Altered states of consciousness refer to qualitative shifts in an individual's overall pattern of mental functioning. This article presents the 3-part development and validation of a multidimensional self-report measure of autonomous sensory meridian response (ASMR). ASMR is an intensely pleasurable, head-orientated tingling sensation that typically occurs in response to specific, audiovisual triggers, producing feelings of comfort, relaxation and euphoria. A mixed-methods approach was adopted, conducting a content analysis on 303 accounts of ASMR, to derive a comprehensive self-report measure. Exploratory (n ϭ 453; n ϭ 448) and confirmatory analyses (n ϭ 448) were utilized to determine the underlying factor structure of the ASMR measure and replicability of findings across assessment applications. Convergent and divergent validity were assessed through comparisons with other, established alterations of consciousness, including frisson, absorption, alexithymia, flow, misophonia and anxiety. The resultant ASMR-15 demonstrated sufficient internal consistency (␣ ϭ .78) and validity as a measure of ASMR propensity, and may be useful to researchers interested in further exploring and disentangling ASMR from other alterations of consciousness.

Autonomous sensory meridian response (ASMR) is a multidimensional sensoryaffective experience typically described as a head-oriented tingling sensation that occurs upon exposure to specific audiovisual triggers. Previous work using a 15-item multidimensional measure of ASMR propensity (Autonomous Sensory Meridian Response Scale [ASMR-15]), with sensory, affective, relaxation, and altered consciousness subscales, established the relationships between openness, absorption, and ASMR. However, the altered consciousness dimension of ASMR experiences remains relatively unexplored. As a result, this article explores the relationships between ASMR and a number of constructs associated with alterations in consciousness. Additional aims of the study were to assess the replicability of the established four factor structure of the modified ASMR-15, when administered to online interest group samples, and to explore the relationships between common ASMR trigger preferences and dimensions of ASMR propensity. To achieve this, the ASMR-15 was administered to participants from Facebook (n ϭ 201) and Reddit (n ϭ 256) ASMR interest groups, alongside measures of transliminality (Revised Transliminality Scale), unusual experiences (Unusual Experiences subscale), mindfulness (Mindful Attention and Awareness Scale), and body consciousness (Private Body Consciousness subscale). Additional items assessed participants' stimulus preferences from a list of common ASMR triggers, with an opportunity for the nomination of additional triggers, via free response. Through quantitative analyses, and categorization of qualitative responses, significant variation in preferences was observed across the sample. Correlational analyses indicated convergence between ASMR, transliminality, body consciousness, and unusual experiences, and divergence between the ASMR-15 and mindfulness scores. These findings open new avenues of ASMR exploration in relation to consciousness, specifically whether ASMR may be an altered state experience facilitated by thinner psychological boundaries.

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Background This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January–October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. Results This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery before and 4371 (59.1 per cent) during the pandemic. Overall, 4.3 per cent (187 of 4371) developed postoperative SARS-CoV-2 in the pandemic cohort. The pulmonary complication rate was similar (7.1 per cent (216 of 3031) versus 6.3 per cent (274 of 4371); P = 0.158) but the mortality rate was significantly higher (0.7 per cent (20 of 3031) versus 2.0 per cent (87 of 4371); P < 0.001) among patients who had surgery during the pandemic. The adjusted odds of death were higher during than before the pandemic (odds ratio (OR) 2.72, 95 per cent c.i. 1.58 to 4.67; P < 0.001). In mediation analysis, 54.8 per cent of excess postoperative deaths during the pandemic were estimated to be attributable to SARS-CoV-2 (OR 1.73, 1.40 to 2.13; P < 0.001). Conclusion Although providers may have selected patients with a lower risk profile for surgery during the pandemic, this did not mitigate the likelihood of death through SARS-CoV-2 infection. Care providers must act urgently to protect surgical patients from SARS-CoV-2 infection.

Abstract. Autonomous Sensory Meridian Response (ASMR) is a pleasurable, tingling sensation induced by exposure to specific, audio-visual triggers, producing feelings of relaxation and euphoria. This article examines the relationship between ASMR propensity using a recently developed self-report measure (ASMR-15), Big-Five personality factors, and sensory-processing sensitivity (SPS), in a general population. Thus far, the ASMR-15 has only been validated on self-selected ASMR-specific samples, and so it is yet to be determined whether the measure may be adapted to assess ASMR in a non-specialized sample. To address this, N = 187 undergraduate psychology students were recruited for a survey study. ASMR was related to greater Openness and SPS, and lower Conscientiousness. A confirmatory factor analysis was undertaken on the ASMR-15, largely replicating the factor structure previously demonstrated. As a result, the ASMR-15 may be useful for researchers interested in further exploring ASMR experiences in both specialized and non-specialized samples.

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The COVID-19 pandemic has the potential to cause high morbidity and mortality in crisis-affected populations. Delivering COVID-19 treatment services in crisis settings will likely entail complex trade-offs between offering services of clinical benefit and minimising risks of nosocomial infection, while allocating resources appropriately and safeguarding other essential services. This paper outlines considerations for humanitarian actors planning COVID-19 treatment services where vaccination is not yet widely available. We suggest key decision-making considerations: allocation of resources to COVID-19 treatment services and the design of clinical services should be based on community preferences, likely opportunity costs, and a clearly articulated package of care across different health system levels. Moreover, appropriate service planning requires information on the expected COVID-19 burden and the resilience of the health system. We explore COVID-19 treatment service options at the patient level (diagnosis, management, location and level of treatment) and measures to reduce nosocomial transmission (cohorting patients, protecting healthcare workers). Lastly, we propose key indicators for monitoring COVID-19 health services.