based on staff feedback. A tablet-based solution would have provided a workable solution, but selection of the large wired video-endpoint enabled the solution to address more of the requirements, based on several device characteristics.The large wired video-endpoint provides a directional microphone and noise-cancelling. This allowed it to sufficiently filter the background noise, to allow staff (despite PPE) or patients with weaker voices (or poor voice projection) to effectively communicate to remote family.The chosen video-endpoint has a 23″ high-definition (HD) screen and high-fidelity camera. Staff noted that this provided high-quality video, for various positioning of the freestanding unit , including when rooms/bays were brightly lit.The chosen endpoint was customized to be freestanding and low-touch—these were essential characteristics in the critical care department. Most critical care patients are not able to independently hold tablet devices, and a freestanding device allows staff to independently move/leave, and could enable less rushed video calls. A freestanding device also gives the ability to setup calls to allow the family to watch the patient sleeping.The chosen video-endpoint provides the option of connecting to a network via wired (Ethernet) and/or wireless (Wi-Fi). Our solution utilized both options, setting up a wired connection as the default and a wireless connection as a fallback. From a technical perspective, this provided a reliable network connection on the hospital side of the video-call. Interestingly, some staff commented that they felt a greater sense of confidence initiating sensitive calls  with a wired connection in place.Prior to the pandemic, video-conferencing systems specifically for family communication were not commonly used. When introducing similar systems, hospitals and staff have a responsibility to ensure patient privacy and to adhere to data protection policies as well as accepted legal and ethical guidance surrounding the appropriate use of video-conferencing in the healthcare setting. These requirements will differ depending on the physical environment of the unit , local policies, and regional regulations.While the system meets the needs of patients, staff, and families, there are limitations and scope for better iterations. The wired network connection requires physical wiring & software configuration and restricts the mobility of the video-endpoints. For this project, we deemed that the benefits, particularly in terms of connection reliability and staff confidence, outweighed those limitations.Solution workflow could be streamlined by integration into the Electronic Health Record (EHR). The solution does not provide an automated process for handling when patients move area/bed.Staff highlighted that the solution does not replace the tactile interaction between family and patient, and the reassurance that it provides.The project was delivered by volunteers, with donated equipment. In a broader rollout cost-effectiveness may be a limitation, given the use of high-end video-call endpoints. This is beyond the scope of this report.n = 4); descriptive statistics of system usage are not supplied; solution options from multiple vendors were not evaluated, as the project was delivered by a coalition of volunteers.The main limitation of this case report is that it is based on implementing a video-call system in the critical care department of just one hospital. The report is also limited in the following aspects: just two video-endpoint types were evaluated as part of the project; ranking of requirements is primarily based on scoring by a small team  and the European Regional Development Fund (ERDF) under grant number 13/RC/2073_P2  and 13/RC/2094_P2 (DOK).All authors meet the four criteria of authorship in accordance with ICMJE guidelines. IC, AM, PA, and FK contributed to conception or design of the work. IC, FK, and LC contributed to data acquisition. IC, AM, PA, DOK, and FK contributed to data analysis and interpretation. IC contributed to literature search. IC and AM contributed to drafting the article. All authors contributed to critical revisions, approved the final version to be published, and agreed to be accountable for all aspects of the work.JAMIA Open online.ooab091_Supplementary_DataClick here for additional data file.


F-score value of 0.97 for anomaly detection and an average root mean square error (RMSE) value of 2.10 for anomaly correction.The location of the plane is key during the landing operation. A set of sensors provides data to get the best estimation of plane localization. However, data can contain anomalies. To guarantee correct behavior of the sensors, anomalies must be detected. Then, either the faulty sensor is isolated or the detected anomaly is filtered. This article presents a new neural algorithm for the detection and correction of anomalies named NADCA. This algorithm uses a compact deep learning prediction model and has been evaluated using real and simulated anomalies in real landing signals. NADCA detects and corrects both fast-changing and slow-moving anomalies; it is robust regardless of the degree of oscillation of the signals and sensors with abnormal behavior do not need to be isolated. NADCA can detect and correct anomalies in real time regardless of sensor accuracy. Likewise, NADCA can deal with simultaneous anomalies in different sensors and avoid possible problems of coupling between signals. From a technical point of view, NADCA uses a new prediction method and a new approach to obtain a smoothed signal in real time. NADCA has been developed to detect and correct anomalies during the landing of an airplane, hence improving the information presented to the pilot. Nevertheless, NADCA is a general-purpose algorithm that could be useful in other contexts. NADCA evaluation has given an average  Anomaly detection is about finding patterns that do not adhere to what is considered normal behavior . AbnormaFraudulent activity in the banking sector, deforestation in the environmental sector, cancer in the healthcare sector, fake news in the social media sector, hacker attacks in cybersecurity, malfunctions in the manufacturing sector, traffic jams in the transportation sector, etc. are some examples of anomalies. Some examples of anomaly detection in different fields are presented in ,3,4,5,6.Commercial aircraft flights are a good example where anomaly detection is very important. Although fault tolerant architectures are in place, anomaly detection is paramount to passivate faulty components. A faulty actuator can be switched to its sane redundant counterpart. A faulty sensor can be put aside from the data fusion process . In partNormally, the set of sensors consists of a global positioning system (GPS), an inertial reference system (IRS), an instrument landing system (ILS), and a radio-altimeter (RA). Typically, these sensors work properly with a specific accuracy and specific fusion techniques are applied to get a good estimate of the airplane’s location .However, sensors can provide data with anomalies. Anomaly detection methods can be applied to guarantee optimal quality of measures. When an anomaly is detected, either the anomalous sensor is isolated or the detected anomaly is filtered.This article presents a new algorithm named NADCA  to detect and correct anomalies in time series. This algorithm is a general-purpose algorithm, but it has been developed in the framework of a project in the field of aeronautics to detect and correct sensor anomalies during airplane landing.NADCA uses a predictive model based on deep learning. More precisely, NADCA is based on a recurrent neural network (RNN) called Long Short-Term Memory (LSTM) .Deep learning has been used with success for classification and prediction purposes . In partLSTM is a good choice for the prediction task of time series because it can deal with chronologically ordered sequences and can track long-term dependencies in these sequences. Like most NN-based algorithms, LSTM relies on the assumption that training and test data share similar statistics.In , variousAn anomaly detection technique based on LSTM is proposed in . The modCNNs) to detect anomalies  for the X coordinate,  for the Y coordinate, and  for the Z coordinate. Each signal is denoted by the “CoordinateSensor” symbol.During a landing, the complete set of signals with respect to the runway reference can be described by three multichannel signals:  for the Z coordinate,  for the Y coordinate, and  for the X coordinate. The approach phase was filtered for each landing. These 36 landings form a real data set.A set of 36 landings from the same airport was selected. Each landing had the following signals: . RMSE calculates the error between the original signal without anomaly and the signal with anomaly correction in the interval . It is useful to evaluate anomaly correction, especially in signals without oscillations.Assume that an anomaly appears in the time interval [GPSZ is a simulated anomaly. The noise anomaly in ILSY is a small real anomaly.ILSY. However, this anomaly was not artificially generated. Consequently, RMSE and F-Score calculation are not possible. There is an anomaly