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Humans have the innate need to belong and relate to others. Stable relationships are a great influencer of happiness and health and, therefore, should receive stronger attention for their nurture. Online environment is steadily becoming the primary source of relationship formation, however, its instability poses threats to build stable relationships. Since online communication is increasingly used in relationship formation and communication, it holds opportunities for design interventions that support stable relationship creation. This paper introduces a pyramidical laddering approach that guides the building of online communication from the basis of stable creation of intimacy, to satisfying the needs of belonging and relatedness, to ultimately delivering wellbeing. The approach that was developed through the authors’ prior research aims to deal with the identified main barriers of online communication, distrust and disengagement, and their influence on the formation of stable connections in order to enable healthy intimacy formation in the online environment. This paper brings attention to the importance of romantic relationships on health and highlights opportunities for further research in the thus far under-researched area of design for relation making to support wellbeing and health of society.

Electrospray ionization mass spectrometry (ESI-MS) experiments, including ion mobility-mass spectrometry (ESI-IM-MS), and electron capture dissociation (ECD) of proteins ionized from aqueous solutions, have been used for the study of solution-like structures of intact proteins. By mixing aqueous proteins with denaturants online before ESI, the amount of protein unfolding can be precisely controlled and rapidly analyzed, permitting the characterization of protein folding intermediates in protein folding pathways. Herein, we mixed various pH solutions online with aqueous cytochrome C for unfolding and characterizing its unfolding intermediates with ESI-MS charge state distribution measurements, ion mobility, and ECD. The presence of folding intermediates and unfolded cytochrome c structures were detected from changes in charge states, arrival time distributions (ATDs), and ECD fragmentation. We also compared structures from nondenaturing and denaturing solution mixtures measured under “gentle” (i.e., low energy) ion transmission conditions with structures measured under “harsh” (higher energy) transmission. This work confirms that when using “gentle” instrument conditions, the gas-phase cytochrome c ions reflect attributes of the various solution-phase structures. However, “harsh” conditions that maximize ion transmission produce annealed, extended structures that no longer correlate with changes in solution structure.

Outcomes, which are the result state or condition from a process or intervention, are essential elements of healthcare system design and an important indicator of performance. They are included in well-known system analysis frameworks such as the Systems Engineering Initiative for Patient Safety (SEIPS) and Cognitive Work Analysis (CWA). However, fewer practical approaches exist for understanding and communicating interactions among healthcare outcomes. This study applies a novel mapping method as a practical approach to collect, aggregate and visualise interrelations among multiple healthcare outcomes. Graphic facilitation mapping sessions with eleven healthcare providers and ten patients with chronic conditions were conducted. Participants created outcome interrelationship maps following a six-step process. Two outcome-based network visualisations were synthesised using network analysis. This outcome-based approach advances how we frame healthcare systems, focussing on accommodating multiple stakeholders' visions, understanding interrelations, and defining trade-offs. This practical approach may complement frameworks such as SEIPS and CWA. Practitioner summary: The presented outcome-based mapping approach can facilitate the understanding of outcomes as part of the interrelated healthcare system. The approach allows the discussion and integration of different stakeholders' outcome priorities to identify critical elements and better inform the development or adaptation of healthcare systems. Abbreviations: SEIPS: engineering initiative for patient safety; CWA: cognitive work analysis; HFE: human factors and ergonomics; AH: abstraction hierarchy; POTS: postural orthostatic tachycardia syndrome; DRM: design research methodology; FA2: forceAtlas2; HbA1c: glycated haemoglobin; NHS: National Health Service; UK: United Kingdom.

People with aphasia often have reading impairments that affect participation in daily activities. Text-to-speech (TTS) devices are technology-based supports that can facilitate processing of written materials. The purpose of this study was to gather information about the reading behaviors and TTS technology perceptions of people with aphasia who had first learned about system features and options. Sixteen people with chronic aphasia participated in single, one-on-one instructional and guided practice sessions using TTS systems. They answered close-ended questions about current reading behaviors and materials and ways they believed these would change given TTS system access. Participants reported reading at home and community locations. Most read calendars, newspapers, magazines, and mail. Participants who did not read lengthy materials - such as newspapers, magazines, and novels - indicated their interest in these materials would likely increase given TTS support. Although participants did not predict substantial comprehension changes given TTS support, most expressed interest in the technology after learning about it. Thus, people with aphasia perceive TTS systems as helpful for comprehending lengthy materials. Given modest predictions about comprehension benefits, presenting TTS as one of several support strategies is an appropriate recommendation.

