Measuring pressure distribution under the seat cushion and dividing the pressure map in six regions might be beneficial for comfort studies of aircraft seats.

Seat pressure maps are often used to evaluate comfort of the users. In this study, we explored the relationships between pressure maps and comfort/discomfort of users in aircraft seats with a focus on a new 6-division method on the pressure maps collected at the bottom of the cushions. An experiment was designed where three cushions with identical shapes but different stiffnesses were prepared. 33 subjects joined the experiment and after sitting on each cushion in 4 postures, they completed comfort questionnaires. Pressure maps on the top as well as the bottom of cushions were collected and analysed. Results indicated that measures on the proposed 6 divisions, especially on the distal posterior thigh regions and regions close to ischial tuberosity of the bottom pressure maps, had larger correlation values to comfort scores compared to other division methods. Practitioner summary: The relations between comfort/discomfort and seat pressure maps collected from the top/bottom of three cushions were studied with 33 subjects in four postures. The distal posterior thigh and ischial tuberosity regions in the proposed 6-division of the bottom pressure maps had larger correlation values to comfort/discomfort compared to other methods.

Differences and similarities in comfort and discomfort experience in nine countries in Asia, the Americas and Europe.

In order to investigate differences in comfort and discomfort experiences amongst different regions of the world (America, Asia and Europe), a cross cultural study was performed. A questionnaire was sent to participants out in nine countries (Brazil, Canada, the USA, China, Indonesia, Thailand, Germany, Italy and the Netherlands). In total 795 participants completed the questionnaires. All countries score the comfort of a luxurious bed higher than a simple bed, first-class seats higher than economy class and all countries rate the comfort lower when the duration of sitting increases. The study suggests that in the USA and Canada softer beds, hammocks, more luxurious seats and softer pillows are scored as more comfortable compared with the other countries. There are indications that China and Germany prefer a harder mattress than in the other countries. For pillows, the differences between countries are large, which might show that much is influenced by habitude or hesitation to use something new. The Asian countries score the comfort of a brace neck pillow higher, which might be because these participants better realise the benefits better or feel less concerned to wear something that might give the appearance of an orthotic device. Further studies are needed to confirm these suggestions. The study shows that obvious differences are seen in all countries, which makes the construct of comfort internationally comparable. Practitioner summary: In designing and manufacturing globally, it is important to know how different parts of the world experience (dis)comfort. This study did not show large cultural differences amongst nine countries. Some differences emerge regarding pillows, perhaps as differences in sleeping habits play a role. Abbreviations: MANOVA: multivariate analysis of variance; VDA: Vargha and Delaney's A statistic; USA: United States of America.

Immunogenicity and Safety of the Adjuvanted Recombinant Zoster Vaccine in Chronically Immunosuppressed Adults Following Renal Transplant: A Phase 3, Randomized Clinical Trial.

BACKGROUND: The incidence of herpes zoster is up to 9 times higher in immunosuppressed solid organ transplant recipients than in the general population. We investigated the immunogenicity and safety of an adjuvanted recombinant zoster vaccine (RZV) in renal transplant (RT) recipients ≥18 years of age receiving daily immunosuppressive therapy. METHODS: In this phase 3, randomized (1:1), observer-blind, multicenter trial, RT recipients were enrolled and received 2 doses of RZV or placebo 1-2 months (M) apart 4-18M posttransplant. Anti-glycoprotein E (gE) antibody concentrations, gE-specific CD4 T-cell frequencies, and vaccine response rates were assessed at 1M post-dose 1, and 1M and 12M post-dose 2. Solicited and unsolicited adverse events (AEs) were recorded for 7 and 30 days after each dose, respectively. Solicited general symptoms and unsolicited AEs were also collected 7 days before first vaccination. Serious AEs (including biopsy-proven allograft rejections) and potential immune-mediated diseases (pIMDs) were recorded up to 12M post-dose 2. RESULTS: Two hundred sixty-four participants (RZV: 132; placebo: 132) were enrolled between March 2014 and April 2017. gE-specific humoral and cell-mediated immune responses were higher in RZV than placebo recipients across postvaccination time points and persisted above prevaccination baseline 12M post-dose 2. Local AEs were reported more frequently by RZV than placebo recipients. Overall occurrences of renal function changes, rejections, unsolicited AEs, serious AEs, and pIMDs were similar between groups. CONCLUSIONS: RZV was immunogenic in chronically immunosuppressed RT recipients. Immunogenicity persisted through 12M postvaccination. No safety concerns arose. CLINICAL TRIALS REGISTRATION: NCT02058589.