in GPSZ. This anomaly was artificially generated. The F-score is 1 because NADCA perfectly detects the anomaly. The RMSE is 0.57. This value is small. There are no anomalies in GPSX, IRSX, GPSY, IRSY, IRSZ, ILSZ, or RAZ and consequently, the value of F-score and RMSE is N/A.GPSZ.GPSZ. The F-score  where X = IRSX. A simulated anomaly appears in both IRSX and ILS.Y A small coupling between IRSX and RAZ is also present. The terrainH value of Equation (1) was obtained using XIRS values.X, Y, and Z. It detects and corrects the anomaly in IRSX and consequently the anomaly does not appear in ILSY and RAZ. If NADCA correctly detects the anomaly in IRSX, then there is no coupling problem and NADCA knows that the source of the anomaly is in IRSX. The right side of IRSX.NADCA works following the order IRSX, ILSY, and RAZ could be detected and corrected. However, the source of the anomaly would not be clear.NADCA can also work after each sample has been generated for each signal, even if there is a coupling problem. Anomalies in F-score of 0.99 due to a non-anomalous sample and a RMSE = 0.61.GPSY. The RMSE is 2.9  is not the only criterion used to start analyzing a possible slow-moving anomaly. For signals with oscillations, such as the F-score value of 0.97 was obtained in relation to the detection of anomalies and an average root mean square error (RMSE) value of 2.10 regarding the correction of anomalies.NADCA was evaluated using a set of 80 simulated sensor anomalies during landing. An average The average F-score value is very high. It does not reach the value 1 because, mainly, NADCA consumes some samples before detecting slow moving anomalies. The average RMSE value is acceptable. This could be lower considering, for example, a higher ND number (see Other strategies for correction could have been considered, for example, using algorithms described in . HoweverNADCA is an algorithm for the detection and correction of anomalies in time series. The algorithm differentiates between time series with oscillations and without oscillations.Three versions of NADCA have been described. NADCA-B is only useful for detecting some obvious anomalies, NADCA-L detects and corrects anomalies in signals without oscillations, and NADCA-O detects and corrects anomalies in signals with oscillations. NADCA-B can be seen as a particular case of NADCA-L. Furthermore, NADCA-L is a special case of NADCA-O.NADCA is robust because the predictions are made on smoothed signals. When a time series has oscillations, the algorithm creates a smooth signal by using the SG filter. A smoothed signal guarantees a small prediction error less than a constant.NADCA has been used for both simulated and real anomalies on real landings.X, Y, and Z. In this way, if an anomaly appears in any sensor coordinate, it is corrected before analyzing the next coordinate since the latter can be a function of the previous coordinate. Consequently, coupling problems are avoided.NADCA is applied following the order of the coordinates GPSZ that could be small anomalies. However, they may not be relevant.Regarding the thresholds that derive from a prediction error, we can compare X axis is not the best to predict the behavior of GPSX. This comes from the fact that the model only combines two sensors and the number of landings used to create the model is small. On the other hand, for the Y and Z axes, despite the small number of landings, the models generalize well for the selected airport. This is so because each model uses more sensors in a compact way.The predictive model for the NADCA was developed primarily to detect and correct anomalies during the landing phase. During this phase, the plane does not make abrupt changes and therefore, NADCA detects anomalies related to the sensors’ operation. However, an abrupt change in the trajectory of the aircraft would generate changes in the sensor signals that would be considered anomalous. These changes usually happen during the approximation phase that has not been considered in this work.It is uncertain whether each predictive model could correctly predict the behavior of the sensors for landings in another airport. This does not have to be the case, and therefore, it is left for future work to consider new landing data from various airports in order to create a predictive model that generalizes to any airport.NADCA is a new algorithm for anomaly detection and correction in time series. The algorithm is robust because it differentiates between oscillating and non-oscillating time series and always makes predictions on smooth signals.U to decide whether or not there is an anomaly. NADCA was tested in time series that describe the landing phase of an airplane with promising results. This algorithm guarantees the quality of measures during landing. Generalization to several airports could be considered if additional data sets from various airports were made available. Importantly, NADCA is a general-purpose algorithm that could also be used in other contexts. Future work will consider applying NADCA for applications in other domains.NADCA uses a predictive model based on an LSTM neural architecture. The predictions provide a reference. The difference between this reference and the raw values is compared with a specific threshold NADCA is a new algorithm for anomaly detection and correction. Detection and correction are performed simultaneously.NADCA uses a new prediction strategy to detect and correct both fast-changing and slow-moving anomalies.NADCA distinguishes between signals with oscillations and without oscillations. The algorithm is similar for both types of signals, however, signals with oscillations require an additional step. This step consists of obtaining a smoothed signal in real time.NADCA works in real time. It uses information from sensors in a compact way and only needs to predict one sample at each iteration.NADCA evaluation has given an average F-score value of 0.97 for detection and an average RMSE value of 2.1 for correction.The different examples in this article show the simultaneous detection and correction of both fast changing anomalies e.g.,  and slowOnce the anomaly is detected, the corresponding sensor does not need to be isolated.The following points summarize the main conclusions of this paper:


Rugby league is a high-intensity collision sport that carries a risk of concussion. Youth athletes are considered to be more vulnerable and take longer to recover from concussion than adult athletes.TM-recorded impacts via video analysis.To review head impact events in elite-level junior representative rugby league and to verify and describe characteristics of X-patchObservational case series.TM was used on twenty-one adolescent players (thirteen forwards and eight backs) during a 2017 junior representative rugby league competition. Game-day footage, recorded by a trained videographer from a single camera, was synchronised with X-patchTM-recorded timestamped events. Impacts were double verified by video review. Impact rates, playing characteristics, and gameplay situations were described.The X-patchTM-recorded 624 impacts ≥ 20g between game start and finish, of which 564 (90.4%) were verified on video. Upon video review, 413 (73.2%) of all verified impacts ≥ 20g where determined to be direct head impacts. Direct head impacts ≥ 20g occurred at a rate of 5.2 impacts per game hour; 7.6 for forwards and 3.0 for backs (range = 0–18.2). A defender’s arm directly impacting the head of the ball carrier was the most common event, accounting for 21.3% (n = 120) of all impacts, and 46.7% of all “hit-up” impacts. There were no medically diagnosed concussions during the competition.The X-patchTM sensor were verified by video. Double verification of direct head impacts in addition to cross-verification of sensor-recorded impacts using a secondary source such as synchronised video review can be used to ensure accuracy and validation of data.The majority (90.4%) of head impacts ≥ 20g recorded by the X-patch There was a substantial number of false-positive high acceleration impacts recorded that occurred before, during, or after the games. Wearable instrumented technology has limitations as a primary data source and should be used in conjunction with video review.The vast majority of high acceleration impacts (≥ 20g) that occurred during game time were verified on video review.Careful time synchronisation of impact sensor-recorded events and match video is vital to help cross-validation and to reduce over-estimation of an athlete’s direct head impact exposure.Rugby league carries a risk of concussion due to its high intensity and frequency of collisions . Youth aSideline video review has become increasingly common in professional sports for identifying head impact events and potential concussions. Recently, multiple experts from seven national and international professional sporting codes developed international consensus definitions of video signs of possible concussion, agreeing on six video signs: (i) lying motionless (for > 2 s); (ii) motor incoordination ; (iii) impact seizure; (iv) tonic posturing (involuntary sustained contraction of one or more limbs); (v) no protective action/floppy; and (vi) blank/vacant look . The NatTM is an impact sensor designed for non-helmeted athletes that has been used in three previous rugby league studies in junior, women’s, and semi-professional competitions  as well as greater PRV compared to indirect VV-HI ≥ 20g . Figure Of the 624 HI ≥ 20g during gameplay, 564 (90.4%) were verified on video. The distribution of all X-patchTM, either because the sensors did not activate  or because the impact did not reach the 10g threshold , one was partially visualised on video but was indeterminant, and 11 recorded impacts had complete visualisation but with no identified contact . In all of these instances, there was clearly no contact from another player. Each of these HI ≥ 20g was verified by two reviewers to confirm them as “false-positive” impacts. There was no significant difference in the PLA of VV-HI ≥ 20g versus false-positive HI ≥ 20g . The magnitude of these direct VV-HI ≥ 20g did not statistically differ between the first and second half . Forwards had a higher rate of direct VV-HI ≥ 20g than backs . However, the intensity of direct VV-HI ≥ 20g did not statistically differ between forwards and backs .Of the 413 direct VV-HI ≥ 20g, players sustained an average of 5.2 direct VV-HI ≥ 20g per hour of gameplay, with a slightly higher rate of direct VV-HI ≥ 20g during the second half of the game . The sensor-derived impact location was poorly correlated with side-on direct head impacts visualised on video, and as such overestimated VV-HI ≥ 20g in all other directions, particularly front-on impacts. A detailed description of the location accuracy for direct and indirect VV-HI ≥ 20g is provided in Table When looking at the location of all direct VV-HI ≥ 20g n = 41 via the n = 260) of total VV-HI ≥ 20g and 53.5% (n = 221) of all direct VV-HI ≥ 20g. For 260 secondary impacts, 16.2% (n = 42) were accompanied by a VV-HI ≥ 20g. There were 456 tackles that resulted in the 535 VV-HI ≥ 20g, excluding impacts that occurred “off the ball.” For 388 tackles there was one impact recorded, for 60 there were two impacts recorded, for 7 there were three impacts recorded, and for 1 there were six impacts recorded. There were an additional 27 incidents occurring off the ball that resulted in 29 VV-HI ≥ 20g (25 with one impact recorded and 2 with two impacts). The hit-up was a play that accounted for approximately 47.1% (n = 215) of all X-patchTM-recorded events. Of the hit-up plays, the forward positions accounted for 62.8% (n = 135) of those impacts, while the back positions accounted for approximately 37.2% (n = 80) of impacts. The tackle accounted for approximately 52.9% (n = 241) of all X-patchTM-recorded events. Of the tackles, the forward positions accounted for 73% (n = 175) of those impacts, while the back positions accounted for approximately 27% (n = 66) of impacts.Secondary impacts during a tackle  accounted for 46.1% . The rate of direct VV-HI ≥ 20g was not significantly different between the first and second half, but showed a greater exposure experienced by forwards when compared to backs, consistent with previous literature , 1817, 1lf n = 62, 48.3% oTM studies [TM.In this study, we employed a video verification approach with two reviewers independently reviewing 60 HI ≥ 20g that occurred during game time that were not verified by video. This was used for quality assurance to verify false-positive readings so that they could be confidently removed from head impact exposure data prior to analysis. Interestingly, upon close review of non-verified impacts, we discovered 33 impacts that occurred while the player was on the sideline. It is unclear how or why these impacts were recorded on the sensors because there was no available video of players on the sidelines. It is possible that these impacts occurred while players were preparing to enter the game by simulating tackles. Previously Cortes and colleagues , in a re studies . There wt tests and Mann-Whitney U tests) were exploratory and should be replicated in larger, more representative samples. Similar to our previous study [This study consisted of a relatively small sample size, and no player played all games. Due to faulty equipment at the end of the season, the number of working sensors was less than the number of participating players in each game. Because of this, sensors were given to players likely to play more minutes throughout the game to maximise data collection. Further, due to time and personnel constraints, training sessions and two games throughout the season were unable to be staffed by research personnel; these data underrepresent the total accumulation of head impacts over the course of a full season. Additionally, our statistical analyses , in combination with a sport that has a high frequency of body contact, it seems likely that the sensor is recording triggered events that are not actually impacts to the head or body [This study utilised one high-definition sideline video camera that panned across the entire field which limits the ability to accurately verify impacts and signs of concussion. Some impacts may be obstructed from view by another player, and thus, the exact location of some impacts may be inaccurate. Research studies on professional sports with multiple camera angles may be more accurate in analysing video signs of concussion and determining location of verified impacts. Critically, the process for synchronising, and interpreting, the video and X-patch or body , 29.TM-recorded data. That is, the X-patchTM has serious limitations as a primary data source [The findings from this study are consistent with previous research, highlighting the importance of using video review as the primary source of information on head impact and supplementing that with X-patcha source , 20, 27.


Some research suggests people are overconfident because of personality characteristics, lack of insight, or because overconfidence is beneficial in its own right. But other research fits with the possibility that fluent experience in the moment can rapidly drive overconfidence. For example, fluency can push people to become overconfident in their ability to throw a dart, know how rainbows form or predict the future value of a commodity. But surely there are limits to overconfidence. That is, even in the face of fluency manipulations known to increase feelings of confidence, reasonable people would reject the thought that they, for example, might be able to land a plane in an emergency. To address this question, we conducted two experiments comprising a total of 780 people. We asked some people (but not others) to watch a trivially informative video of a pilot landing a plane before they rated their confidence in their own ability to land a plane. We found watching the video inflated people's confidence that they could land a plane. Our findings extend prior work by suggesting that increased semantic context creates illusions not just of prior experience or understanding—but also of the ability to actually do something implausible. You are the only other person on the plane. How confident are you that you could land the plane without dying? It seems obvious that for anyone without flight experience that confidence should be vanishingly small. After all, landing a plane is a highly specialized skill, requiring hundreds of hours of training and a deep understanding of physics, engineering and meteorology ,2. But h‘overclaim’ what they know, or what they can do, so other people think better of them . In null hypothesis testing terms, both the Welch's t-test and Wilcoxon signed-rank test showed the same pattern, t184 = 2.057, p = 0.04; Z = 2.15, p = 0.03. Second, we asked a pilot with 35 years' experience flying commercially and internationally for Air New Zealand for his estimate on the chances of surviving the landing and his estimate was 10–15%. A one-sample t-test showed that subjects’ responses to the ‘without dying’ question were significantly higher than this estimate, t184 = 8.92, p < 0.001.We observed a marked skew in confidence ratings: the lower quartile was 9 and the modal response was 0; clearly, no transformation could restore normality. But t-tests—especially Welch's, a parametric test that does not assume equal variance—are robust to most deviations in normality ,61. TherMvideo = 25.27, Mno video = 15.70, Mdiff = 9.57, 95% CI . The Welch's t-test and Wilcoxon signed-rank test showed the same pattern, t166 = 2.56, p = 0.01; Z = 2.15, p = 0.03.We then carried out the same analyses on subjects' confidence ratings for the higher standard, the ‘as well as a pilot could’ question. We display these data in To determine if men and women reported different degrees of confidence, we first classified responses by gender and video condition; we then calculated mean confidence ratings. Two caveats are warranted. First, because there was only one non-binary subject, we excluded that subject from this particular analysis. Second, classifying data by gender broke random assignment. We checked to make sure there were similar numbers of men and women in each of the four cells; there were . With these caveats in mind, we found that subjects who watched the video were more confident in their ability to