Concentrated boarding describes the phenomenon when rail passengers congregate in certain areas of the platform and board the train carriages that stop near these areas. This influences the distribution of passengers throughout the carriages, which can negatively affect passenger comfort, safety at the platform-train interface, efficiency of the rail network, and the reputation of rail travel as a whole. This project aimed to determine whether concentrated boarding occurs in stations in the UK in order to understand its relevance for future rolling stock, infrastructure design and its associated manufacturing research. Video recording technology was used to observe the movements of passengers in Oxford Station and data was collected for nine individual trains. By reviewing the recordings, the number of passengers boarding through each door of the trains was determined, and the boarding distribution along the length of the platform was plotted. Several reasons for noted trends are offered, and potential solutions proposed. The use of real time information could be invaluable to minimise concentrated boarding, as it would allow passengers to make informed decisions as to where they could board trains to have a better journey experience. These findings indicate the relevance of a human-centred design process, particularly the user research stages, in the process of defining priorities for manufacturing and engineering.

On-street Vehicle-to-Grid (V2G) allows battery electric vehicles (BEVs) to park on the street, charge from the electricity grid, and give electricity back to the grid. It could encourage people without off-street parking at home to adopt electric vehicles. On-street V2G is technically feasible, but there is a lack of understanding of consumer perceptions of On-street V2G features and services. This study aims to quantitatively and empirically explore people’s attitudes towards On-street V2G with a focus on preference and willingness-to-pay. An online survey was carried out and 495 successful responses were collected. In the survey, a video clip that explained On-street V2G was included to better sensitise participants to the futuristic scenario of On-street V2G. This study found that ‘required plug-in hours per month’ was viewed as more important regarding preference for On-street V2G, while ‘minimum level of battery guaranteed’ was more important regarding willingness-to-pay. People hold opposite views towards these two features concerning preference and willingness-to-pay. The theoretical contribution, practical implications, and future research directions are discussed.

Healthcare needs to be delivered more holistically, in a way that addresses outcomes for different stakeholders at different levels. Systems thinking has conceptually helped the understanding of the increasing complexity of healthcare outcomes. However, little consideration has been given on how to practically apply this concept to holistic outcome understanding to (re)design healthcare systems. Therefore, this paper aims to develop and evaluate a holistic outcome-based approach to healthcare systems co-creation. Participatory mapping workshops and interviews to co-visualise outcomes as an interconnected system were conducted with two groups: twenty-three design practitioners/researchers and twenty-one patients and healthcare service providers. Results emerged from network analysis which identified critical outcomes, disagreements, gaps and opportunities for system (re)design. The results demonstrated the potential role that this approach could have in gathering, communicating and negotiating the complex needs of multiple stakeholders for healthcare system (re)design.

Customer-facing train crew have to follow strict procedures to guarantee that trains are safe and run on time. They are also responsible for revenue protection and customer care. Human factors and ergonomics research are instrumental to understand the safety-critical aspects and improve work. We bring user experience research and personas to describe how train crew perceive their routines and how new technology may impact them. We conducted seven hours of interviews and 30 hours of shadowing observations with train crew (n = 22) to provide an understanding of who are they and to define their experiences. We present crew’s current routines and created two personas to represent them. One is slightly reluctant to adopt the proposed technology, whereas the other is more accepting. Results indicate how such technology may affect crew work ergonomics and experiences, and suggest which valuable aspects should be maintained, for example the positive interactions with passengers.\ud \ud

Technological developments present diverse opportunities to modernise services for the rail industry. Systems can be implemented to improve passengers’ experiences, but these may also affect the experiences of crew working on board trains. This first-of-a-kind research extends the concept of customer journey mapping as a design tool to understand the experiences of train crew. To produce these crew journey maps, interviews and user observation methods were adopted (N = 22). Results show that two main negative touchpoints for the crew occur at the platform-train interface and during revenue protection activities. This paper presents an innovative methodological contribution around journey mapping to better understand rail experiences, but revolving around the crew rather than the expected consumer experience. We conclude this paper proposing requirements for technological systems and indicate opportunities for the design of systems to generate human-centred improvements for the working practices and experiences of train crew.

