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However, validated strategies are invasive and expensive. Although promising, aural canal temperature (T\n                    <jats:sub>ac<\/jats:sub>\n                    ) is susceptible to environmental influences. This study investigated whether incorporation of external auricle temperature (T\n                    <jats:sub>ea<\/jats:sub>\n                    ) into an ear-based T\n                    <jats:sub>c<\/jats:sub>\n                    algorithm enhances its accuracy during multiple heat stress conditions. Twenty males (mean\u2009\u00b1\u2009SD; age\u2009=\u200925\u2009\u00b1\u20093\u00a0years, BMI\u2009=\u200921.7\u2009\u00b1\u20091.8, body fat\u2009=\u200912\u2009\u00b1\u20093%, maximal aerobic capacity (VO\n                    <jats:sub>2max<\/jats:sub>\n                    )\u2009=\u200964\u2009\u00b1\u20097\u00a0ml\/kg\/min) donned an ear-based wearable and performed a passive heating (PAH), running (RUN) and brisk walking trial (WALK). PAH comprised of immersion in hot water (42.0\u2009\u00b1\u20090.3\u00a0\u00b0C). RUN (70\u2009\u00b1\u20093%VO\n                    <jats:sub>2max<\/jats:sub>\n                    ) and WALK (50\u2009\u00b1\u200910%VO\n                    <jats:sub>2max<\/jats:sub>\n                    ) were conducted in an environmental chamber (T\n                    <jats:sub>db<\/jats:sub>\n                    \u2009=\u200930.0\u2009\u00b1\u20090.2\u00a0\u00b0C, RH\u2009=\u200971\u2009\u00b1\u20092%). Several T\n                    <jats:sub>c<\/jats:sub>\n                    models, developed using T\n                    <jats:sub>ac<\/jats:sub>\n                    , T\n                    <jats:sub>ea<\/jats:sub>\n                    and heart rate, were validated against gastrointestinal temperature. Inclusion of T\n                    <jats:sub>ea<\/jats:sub>\n                    as a model input improved the accuracy of the ear-based T\n                    <jats:sub>c<\/jats:sub>\n                    algorithm. Our best performing model (T\n                    <jats:sub>rf3<\/jats:sub>\n                    ) displayed good group prediction errors (mean bias error\u2009=\u2009\u2212\u00a00.02\u2009\u00b1\u20090.26\u00a0\u00b0C) but exhibited individual prediction errors (percentage target attainment\u2009\u00b1\u20090.40\u00a0\u00b0C\u2009=\u200988%) that marginally exceeded our validity criterion. Therefore, T\n                    <jats:sub>rf3<\/jats:sub>\n                    demonstrates potential utility for group-based T\n                    <jats:sub>c<\/jats:sub>\n                    monitoring, with additional refinement needed to extend its applicability to personalized heat strain monitoring.\n                  <\/jats:p>","DOI":"10.1038\/s41598-024-63241-2","type":"journal-article","created":{"date-parts":[[2024,5,30]],"date-time":"2024-05-30T00:14:11Z","timestamp":1717028051000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["External auricle temperature enhances ear-based wearable accuracy during physiological strain monitoring in the heat"],"prefix":"10.1038","volume":"14","author":[{"given":"Shawn Chee Chong","family":"Tan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trinh Canh Khanh","family":"Tran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charis Yi Ning","family":"Chiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jieming","family":"Pan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan Cherh Chiet","family":"Low","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,5,30]]},"reference":[{"key":"63241_CR1","doi-asserted-by":"publisher","first-page":"1619","DOI":"10.1016\/S0140-6736(22)01540-9","volume":"400","author":"M Romanello","year":"2022","unstructured":"Romanello, M. et al. 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