land the plane both ‘without dying’ and ‘as well as a pilot could’ compared with subjects who did not watch the video. But we also found gender mattered for the ‘without dying’ confidence rating; men were more confident than women in every condition.Mdiff = 12.24, 95% CI , F1,196 = 4.46, p = 0.01; ‘as well as a pilot could’; Mdiff = 5.17, 95% CI , F1,196 = 1.96, p = 0.16. There was no interaction between gender and video condition for either measure .In other words, we conducted two separate  x 2  ANOVAs, the first on subjects' ‘without dying’ ratings and the second on their ‘as well as a pilot could’ ratings. There was a main effect of video for both ratings, but also a main effect of gender for the ‘without dying’ rating, ‘without dying’ Mvideo = 3.00, Mno video = 3.02; Mdiff = −0.02, 95% CI , p = 0.93). But in unplanned follow-up analyses, we found people's ease of imagining and confidence they could land a plane without dying were strongly associated when they had watched the pilot  and weakly associated—including plausibly zero—when they had not . A Fisher's z-test indicated that these correlations were significantly different . These findings fit with the idea that when people watched the pilot land the plane, they were more sensitive to ease of processing cues , p = 0.83. Considered together, these data do not support the counter-explanation.Taken together, our findings show that watching one short non-instructional video of a pilot landing a plane inflated people's confidence in their own ability to land the plane—a specialized task requiring a great deal of expertise. One possible counter-explanation for our results could be that people do not know landing a plane requires much expertise, or that after watching the video, people re-evaluate their knowledge about what expertise is necessary. To address this possibility, we classified subjects according to whether they had watched the video and calculated their mean response to the question ‘How much expertise do you think is involved in landing a plane?’  to calculate sample size based on the data from Experiment 1. Using those data and a desired power 0.90, the target n per condition was 226, or a total of 502. Anticipating exclusions, we aimed to collect data from 600 people, but because Qualtrics and MTurk interact in such way that it is possible to unintentionally collect more data than required, we ultimately collected data from a total of 632 subjects. After applying exclusions as detailed below, we retained 582 subjects in the dataset ; 94% of subjects reported English was their first language.We recruited subjects from Amazon's Mechanical Turk (MTurk), an online source of a vast and diverse population, who received $0.30 USD for participating . We used. 3.1.2We used the same design as in Experiment 1, a between-subjects design with two conditions .. 3.1.3We used the same basic method as in Experiment 1. This time, however, we counterbalanced the order of the ‘without dying’ and ‘as well as a pilot could’ questions.. 3.2Mvideo = 34.23, Mno video = 28.79, Mdiff = 5.44, 95% CI , t561.43 = 2.33, p = 0.020. But we did not find the same pattern for the higher standard, ‘as well as a pilot could’, Mvideo = 22.42, Mno video = 19.20, Mdiff = 3.22, 95% CI , t568.18 = 1.51, p = 0.13.Consistent with our pre-registration, we first excluded 50 subjects who provided non-sensical descriptions of the situation they were asked to imagine, failed our attention check, had a valid pilot's licence or had flown or landed a plane before. We pre-registered an independent t-test with video  as a between-subjects factor, collapsing the order of the dying and pilot questions, because we did not expect to see an effect for order. When we carried out this pre-registered test, we found subjects who watched the video of a pilot landing a plane were more confident in their own ability to land the plane at the lower standard, ‘without dying,’ When we took a closer look with exploratory analyses, we found evidence that question order mattered . That isF1,581 = 5.23, p = 0.02; a marginal effect of question order, F1,581 = 3.40, p = 0.07; and an interaction, F1,581 = 4.04, p = 0.04, such that watching the video inflated people's confidence when the ‘without dying’ question was asked first, Mdiff = 9.96, 95% CI , p = 0.01; but not when the ‘as well as a pilot could’ question was asked first, Mdiff = 0.64, 95% CI , p = 0.99. For the ‘as well as a pilot could’ ratings, we found a main effect of question order, F1,581 = 5.2, p = 0.02 and an interaction, F1,581 = 6.34, p = 0.01, such that watching the video inflated people's confidence when the ‘without dying’ question was asked first, Mdiff = 8.49, 95% CI , p = 0.02; but not when the ‘as well as a pilot could’ question was asked first, Mdiff = −2.15, 95% CI , p = 0.89In null hypothesis testing terms, we conducted two separate 2  × 2  ANOVA—the first on subjects' ‘without dying’ ratings and the second on their ‘as well as a pilot could’ ratings. For the ‘without dying’ ratings, we found a main effect of video condition, et al. carried out a series of Monte Carlo simulations with a range of distributions including extreme skewness and kurtosis values (of up to skewness = 2 and kurtosis = 6), they found that ANOVA can be robust to such deviations [F1,581 = 6.44, p = 0.01. The order of the questions mattered such that people were more confident they could land the plane without dying when they were asked that question first; F1,578 = 5.02, p = 0.03. We also found a marginally significant interaction; F1,581 = 3.53, p = 0.06, such that watching the video inflated people's confidence when the ‘without dying’ question was asked first.The data showed small deviations from normality and variance. But when Blanca viations . Our skeviations . Using tThough these patterns are the result of exploratory analyses, they raise the possibility that responses to the first question anchored responses to the second question—in particular, being asked the lower standard ‘without dying’ question first allows subjects to nod along with feelings of ease they experience through watching the video, and although the second question about the pilot standard might shift subjects away from their intuitive hunch, they adjust insufficiently from their answer to the ‘without dying’ standard ,65. We cN = 6). We found that subjects who watched the video were more confident in their ability to land the plane ‘without dying’ compared with subjects who did not watch the video. But we also found gender mattered; men were more confident than women in every condition.Next, and consistent with our pre-registration, we determined if men and women reported different degrees of confidence. To address this issue, we again classified responses by gender and video condition, and calculated the mean confidence ratings. Like Experiment 1, we excluded the small number of non-binary subjects from this particular analysis . There was no interaction between gender and video condition for either measure . Of course, these data are exploratory, not randomized, and we therefore urge caution in interpretation.In other words, we conducted two separate 2  x 2  ANOVAs, the first on subjects ‘without dying’ ratings and the second on their ‘as well as a pilot could’ ratings. We again found a main effect of video, but also a main effect of gender . But, consistent with the pattern of results from Experiment 1, we found that people's ease of imagining and confidence they could land a plane without dying was moderately associated when they had watched the pilot  and weakly associated when they had not . A Fisher's z-test indicated that these correlations were significantly different . These findings provide more support for the idea that the video may enable subjects to develop more detailed imaginations of themselves landing the plane, that they misconstrue as evidence that they could actually land the plane.Then, and also as a pre-registered analysis, we determined if people who watched the pilot land the plane reported it was easier to imagine landing a plane relative to their counterparts who did not watch the pilot. As in Experiment 1, we found no evidence to support this idea when comparing mean responses to this question across the video and no video conditions .Finally—and as in Experiment 1—we found that regardless of whether subjects saw the video, they reported similar awareness that being a pilot demands great expertise  is reminiscent of the effect of antihistamine reducing runny noses, the link between combat exposure in Vietnam and PTSD over the next two decades, and the link between exposure to lead and impaired intelligence scores in children [How are we to understand this effect size? We can address this question by first turning to the related literature. First, our effect size is similar to that of the effect called  problem . Second, problem . Third,  problem . Fourth, problem . And finchildren .. 