This article explores user experience research within a consequentialist philosophical framework, where an optimal design depends on users’ resultant levels of satisfaction and pleasure. Personas and customer journey maps can be pragmatic in indicating the requirements of a system by aggregating the overall pleasure of the majority of users. However, a revised approach, focused on minimising displeasures at the expense of reducing the pleasures of others, may level out individuals’ satisfactory experiences with a view toward more holistic, systemic satisfaction for all users. We explore our philosophical thinking and illustrate these premises with a project set out to develop technological innovation for the rail industry. We conclude with recommendations of how designers could think about user experience to incorporate systemic views of pleasure when proposing innovations.

Technology has the potential to provide more up-to-date information and customised services to train passengers and therefore improve the rail journey experience. However, there is a lack knowledge about which innovations and services are preferred by the travelling public. The purpose of this study was to understand the value which passengers placed on technological innovations to improve the overall passenger journey experience. A conjoint analysis survey based on the best-worst scale of preference was developed to evaluate how passengers (N = 398) value different system features proposed to improve passenger experience in the UK. Results show that the automatic compensation for delayed or cancelled trains was valued the highest, and the ability to pre-order special services ranked as least value from a set of ten features. Additional results include the segmentation of responses according to passenger type (commuters, business and leisure) and the similarities and differences in responses from the public versus those working directly in the rail industry. The insights gained from this study suggest which features should be prioritised to improve rail passenger journey experiences.

Background: Results of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects.Methods: FOCUS was a pragmatic, multicentre, parallel group, double-blind, randomised, placebo-controlled trial done at 103 hospitals in the UK. Patients were eligible if they were aged 18 years or older, had a clinical stroke diagnosis, were enrolled and randomly assigned between 2 days and 15 days after onset, and had focal neurological deficits. Patients were randomly allocated fluoxetine 20 mg or matching placebo orally once daily for 6 months via a web-based system by use of a minimisation algorithm. The primary outcome was functional status, measured with the modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care staff, and the trial team were masked to treatment allocation. Functional status was assessed at 6 months and 12 months after randomisation. Patients were analysed according to their treatment allocation. This trial is registered with the ISRCTN registry, number ISRCTN83290762.Findings: Between Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564 patients were allocated fluoxetine and 1563 allocated placebo. mRS data at 6 months were available for 1553 (99·3%) patients in each treatment group. The distribution across mRS categories at 6 months was similar in the fluoxetine and placebo groups (common odds ratio adjusted for minimisation variables 0·951 [95% CI 0·839–1·079]; p=0·439). Patients allocated fluoxetine were less likely than those allocated placebo to develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26–6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs 23 [1·47%]; difference 1·41% [95% CI 0·38–2·43]; p=0·0070). There were no significant differences in any other event at 6 or 12 months.Interpretation: Fluoxetine 20 mg given daily for 6 months after acute stroke does not seem to improve functional outcomes. Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function.Funding: UK Stroke Association and NIHR Health Technology Assessment Programme.

Sound level measurement is used to assess sound within any environment, never more so than in hospitals. This is due to the negative effects that high sound level can have on patients and staff. However, other ways of exploring sound and the soundscape within the hospital context have been used: sound art has conveyed the experiences of heart transplant patients. Art may act as juxtaposition to objective sound level measurement but the two fundamentally attempt to depict attributes of the soundscape. Using theory from design and concepts from art a framework is presented for designing a positive soundscape experience. This is not through the addition of sound per se but through creatively communicating the information contained within a soundscape to enable the everyday listener to interpret a cacophony of hospital sounds more positively. In representing visual communication of sound as a design object, a new way to explore sound may exist.

Space heating in the UK is responsible for 60% of the total UK energy consumption by domestic buildings. The UK has committed to reduce heating consumption through its ‘Smarter Heating Controls Research Programme’, by educating people on how they heat their homes. UK utility companies have trialed smart home heating controls and claim that these packages, consisting of a smart thermostat, a mobile application and an online portal, can save energy. However, there is little robust evidence on people’s perceptions and reported experiences of using smart heating controls. This study aimed to understand homeowners’ perceptions and experiences in using a domestic home heating controller in order to develop recommendations for the technology and its implementation into people’s homes. Perceptions and experiences were investigated in three phases focusing on (a) the pre-use phase, which collected demographic information, awareness and expectations, (b) the in-use phase, which included habits of use, and (c) the post-use phase, which addressed satisfaction, motivation and feedback. Four online questionnaire surveys (with closed and open-ended questions) were used throughout the study, supplemented with telephone interviews in the post-use phase. Together these generated an understanding of the finer nuances of perceptions towards the smart home heating controller and underpinned recommendations for future technology development. The results showed that the smart home heating controller was perceived by 70% of participants as successfully influencing and changing their home heating behaviour. In order for smart home heating controllers to be successful, more intuitive technology with additional personalised information throughout the installation and familiarisation process may be beneficial.