Immunogenicity and safety of the adjuvanted recombinant zoster vaccine in patients with solid tumors, vaccinated before or during chemotherapy: A randomized trial.

BACKGROUND: The adjuvanted recombinant zoster vaccine (RZV) has demonstrated >90% efficacy against herpes zoster in adults ≥50 years of age and 68% efficacy in autologous hematopoietic stem cell transplant recipients ≥18 years of age. We report the immunogenicity and safety of RZV administered to patients with solid tumors (STs) before or at the start of a chemotherapy cycle. METHOD: In this phase 2/3 observer-blind, multicenter study (NCT01798056), patients with STs who were ≥18 years of age were randomized (1:1) to receive 2 doses of RZV or placebo 1-2 months apart and stratified (4:1) according to the timing of the first dose with respect to the start of a chemotherapy cycle (first vaccination 8-30 days before the start or at the start [±1 day] of a chemotherapy cycle). Anti-glycoprotein E (gE) antibody concentrations, gE-specific CD4+ T cell frequencies, and vaccine response rates (VRRs) were assessed 1 month after dose 1 and 1 and 12 months after dose 2. Reactogenicity and safety were assessed in the total vaccinated cohort through 12 months after dose 2. RESULTS: There were 232 participants in the total vaccinated cohort, 185 participants in the according-to-protocol cohort for humoral immunogenicity, and 58 participants in the according-to-protocol cohort for cell-mediated immunogenicity. Postvaccination anti-gE antibody concentrations, gE-specific CD4+ T cell frequencies and VRRs were higher in RZV recipients than in placebo recipients. Solicited adverse events (AEs) were more frequent among RZV recipients than placebo recipients. Incidence of unsolicited AEs, serious AEs, fatalities, and potential immune-mediated diseases were similar between RZV and placebo recipients. CONCLUSION: RZV was immunogenic in patients with STs receiving immunosuppressive chemotherapies. Humoral and cell-mediated immune responses persisted 1 year after vaccination. No safety concerns were identified.

Future vehicles: the effect of seat configuration on posture and quality of conversation.

The percentage of passengers that prefer travelling in groups is increasing. In most vehicles, passengers sit side by side and need to turn their body to be engaged in the conversation with their fellow travellers. However, rotating the body could lead to discomfort which influences conversation quality. The aim of this research is to study the effect of seat configuration on the (dis)comfort experience, conversation quality and posture. Experiments in which participants were asked to talk to each other while sitting at the same distance (1 m) were conducted in four seating arrangements (with seat-belts on), where the angle between the forward directions of two seats were positioned at 0° (side by side), 22.5°, 90° and 120° (almost opposite each other), respectively. Optical tracking has been deployed and the collected data were processed with MatLab® to acquire postural angles over time. Questionnaires were also used to evaluate the perceived (dis)comfort and the quality of the conversation. Experiment results indicate that the 120° configuration scored the best in the overall comfort and the quality of conversation, but only slightly better than the 90° configuration. Practitioner summary: Seating side by side is not optimal to have a comfortable conversation with your seatmate. To improve comfort and quality of conversation in future vehicles, we tested four seating arrangements analysing the effect of seat layout on (dis)comfort experience. Statistical analysis of objective and subjective data shows the optimal configuration for a comfortable conversation. Abbreviation: LPD: localized postural discomfort; PDF: probability density function; OCRA: occupational repetitive action.

Consciousness assessment: A questionnaire of current neuroscience nursing practice in Europe.