5We found evidence that simply watching one non-instructional demonstration of an expert performing a highly complex skill leads people to become more confident in their ability to perform that skill. More specifically, when people watched a trivially informative video of a pilot landing a plane, it inflated their confidence that they themselves could land a plane.These findings contribute to several literatures. First, our findings suggest that increased semantic context creates illusions not just of prior experience, knowing or understanding—but also of the ability to actually do something implausible ,35,71,72Second, our findings fit with the literature suggesting that when imagining an experience in the future brings those self-generated mental products to mind easily—and with low cognitive markers of effort—people think that experience is more likely to happen ,73. TakeThird, these findings extend what we know about the kinds of situations in which people experience ‘knowledge neglect’—the failure to retrieve or apply their previously demonstrated knowledge, resulting in a failure to spot errors ,75. HereFourth, they fit with an anchoring-and-adjustment account in which the order of items affects people's evaluations of their performance on those items. That is, our findings from Experiment 2 support the possibility that the question people encountered first anchored their response to the second. In other words, when people first face the lower standard ‘without dying’ question, they might be lulled into a more heuristic type of processing, essentially ‘nodding along’ with the scenario, and tending to rely on recent feelings of easy processing that the added semantic context of the video provided . Then, tAlthough we cannot determine the extent to which these mechanisms—in whole or in part—drive our effects, across two experiments our data suggest a general mechanism in which the semantic context of the video helps people mentally manufacture thoughts, images and feelings consistent with the proposition that they could land the plane. But there is more work to be done. For instance, it is not clear exactly what aspects of the video led people to be overconfident. For instance, our video depicted a successful, smooth, landing with no complications. Perhaps if people saw a challenging landing, it might draw their attention to their genuine lack of skill. Furthermore, the video was not designed to be instructional . Perhaps if the pilot in the video stepped through the specific actions necessary to land the plane, explaining the purpose behind them, that shift to a more concrete level of construal would encourage people to evaluate their abilities more accurately . We knowIn addition, the successful, smooth landing with no complications left subjects in the dark about the decisions driving the pilot's actions; subjects might therefore have developed their own error-filled notions to fill in the gaps. Such a process could be explained by the ‘beginner's bubble’ . The ideEven though our findings fit with the idea that the video provided semantic context that supported fluent generation of relevant thoughts, images and feelings, it is possible that some mechanisms other than fluency have driven these effects. For instance, it is possible that our effects arise from the combination of knowledge neglect and the beginner's bubble. It is also worth considering the role of individual differences given that most people reported realistic appraisals of their ability to land a plane. First, the literature on the need for self-enhancement and narcissism suggests it can lead to ‘overclaiming’, or claiming to know terms that do not exist. Perhaps people high on these traits would be more susceptible to the illusions of confidence we report here ,4. SeconThe effects we report here might also be considered new and surprising examples of the confidence-boosting effects of videos demonstrated by Kardas & O'Brien , who fou


P < 0.001), with a longer hospital stay  and different coinfections. The predominant strains in 2015 and 2016 were ciprofloxacin-resistant Shigella sonnei and azithromycin non-susceptible Shigella flexneri (S. flexneri) 3a, which had been replaced by ciprofloxacin-resistant S. flexneri 2a since 2018. Notably, six indigenous cases were caused by cefotaxime-resistant S. flexneri. Inappropriate use of empiric antibiotic treatment was common. In conclusion, there is an ongoing spread of ciprofloxacin-resistant shigellosis among PLWH and MSM and cefotaxime-resistant S. flexneri is an emerging threat in Taiwan.Shigellosis appears to increase in certain at-risk populations in developed countries. Based on the nationwide surveillance, the annual incidence of shigellosis in Taiwan (1999-2019) was 0.38-5.77 cases per 100,000 people. Indigenous shigellosis has mostly affected men who have sex with men (MSM) and people living with HIV (PLWH) since 2015. In this retrospective study, compared with those diagnosed before 2015, indigenous cases diagnosed during 2015–2019 mostly occurred in male adults (96.0% vs 47.1%,  Shigella is a non-spore-forming, non-motile, Gram-negative bacterium, and is well-known as an etiologic agent of bacillary dysentery. The genus includes four serogroups with multiple serotypes: S. dysenteriae, (serogroup A), S. flexneri (serogroup B), S. boydii, (serogroup C), and S. sonnei (serogroup D) , National Taiwan University Hospital Hsinchu Branch [105-017-F] and Far Eastern Memorial Hospital [105040-F], and Institutional Review Boards of Taoyuan General Hospital [TYGH103011], Hsinchu Mackay Memorial Hospital [18MMHIS008e], Chung Shan Medical University Hospital [CS14034], Changhua Christian Hospital [160408], National Cheng Kung University Hospital [B-BR-109-032], Chi Mei Medical Centre [10505-002], Kaohsiung Medical University Hospital [KMUH-IRB-20110040], and Kaohsiung Chang Gung Memorial Hospital [202001763B0C501]. The informed consent was waived. This study was conducted according to the principles expressed in the Declaration of Helsinki.According to the statistics of NDSS, the annual incidence of shigellosis in Taiwan from 1999 to 2019 was approximately 0.38-5.77 cases per 100,000 people. Before 2010, indigenous cases of shigellosis accounted for most of the cases. Most of the indigenous cases occurred in mountainous townships; and several outbreaks had been reported in schools, mental health institutions, and long-term care facilities (LTCFs) in urban areas . During Shigella dysentery, 10 (5.0%) Shigella bacteraemia, and one both dysentery and bacteraemia; and the remaining three cases were diagnosed by either rectal swab (2 cases) or wound culture from an anal abscess (1 case). Among the cases, 83.6% (168/201) occurred in individuals without a recent history of travel abroad before the onset of symptoms and were regarded as indigenously acquired. Among the indigenous cases, males were predominant  and the majority  were diagnosed during 2015–2019 . The clinical characteristics of the patients diagnosed with indigenous cases of shigellosis during 2010–2014 (Group A) and those during 2015–1019 (Group B) are summarized in P = 0.002). More than half of the affected individuals in Group A were aged <18 years, while in Group B they were mostly male aged 18–65 years. In addition, recent ingestion of uncooked food was more common in Group A (P = 0.009), and none in Group A had prior STDs. On the contrary, most patients in Group B were PLWH. Except for a longer hospital stay for Group B (P = 0.029), there were no significant differences in clinical manifestations, such as fever, abdominal pain, tenesmus, bloody diarrhoea, or chronic diarrhoea, between the two groups . Of the 201 cases, 189 (94.0%) were o groups .Table 1Campylobacter colitis, and intestinal giardiasis), Campylobacter bacteraemia, and opportunistic infections (such as tuberculosis or candidiasis) were concurrently diagnosed in the patients in 2015–2019 (Group B). Only one patient in Group B had concurrent rotavirus gastroenteritis (Supplementary Table 2).All 115 PLWH with indigenous cases of shigellosis were males, predominantly MSM . The annual proportion of PLWH among MSM increased from 36.4% in 2015–70.3% in 2019 . Of the Shigella isolates from male patients with indigenous shigellosis, 33 (21.6%) and 116 (75.8%) were S. sonnei and S. flexneri, respectively, and 4 (2.6%) unidentified species. An increase of S. sonnei isolates was noted during 2015-2016, while S. flexneri was responsible for the majority  of indigenous shigellosis between 2017 and 2019. Serotyping was performed for 109 indigenous S. flexneri isolates. The predominant serotype during 2016–2017 was 3a, accounting for 64.7% (22) of 34 S. flexneri isolates  and 40.4% (46/114), respectively. In 2018 and 2019, with S. flexneri as the predominant aetiology of indigenous shigellosis, isolates with antimicrobial resistance became prevalent in S. flexneri; of note, only one (2.8%) of 36 S. flexneri isolates was susceptible to fluoroquinolones.Antibiotic susceptibility profiles of S. flexneri to ampicillin and azithromycin and S. sonnei to trimethoprim-sulfamethoxazole (TMP-SMX)  .S. flexneri isolates identified from male patients with indigenous cases of shigellosis, 7 (6.0%) were resistant to cefotaxime  patients with indigenous shigellosis received inappropriate antibiotics as the initial therapy, including a fluoroquinolone in 41.5% (34/82) of the cases. Such an emerging threat of ciprofloxacin-resistant