AIMS AND OBJECTIVES: To study practice in consciousness assessment among neuroscience nurses in Europe. BACKGROUND: Over the years, several instruments have been developed to assess the level of consciousness for patients with brain injury. It is unclear which instrument is being used by nurses in Europe and how they are trained to use these tools adequately. DESIGN/METHODS: A cross-sectional questionnaire, created by the European Association of Neuroscience Nurses Research Committee, was sent to neuroscience nurses in 13 European countries. The countries participated in 2016 with a response period of 3 months for each country. RESULTS: A total of 331 questionnaires were completed by nurses in 11 different countries. Assessment of consciousness was part of the daily routine for a majority of bedside nurses (95%), with an estimated median frequency of six times per shift. The majority uses a standardised instrument, and the Glasgow Coma Scale is the most common. Most participants assess consciousness primarily for clinical decision-making and report both total scores and subscores. The majority was formally trained or educated in use of the instrument, but methods of training were divers. Besides the estimated frequency of assessments and training, no significant difference was found between bedside nurses and other nurse positions, educational level or kind of institution. CONCLUSION: Our study shows that consciousness assessment is part of the daily routine for most nurses working in neurology/neurosurgery/neurorehabilitation wards in Europe. The greatest variation existed in training methods for the use of the instruments, and we recommend standardised practice in the use of assessment scales. RELEVANCE TO CLINICAL PRACTICE: In clinical practice, both managers and staff nurses should focus on formalised training in the use of assessment tools, to ensure reliability and reproducibility. This may also increase the professionalism in the neuroscience nurses' role and performance.

Predicting passenger seat comfort and discomfort on the basis of human, context and seat characteristics: a literature review.

This literature review focused on passenger seat comfort and discomfort in a human-product-context interaction. The relationships between anthropometric variables (human level), activities (context level), seat characteristics (product level) and the perception of comfort and discomfort were studied through mediating variables, such as body posture, movement and interface pressure. It is concluded that there are correlations between anthropometric variables and interface pressure variables, and that this relationship is affected by body posture. The results of studies on the correlation between pressure variables and passenger comfort and discomfort are not in line with each other. Only associations were found between the other variables (e.g. activities and seat characteristics). A conceptual model illustrates the results of the review, but relationships could not be quantified due to a lack of statistical evidence and large differences in research set-ups between the reviewed papers. Practitioner Summary: This literature review set out to quantify the relationships between human, context and seat characteristics, and comfort and discomfort experience of passenger seats, in order to build a predictive model that can support seat designers and purchasers to make informed decisions. However, statistical evidence is lacking from existing literature.

Nurses assessing pain with the Nociception Coma Scale: interrater reliability and validity.

The Nociception Coma Scale (NCS) is a pain observation tool, developed for patients with disorders of consciousness (DOC) due to acquired brain injury (ABI). The aim of this study was to assess the interrater reliability of the NCS and NCS-R among nurses for the assessment of pain in ABI patients with DOC. A secondary aim was further validation of both scales by assessing its discriminating abilities for the presence or absence of pain. Hospitalized patients with ABI (n = 10) were recorded on film during three conditions: baseline, after tactile stimulation, and after noxious stimulation. All stimulations were part of daily treatment for these patients. The 30 recordings were assessed with the NCS and NCS-R by 27 nurses from three university hospitals in the Netherlands. Each nurse viewed 9 to 12 recordings, totaling 270 assessments. Interrater reliability of the NCS/NCS-R items and total scores were estimated by intraclass correlations (ICC), which showed excellent and equal average measures reliability for the NCS and NCR-R total scores (ICC 0.95), and item scores (range 0.87-0.95). Secondary analysis was performed to assess differences in ICCs among nurses' education and experience and to assess the scales discriminating properties for the presence of pain. The NCS and NCS-R are valid and reproducible scales that can be used by nurses with an associate (of science) in nursing degree or baccalaureate (of science) in nursing degree. It seems that more experience with ABI patients is not a predictor for good agreement in the assessment of the NCS(-R).

Activities, postures and comfort perception of train passengers as input for train seat design.

Working in the train is a part of new ways of working. However, the ideal working position is unknown. Moreover, the ideal position for leisure and relaxing is also unknown. This article defines what activities train passengers mainly perform and which corresponding postures are seen. Based on the observations on actual train rides, four main activities could be identified: Reading, Staring/sleeping, Talking and Working on laptop. Working on laptop was the activity with the longest duration and talking had the shortest duration. Associated with these four activities, a top eight of different postures were observed. Except for headrest comfort, comfort scores were not significantly different between activities. The top eight corresponding postures combined with comfort scores showed that per activity different postures were observed and the comfort scores varied in relation to the combination of posture and activity. Nearly for all activities, the majority of passengers preferred adjustability options to fit the seat to the performed activity.

Modeling passenger comfort in turboprop aircraft using objective measures.

BACKGROUND: A quantitative comfort model will aid in evaluating comfort levels of various target groups before the actual flight of an airplane. However, constructing the model is always a challenge due to the complexity of the phenomenon. OBJECTIVES: In this paper, we present quantitative comfort models to predict the (dis)comfort of passengers flying with turboprops based on objective measures. METHODS: Ninety-seven participants took part in two experiments conducted during real flights, during which forty of them had environmental and personal factors recorded using (self-developed) measurement tools. The collected data were analyzed to model the relations between objective measures and subjective feelings. RESULTS: Two preliminary models based on gradient boosting regression were developed. The models were able to predict the changes in comfort and discomfort of individual passengers with an accuracy of 0.12±0.01 and 0.21±0.01 regarding normalized comfort and discomfort scores, respectively. Additionally, contributions of different factors were highlighted. CONCLUSION: The outcomes of the models show that we took a step forward in modeling the human comfort experience using objective measurements. Anthropometry (including age), seat positions, time duration, and row (noise) emerged as leading factors influencing the feeling of (dis)comfort in turboprop planes.

Does a reclined backrest with less legroom meet the same comfort as a fixed backrest with 80 mm more leg room?

BACKGROUND: In vehicles there is often limited space for seats. This might mean that reclining the back rest reduces the legroom. The second row in a cargo van has this problem and in this limited space an upright seat and a reclined seat with less legroom was developed and tested. OBJECTIVE: The research question of this study is: Does a reclined backrest with less leg room result in the same comfort and/or discomfort as an upright backrest with more leg room? METHODS: Twenty participants are asked to sit 45 minutes in the upright seat with 8 cm more legroom and 45 minutes in the reclined seat. Ten participants started in the upright seat and ten in the reclined. Participants had to complete a comfort and discomfort questionnaire every 15 minutes and a qualitative interview was conducted after experiencing both seats. RESULTS: For comfort no statistically significant differences were found between both seats. For discomfort statistically significant differences were found where discomfort was lower in the reclined seat. Half of the participants preferred the upright and half the reclined seat. The interviews showed that the reclined position was more related to relaxation. CONCLUSIONS: This study indicates that a more reclined back rest results in less discomfort, but that does not lead to a clear preference of participants. The reclined position is associated with relaxing, and this study indicates that for the relaxing state the more reclined seat is preferred. For more active situations the upright posture seems better.

Recruiting participants for ergonomic research using self-reported stature and body mass.

BACKGROUND: A valid distribution of key anthropometric parameters among participants is often a perquisite of ergonomics research. OBJECTIVE: In this paper, we investigated the accuracy of self-reported stature and body mass of the population in the Netherlands. METHODS: Data from 4 experiments was synthesized where in each experiment, participants self-reported their stature and body mass prior to being measured, of which they were not notified before. RESULTS: Statistical analysis of 249 records indicated that on average, participants overreported their stature by 1.31 cm and underreported their mass by 1.45 kg. This is especially true for people with a BMI≥25. CONCLUSION: Two models were proposed to adjust the self-reported stature and body mass for ergonomic researchers in a survey or recruitment. Limitations in using the models are highlighted as well.

Safety and efficacy of recombinant and live herpes zoster vaccines for prevention in at-risk adults with chronic diseases and immunocompromising conditions.