ulations . Up to nulations . With thShigella isolates and to track the route of possible international spread.There are some limitations in this study. Firstly, the retrospective study of clinical characteristics of shigellosis involved 11 participating tertiary hospitals around Taiwan. We might miss indigenous cases of shigellosis that occurred in mountainous townships or in densely populated institutions in urban areas, who might be treated in local clinics or public health centres. In contrast, after 2015 shigellosis cases involved mostly MSM and PLWH, who were accustomed to seek HIV care at these tertiary hospitals. Furthermore, in PLWH and MSMs other STDs and viral hepatitis cared at tertiary hospitals would be studied concurrently; in contrast, not all paediatric patients had such detailed information. Therefore, selection and information biases were inevitable in our study. Secondly, though we described the changing epidemiology of shigellosis in a ten-year study period, the reason why shigellosis had predominantly affected MSM or PLWH after 2015 remains unclear. At the same time, beginning from 2015-2016, an unprecedented large outbreak of acute hepatitis A that predominantly affected MSM occurred in Taiwan ,40. We cShigella spp., for which programmes to promote appropriate use of antibiotics should be reinforced. Novel vaccine strategies, including serotype-based vaccines and conserved antigen vaccines, are regarded as being promising, and there are several vaccine candidates under development or clinical trials [Our study has clinical and public health implications. To prevent from shigellosis, people should avoid ingestion of uncooked food and unboiled water. Personal hygiene should be maintained, including hand washing, disinfection of bathroom faucets and door handles, especially before and after approaching diarrheal patients. For MSM, multiple sexual partners, condomless or oro-anal sex should be avoided; wearing latex gloves or dental dam may help protect themselves . The publ trials .Shigella dysentery in MSM and PLWH, which often manifested as chronic diarrhoea and led to a longer duration of hospital stay. The predominant strains of shigellosis have shifted from fluoroquinolone-resistant S. sonnei to azithromycin non-susceptible S. flexneri 3a and fluoroquinolone-resistant S. flexneri 2a with the emergence of cefotaxime-resistance Shigella species. Physicians should consider such trends of antimicrobial resistance in choosing the optimal treatment for suspected cases of shigellosis.In conclusion, we report the changing epidemiology of shigellosis in Taiwan in 2010-2019. There was a growing number of indigenous cases of Click here for additional data file.Click here for additional data file.


The COVID-19 pandemic restricted everyday life during 2020-2021 for many people worldwide. It also affected alcohol consumption patterns and leisure activities, including the use of social media.The aim of this study was to analyze whether social media use predicts increased risky drinking over time and during the COVID-19 pandemic restrictions in particular.This 5-wave longitudinal survey study, based on a nationwide sample of workers, was conducted in Finland in 2019-2021. A total of 840 respondents  participated in all 5 waves of the study. The outcome variable was risky drinking, measured using the 3-item Alcohol Use Disorders Identification Test (AUDIT-C). Multilevel linear hybrid modeling enabled the investigation of both within-person and between-person effects. Predictors included social media use and communication, involvement in social media identity bubbles, psychological distress, and remote working. Controls included sociodemographic factors and the Big Five personality traits.Increased involvement in social media identity bubbles was associated with an increase in risky drinking behavior. Of all social media platforms examined, online dating app use was associated with riskier use of alcohol over time during the COVID-19 crisis. Daily social media communication with colleagues about nonwork topics was associated with risky drinking. Female gender, younger age, university education, nonindustrial occupational field, conscientiousness, agreeableness, and neuroticism were associated with lower levels of risky drinking.Social media use during a pandemic carries some risks for alcohol consumption. Involvement in social media identity bubbles and online dating are risk factors for excessive drinking during the COVID-19 pandemic. The COVID-19 pandemic has remarkably changed everyday life for people worldwide. Restrictions placed on social gatherings, public events, bars, and restaurants are likely to affect peoples’ drinking habits . ResearcDifferent forms of social media have become a central part of communication and interaction among people across the world -21. SociThe underlying mechanisms between social media use and related alcohol use are not entirely known, although previous studies suggest that perceived drinking norms and exposure to alcohol content and marketing might be possible factors ,39-41. AResearch on social media identity bubbles  shows that people are drawn toward similar-minded individuals with whom they identify strongly and share information ,44,45. TThere are likely to be major differences in drinking during the COVID-19 pandemic at the individual level. Although the ongoing pandemic has been reported to have a negative impact on the mental well-being of people in Europe ,48, it sAccording to pre-pandemic studies, younger people and men are more likely to be risky drinkers -56. SomeThis longitudinal study focused on analyzing risky drinking behaviors before and during the COVID-19 pandemic restrictions in Finland. The first COVID-19 case in Finland was reported in January 2020, and the country reacted to the rising worldwide crisis in March 2020 by placing several restrictions: large public events were cancelled and recommendations for remote work were implemented . On MarcThis longitudinal study aimed to analyze risky drinking behaviors before and during the COVID-19 pandemic restrictions in Finland. The research questions were (1) How did alcohol use change during the COVID-19 pandemic restrictions? (2) Do social media–related factors predict alcohol use over time? (3) Are psychological and social factors, such as psychological distress, remote working, and personality, associated with drinking?Social Media at Work in Finland Survey study started in Finland in mid-March 2019, and data were collected at 6-month intervals. A total of 5 waves were collected from Finnish employees. The baseline survey data collection commenced in mid-March 2019 , with a response rate of 28.3%. The same participants were contacted for the follow-up surveys in mid-September 2019 , mid-March 2020 , mid-September 2020 , and mid-March 2021 (n=1018). The third survey was sent only to those who had responded to the second survey, whereas the fourth and fifth surveys were sent to all original respondents. Of the original 1817 survey respondents, 840 (46.23%) participated in all 5 surveys.The longitudinal The survey was designed to represent the Finnish working population. The survey was conducted in Finnish, and responses were collected from all areas of mainland Finland. All participants were working at T1, and they were from various major occupational fields  and those who responded only to some waves (n=977) showed that the final sample included slightly older respondents and more male participants. However, we found no differences in other variables included in this study, such as risk drinking, between those who had participated in all 5 surveys and others. In other words, dropout from the survey is not associated with our main points of interest. Our final sample is very close to the official census figures provided by Statistics Finland in terms of mean age (43.90 years in our sample vs 41.81 years in the Finnish population), gender , and university-level education (47.74% in our sample vs 42.46% in the Finnish population) ,63.The study protocol was reviewed and accepted by the Academic Ethics Committee of the Tampere region (decision 90/2018). All participants agreed to voluntarily participate in the web-based surveys, and they were informed about the purpose of the study and data processing procedures. Data collection was carried out in collaboration with Norstat, a data solutions provider.. Our models used AUDIT-C as a continuous variable. We also report the proportion of excess users, using a cutoff of ≥6 points for men and ≥5 points for women [We used the 3-item Alcohol Use Disorders Identification Test (AUDIT-C) to measure risky drinking. AUDIT-C is a widely used screening tool for excessive drinking -68. AUDIor women .excellent at all time points .We used the 12-item General Health Questionnaire (GHQ-12) to measure psychological distress -72. All does not describe me at all) to 7 (describes me completely). The original scale ranged from 6 to 42, but we transformed it to a scale of 0 to 1. The internal consistency of the scale was good at all time points .We measured involvement in social media identity bubbles using the 6-item Identity Bubble Reinforcement