Compared with the general population, older adults with immune senescence and individuals who are immunocompromised (IC) due to disease or immunosuppressive therapy are at increased risk for herpes zoster (HZ) and its associated complications, which can be debilitating and life-threatening. Vaccination can be an effective strategy against HZ and studies have shown that HZ vaccination in IC individuals can elicit immune responses and provide protection from infection. Recently, the first approvals have been granted in the United States and the European Union for the recombinant HZ vaccine (RZV) in adults ≥ 18 years of age at risk of HZ due to immunodeficiency or immunosuppression. Existing systematic reviews have highlighted the risks for HZ in limited immunocompromising conditions and have only examined clinical data for RZV. This review details the risks and burden of HZ in a broad range of clinically relevant IC populations and summarizes key efficacy and safety data for RZV and live HZ vaccine in these individuals. Research has shown IC individuals can benefit from HZ vaccination; however, these insights have yet to be fully incorporated into vaccination guidelines and clinical care. Clinicians should consider HZ vaccination in eligible at-risk populations to protect against HZ and its associated complications and thereby, reduce the burden that HZ poses on the healthcare system. Electronic health records and linked personal health records could be used to identify and contact patients eligible for HZ vaccination and provide clinical decision support-generated alerts for missing or delayed vaccinations. This review will help clinicians identify eligible IC individuals who may benefit from HZ vaccination. A video abstract linked to this article is available on Figshare https://doi.org/10.6084/m9.figshare.21517605.

Development of a Soft Robotics Module for Active Control of Sitting Comfort.

Sitting comfort is an important factor for passengers in selecting cars, airlines, etc. This paper proposes a soft robotic module that can be integrated into the seat cushion to provide better comfort experiences to passengers. Building on rapid manufacturing technologies and a data-driven approach, the module can be controlled to sense the applied force and the displacement of the top surface and actuate according to four designed modes. A total of 2 modules were prototyped and integrated into a seat cushion, and 16 subjects were invited to test the module's effectiveness. Experiments proved the principle by showing significant differences regarding (dis)comfort. It was concluded that the proposed soft robotics module could provide passengers with better comfort experiences by adjusting the pressure distribution of the seat as well as introducing a variation of postures relevant for prolonged sitting.

The Haptic Fidelity Framework: A Qualitative Overview and Categorization of Cutaneous-Based Haptic Technologies Through Fidelity.

After decades of research and development, haptic feedback is increasingly appearing in consumer products. While the prevalence of haptic feedback is increasing, the integration rarely offers increased fidelity to previous generations. We argue this is because of the tremendous complexity of successful haptic design engineering, but critically, also because of information saturation. With novel cutaneous feedback technologies and companies emerging almost daily, the multi-disciplinary nature of haptics and the marketing-driven terminology used to stand out in a crowded market makes it challenging to select and integrate actuators correctly. To manage this complexity and facilitate the interdisciplinary exchange of user requirements and material affordances, we introduce a novel classification criterion for haptic actuators focused on the bandwidth and fidelity of potential effects. We introduce vocabulary for describing the precise experience the actuators and corresponding systems should deliver. Lastly, we summarize currently commercially available cutaneous-based haptic technology. In the nearby future, the same criterion and language can also prove valuable for steering technology development of new and improved actuators and enabling novice and experienced practitioners to understand and integrate cutaneous feedback in their products.

The effect of a lightweight massage system in a car seat on comfort and electromyogram.

OBJECTIVE: The objective of this study was to determine the effect of a lightweight low-intensity massage system (LWMAS) in a car seat on the electromyogram (EMG) of the neck and shoulder muscles and on the comfort experience during driving. METHODS: Two experiments were performed during driving with and without the active LWMAS in the seat. Subjective measurements were taken, in which the comfort experience was recorded for 20 participants driving a prescribed path around Munich for 120 minutes. Then objective (surface EMG above the rhomboideus and trapezius muscles) measurements and subjective measurements of the comfort experience were recorded over 7 laps on a test track for 24 participants. RESULTS: The comfort was higher, and the EMG was significantly lower in the trapezius area while driving with the LWMAS. CONCLUSION: Despite the fact that the LWMAS system is lightweight, has low intensity, and might have had a smaller effect, similar effects to previous studies with heavier systems were found, indicating that this massage system increases comfort and reduces muscle activity during driving as well.

Chosen postures during specific sitting activities.

This research study analysed the interaction between people's postures and activities while in semi-public/leisure situations and during transportation (journey by train). In addition, the use of small electronic devices received particular emphasis. Video recordings in German trains and photographs in Dutch semi-public spaces were analysed using a variation of Branton and Grayson's (An evaluation of train seats by observation of sitting behaviour. Ergonomics, 10 (1), (1967), 35-51) postural targeting forms and photos. The analysis suggests a significant relationship between most activities and the position of the head, trunk and arms during transportation situations. The relationship during public situations is less straightforward. Watching, talking/discussing and reading were the most observed activities for the transportation and leisure situations combined. Surprisingly, differences in head, trunk, arm and leg postures were not significant when using small electronic devices. Important issues not considered in this study include the duration of the activities, the gender and age of observed subjects and the influence of the time of day. These are interesting issues to consider and include for future research. STATEMENT OF RELEVANCE: This study shows what activities people choose to carry out and their related postures when not forced to a specific task (e.g. driving). The results of this study can be used for designing comfortable seating in the transportation industry (car passenger, train, bus and aircraft seats) and semi-public/leisure spaces.

Identify dominant dimensions of 3D hand shapes using statistical shape model and deep neural network.

Hand anthropometry is one of the fundamentals of ergonomic research and product design. Many studies have been conducted to analyze the hand dimensions among different populations, however, the definitions and the numbers of those dimensions were usually selected based on the experience of the researchers and the available equipment. Few studies explored the importance of each hand dimension regarding the 3D shape of the hand. In this paper, we aim to identify the dominant dimensions that influence the hand shape variability while considering the stability of the measurements in practice. A novel four-step research method was proposed where in the first step, based on literature study, we defined 58 landmarks and 53 dimensions for the exploration. In the second step, 80,000 virtual hand models, each had the associated 53 dimensions, were augmented by changing the weights of Principle Components (PCs) of a statistical shape model (SSM). Deep neural networks (DNNs) were used to establish the inverse relationships from the dimensions to the weight of each PC of the hand SSM. Using the structured sparsity learning method, we identified 21 dominant dimensions that represent 90% of the variance of the hand shape. In the third step, two different manual measuring methods were used to evaluate the stability of the measurements in practice. Finally, we selected 16 dominant dimensions with lower measurement variance by synthesizing the findings in Step 2 and 3. It was concluded that the recognized 21 dominant dimensions can be treated as the reference dimensions for anthropometric study and using the selected 16 dominant dimensions with lower measurement variance, ergonomists are able to generate a 3D hand model based on simple measurement tools with an accuracy of 5.9 mm. Though the accuracy is limited, the efforts are minimum, and the results can be used as an indicator in the early stage of research/design.

Designing a floor plan using aircraft seat comfort knowledge by aircraft interior experts.

BACKGROUND: Recent research indicated that an 18'' ×30'' aircraft seat resulted in nearly the same level of comfort as a 17'' ×34'' seat. However, it took less space in the floor plan. OBJECTIVES: This study explores seat layouts preferred by experts regarding different criteria. Those results of the experts are later compared to layouts produced by computational algorithms to evaluate the advantages of each method. METHODS: Eighty-eight experts in the field of aircraft interior were invited to make a floor plan of a part of a Boeing 777 aircraft where comfort was one of the main goals. Participants worked in groups of 3 and are given the freedom to design a section of the cabin between economy and first-class (5.87 m wide and 3.7 m long), where besides these two types of seats, an old business-class size seat of 20'' ×36'' was introduced as well for more flexibilities in design. Computational algorithms were also applied with the same inputs and constraints to generate layouts as a comparison. RESULTS: In total, 29 floor-plans were made, and these plans were analysed to compare against the complexity of the operations, the number of passengers on board, the revenue of the airline, and the width of the aisle. Results showed that 14 groups opted for the economy seats, while the rest utilized a hybrid setup where the business class seats were used in the configuration. These results are compared to the 126 computerized layouts generated. CONCLUSIONS: Among all layouts designed by experts, a combination of 28 18'' ×30'' seats and 20 17'' ×34'' seats had the highest potential revenue of US$21,984. This floor plan fits the regulations with an aisle width of 0.93 m. The computerized layout had a better outcome in maximizing profit of US$22,416 with 32 18'' ×30'' seats and 16 20'' ×36'' seats. However, the comfort of such results was to be explored as some seats were rotated 90 degrees.