Scale (IBRS-6) . InvolveThe use of different social media platforms and apps was determined by asking the study participants questions about their general use of social media  and their use of social media for work purposes . Both questions were followed by separate items for different social media apps and internet services, such as Facebook, Instagram, Twitter, YouTube, LinkedIn, Microsoft Teams, and “Dating apps” . Answer options included “I don’t use it,” “less than weekly,” “weekly,” “daily,” and “many times a day.” All commonly used apps were first analyzed separately by using dummy variables for weekly users. In the final models, we used a dummy variable for use of online dating apps (0=no use and 1=at least sometimes). Sensitivity analyses were performed for weekly and daily users of online dating apps. The models also included a variable for general social media use. This variable was combined from the most used social media platforms , and the dummy variable was created on the basis of social media use several times a day .We used a single-item measure for daily social media communication with colleagues about nonwork topics: “How often do you use social media to keep in touch with your colleagues or work community regarding nonwork-related matters?” Answer options included “I don’t use it,” “less than weekly,” “weekly,” “daily,” and “many times a day.” A dummy variable was created indicating those communicating with their colleagues informally at least once a day. The measure was previously validated with two Finnish cross-sectional samples ,24.We measured remote work with a question on whether respondents were working remotely. Those respondents who indicated that they were working remotely at least 3 days a week were considered remote workers in this study.other gender, and none were among those who had participated in all waves (n=840). Hence, gender was used as a dummy variable . Information on participants’ education was obtained via a question including 7 categories , and occupational area . Gender included options for male, female, and other gender. Very few participants selected ries see . We usedα=.69; conscientiousness α=.67; agreeableness: α=.56; and neuroticism: α=.71) to good (extroversion: α=.87).We used the 15-item Big Five Inventory for personality . All iteDescriptive results of the study are reported in In our models, all main time-varying variables had both within-person and between-person effects. Within-person effects show how changes in predictors over time are associated with the change in the outcome variable. Between-person variables show group differences between individuals. The models also included several between-person control variables.We first focused on analyzing within-person and between-person effects of social media app use on risky drinking. We performed analyses on the use of such apps, as well as on weekly and daily use, when possible. The full model reporting our main findings included only those social media apps that were found relevant during this analysis. Different sensitivity analyses were performed, and we also checked interactions with COVID-19 time points (T3-T5) to determine whether some effects were stronger or different during the pandemic.Descriptive results showed changes in risky drinking measured were relatively small during the COVID-19 time points examined (T3-T5) compared to the pre-pandemic time points (T1-T2). Drinking decreased slightly, especially at T5 see . The proP=.04). Use of online dating apps  was strongly associated with risky drinking in all models. In particular, between-person effects were strong for users in general , weekly users , and daily users  in models adjusting for age and gender. Therefore, of all the different social media apps, online dating app use was included in our final model.Our results showed that the most used social media apps were not strongly associated with risky drinking . Additionally, those respondents who had daily social media communication with colleagues about nonwork topics drank more than others did . Women  and those with an MA degree or higher from university drank less than others did . Older age was associated with higher risky drinking . Workers in the industrial sector drank more than others did . Lower conscientiousness , lower agreeableness , and lower neuroticism  were associated with higher drinking. In addition, the full model shows that participants drank less during the COVID-19 era than they previously did .Analysis based on the full hybrid model showed that of the within-person predictors, only involvement in social media identity bubbles was significantly associated with risky drinking . Other relevant interactions with time were not observed.The last part of our analysis aimed at reviewing whether these within-person and between-person effects were stronger during the pandemic. This analysis showed that the within-person effect of Tinder use was observed during the pandemic  was also found, but only during the COVID-19 pandemic. This finding suggests that unusual circumstances have perhaps led to unusual and risky drinking habits. Online dating app users also drank more than others. Moreover, we found that daily social media communication with colleagues about nonwork topics was associated with risky drinking. Altogether, our results suggest that people engaged in drinking as part of involvement in web-based social bubbles. Furthermore, as dating in bars, clubs, and restaurants was not possible during the COVID-19 pandemic, dating apps such as Tinder were considered an alternative. These dating activities were found to be associated with risky drinking, despite the closure of bars.Previous cross-sectional studies conducted during the COVID-19 pandemic have reported decreased drinking, especially in Europe , but incOur finding on the within-person effect of involvement in social media identity bubbles offers an interesting contribution to the literature. Previous studies have especially considered social media postings as motivational determinants of alcohol use  and geneWe discovered that increased use of dating apps was associated with increased risky drinking during the pandemic. Our longitudinal evidence supports previously noted findings that dating app users drink more than nonusers, and this pattern increases during their dates -36. It iOur findings further showed that female gender, younger age, university education, nonindustrial occupational field, conscientiousness, agreeableness, and neuroticism were associated with lower levels of drinking. These results reflect the findings of previous studies ,58.Der Spiegel indicated that Finland had coped the best with COVID-19 in comparison with 154 other countries [We found no longitudinal evidence on the effect of psychological distress on risky drinking during the COVID-19 pandemic. This finding contrasts previous findings on the role of psychological distress and mental well-being in drinking during the pandemic -18. One ountries . It is fOur study was limited to Finland and its working population. Hence, some risk drinking groups, including full-time students and retired elderly people, were not part of the study. The results only cover the timeframe of 2019-2021, and it is too early to estimate how the crisis and drinking will further develop. Our results are limited to self-reported information on drinking. Despite these limitations, a major strength of our study is the use of multi-wave, longitudinal data. Data collection started before the COVID-19 crisis, enhancing estimation of the effects of the pandemic on drinking. Our data are particularly strong on social media measures, and the response rate for surveys was high. Our modelling strategy used within-between person hybrid models that provide an advanced way of estimating longitudinal effects of independent variables.This longitudinal study of workers in Finland showed a decrease in risky drinking during the COVID-19 crisis. The main risk factors for increased risky drinking were found to be related to social media use. Involvement in social media identity bubbles was associated with risky drinking over time. Dating app users were more likely to drink more during the pandemic. Moreover, daily social media communication with colleagues about nonwork topics was associated with higher risky drinking. Our results provide significant evidence of the power of social media during unusual times.The role of social media in drinking should be considered by social media companies such as Tinder to monitor and regulate alcohol-related postings and advertising on their services and promote more healthy ways of social interaction. This is especially essential during a crisis like the COVID-19 pandemic, when social media services present virtually the only possibilities for forming new social relationships due to lockdowns and restrictions on movement. The connection between social media use, involvement in social media identity bubbles, and increase in alcohol consumption are important findings for organizations and policy makers alike. Education and prevention efforts should consider these risk factors and, possibly, be targeted to at-risk groups.


Objective: The duration of hypothermic circulatory arrest (HCA) is one of the important factors affecting the prognosis of arch surgery, which is still controversial. The purpose of this study was to investigate the effect of HCA duration on early prognosis in type A aortic dissection (TAAD) patients who underwent arch surgery in our center.Methods: All consecutive patients who underwent surgical treatment for TAAD in Fuwai Hospital from January 2013 to December 2018 were included in this study and divided into four quartile groups based on HCA time. Baseline characteristics, perioperative indicators, and early mortality were statistically analyzed by propensity score matching (PSM) and restricted cubic spline (RCS) method. Perioperative adverse events were confirmed according to the American STS database and Penn classification.Results: About 1,018 consecutive patients  with TAAD treated surgically were eventually included in this study. After PSM, with the prolongation of HCA time, the surgical mortality rates of group , .Conclusions: The early mortality increases significantly with the duration of HCA time when arch surgery was performed. And multiple systems throughout the body can be adversely affected. Acute aortic dissection (AAD) is a life-threatening disease characterized by high morbidity and mortality and remains a challenge in its diagnosis and treatment, especially in type A aortic dissection (TAAD). Although the in-hospital or 30-day mortality rate has decreased in recent years from 31 to 22%) with the improvement of surgical techniques and strategies, the long-term overall mortality rate remains high (57%) ( to 22% wHypothermia circulatory arrest (HCA) provides the surgeon with a safe time to perform arch reconstruction surgery. Combined with unilateral or bilateral cerebral perfusion, the clinical effect and safety of total arch surgery can be significantly improved , 4. HCA Many aortic surgery centers have focused on the effects of different core temperatures and assisted cerebral perfusion strategies on surgical outcomes –14, whilAll consecutive patients who underwent surgical treatment for TAAD in Fuwai Hospital  from January 2013 to December 2018 were included in this study. Patient inclusion criteria are as follows: (1) TAR was performed for DeBakey I aortic dissection and (2) adopt HCA technology. A total of 1,018 TAAD patients were included in the final analysis. The study was approved by the Chinese Ethics Committee, with informed consent not required due to its observational nature (Reference Number: ChiECRCT-20180041).According to the experience and operation habits of our center, the core temperature maintained at 20–24°C is defined as deep HCA (DHCA), and the temperature maintained at 24-28°C is defined as MHCA. About 1,018 patients were divided into four quartile groups based on HCA time. HCA time between 2 min (inclusive) and 15 min (inclusive) was defined as  group, between 15 min and 18 min (inclusive) was defined as . For continuous variables, a normal distribution test was first carried out. The normally distributed data were expressed as mean ± SD, and a P-value of the preoperative variable after matching was close to 1. Then, the preoperative and postoperative variables were compared between the groups. A restricted cubic spline (RCS) was used to flexibly model and visualize the relation of HCA time with surgical mortality. Further, a subgroup analysis was performed by temperature, gender, age, year of operation, acuity, and Penn classification, respectively.To adjust for unbalanced basic characteristics, a propensity score matching (PSM) analysis was performed. The preoperative variables in the four groups were performed with PSM, and the About 1,018 consecutive patients  with TAAD treated surgically were admitted to the Fuwai Hospital. Patients in the acute stage before surgery accounted for 84%. Preoperative Marfan's syndrome (MFS) and other family histories of aortic disease were identified in 91 (8.9%) and 20 (2.0%) patients, respectively. According to Penn classification, 761 (74.8%) was Penn Aa, 229 (22.5%) was Penn Ab, 21 (2.1%) was Penn Ac, and 7 (0.7%) was Penn Abc. The overall baseline data are shown in p = 0.036). The incidence of this ABO was highest (80 (24.3%), p < 0.001) and traditional TAR+FET was lowest  and statistically significant in group . From group  to . There was statistically significant difference in ICU stay time among four groups, which was shortest in group   and longest in group  with p < 0.001. There were also significant differences in the use of postoperative blood products; with the prolongation of HCA time, the use of blood products tended to increase . There were also significant differences in the use of postoperative blood products; from the group  to  , p <0.001), while the group performed the least TAR+FET surgery (763.7 (75.2%), p <0.001). While focusing on clinical outcomes, the surgical mortality rates of four groups were 4.1, 6.6, 7.8, and 10.9%, with  < 0.05) –3.In p = 0.012). For women , age <60 , and in the acute phase , the HCA time of 22 min or less is associated with better clinical outcomes. Controlling HCA time ≤ 22 min can lead to better clinical outcomes in patients with preoperative malperfusion, regardless of the Penn classification (p <0.05).Overall, the HCA time of 22 min or less was associated with better clinical outcomes ; the data of subgroup analysis are shown in The application of the HCA technique can provide a relatively bloodless field of operation for arch surgery; meanwhile, it aims to protect the brain and other terminal organs. In 1975, Dr. Griepp and his colleagues developed the HCA technique and performed aortic arch replacement surgery. Satisfying clinical results were obtained, and the safety and feasibility of this technique had been proved as well . In the It is one-sided to talk about “duration” apart from “temperature” for HCA technology. A retrospective study focus on aortic arch surgery with HCA and ACP showed that a high temperature (24.1–28.0°C) is more effective in providing cerebral protection than a low temperature (≤24.0°C) in patients for <40 min, and suggested that the high-temperature group was an independent risk factor for 30-day mortality . In our With the improvement of surgical techniques and equipment, the temperature of HCA has gradually increased (20–28°C), but the safe time range for HCA is still very different and controversial. Perreas et al. studied the use of DHCA+RCP  in hemi-arch replacement, whose results showed that duration of DHCA is the only and main factor related to death . Their 3p < 0.05) with the prolongation of HCA time. In addition, our data showed that there was no significant correlation between stroke, paralysis, and the use of continuous renal replacement therapy (CRRT) and the duration of HCA  device, with which a significantly shortened HCA time of 5–10 min, as well as a higher core temperature of 28–30°C, can be reached. This device is currently undergoing clinical trials and may further benefit patients with TAAD .The study is observational and retrospective in nature. Our study is based on the overall situation of the medical facilities in our center, the surgeons, anesthesiologists, and ICU physicians, as well as the patients' condition in the region, so there may be differences between the results of our study and those of other centers. In addition, different centers have different definitions of HCA temperature (DHCA or MHCA). However, we performed a variety of statistical methods, such as PSM, RCS, and subgroup analysis, to reduce the impact of potential bias. We look forward to prospective controlled trials with larger sample sizes and more reasonable results.When arch surgery is performed, it is safe to keep the HCA time to <22 min from our single-center experience, at a core temperature of 20–28°C. Beyond this range, the early mortality increases significantly with the duration of HCA time. Of course, the degree of aortic dissection lesion and the complexity of surgical procedures must also be considered. The HCA time needs to be further controlled to bring a better early prognosis for patients.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Ethics Committee of Fuwai Hospital (ChiECRCT-20180041). Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.JS, JW, and JuQ developed study design. JS wrote the paper. JiQ, FC, WG, RZ, LD, SF, and EX organized patient recruitment and collected study statistics. JW involved in the statistical analyses and diagramming. XS, XQ, BW, WW, DW, XL, and CY supervised and provided guidance to the whole research process. All authors contributed to the article and approved the submitted version.This study was supported by Beijing Science and Technology Program (No. Z191100007619042), Capital Health Development and Scientific Research Foundation (No. 2018-2-4035), and the National Key Research and Development Program (No. 2018YFB1107102).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.