Partially automated vehicles present interface design challenges in ensuring the driver remains alert should the vehicle need to hand back control at short notice, but without exposing the driver to cognitive overload. To date, little is known about driver expectations of partial driving automation and whether this affects the information they require inside the vehicle. Twenty-five participants were presented with five partially automated driving events in a driving simulator. After each event, a semi-structured interview was conducted. The interview data was coded and analysed using grounded theory. From the results, two groupings of driver expectations were identified: High Information Preference (HIP) and Low Information Preference (LIP) drivers; between these two groups the information preferences differed. LIP drivers did not want detailed information about the vehicle presented to them, but the definition of partial automation means that this kind of information is required for safe use. Hence, the results suggest careful thought as to how information is presented to them is required in order for LIP drivers to safely using partial driving automation. Conversely, HIP drivers wanted detailed information about the system's status and driving and were found to be more willing to work with the partial automation and its current limitations. It was evident that the drivers' expectations of the partial automation capability differed, and this affected their information preferences. Hence this study suggests that HMI designers must account for these differing expectations and preferences to create a safe, usable system that works for everyone. [Abstract copyright: Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.]

Research with end users can contribute to the design of technologies such as intelligent transport systems. However, it is important to use methods that can facilitate the uptake of research outcomes by the industry. This paper presents the use of passenger personas as part of the process of developing new technologies for the rail industry in the UK. Personas represent archetypal users and can facilitate the understanding of user behaviours, needs, motivations, characteristics and limitations. We aggregated existing knowledge and complemented it with bespoke data collection to understand passengers’ perceptions about the rail system. The study design focused on current user experiences and also where technology can improve these experiences. A set of four personas was produced in order to illustrate who the users of the train systems are as well as their characteristics. This knowledge informed the requirements of innovative technologies that can enhance user experiences during rail travel.

Trust has been shown to play a key role in our ability to safely use autonomous vehicles; hence the authors used the Ideas Cafe to explore the factors affecting trust in autonomous vehicles. The Ideas Cafe is an informal collaborative event that brings the public together with domain experts for exploratory research. The authors structured the event around factors affecting trust in the technology, privacy and societal impact. The event followed a mixed methods approach using: table discussions, spectrum lines and line ups. 36 participants attended the Ideas Cafe event held at the Coventry Transport Museum in June 2017. Table discussions provided the key findings for Thematic Analysis as part of Grounded Theory; which found, contrary to current research trends, designing for the technology’s integration with society as equally important for trust as the vehicle design itself. The authors also reported on the emergent high level interface guidelines.

BACKGROUND With the advent and popularity of social media and consumer rating websites, as well as the emergence of the digitally engaged patient, there has been an increased interest in doctor rating websites or online patient feedback websites, both inside and outside academia. However, there is very little known about how the public across England views such rating websites as a mode to give patient experience feedback. OBJECTIVE The aim of the overall study was to measure and understand public awareness, usage, and attitudes towards doctor rating websites as a mode to give experiential feedback about GPs in general practice in England. This paper reports on the findings of one of the aims of the study, which was to measure public awareness, current usage and future consideration of usage of online patient feedback websites, within the context of other feedback methods, This could allow the value of online patient feedback websites to be determined from the patients’ perspective. METHODS A mixed methods population questionnaire was designed, validated and implemented face-to-face using a cross-sectional design with a representative sample of the public (n=844) in England. The results of the questionnaire were analyzed using chi-square tests, binomial logistic regressions, and content analysis. The qualitative results will be reported elsewhere. RESULTS Public awareness of online patient feedback websites as a channel to leave experiential feedback about GPs was found to be low at 15.2% (128/844). However, usage and future consideration to use online patient feedback websites were found to be extremely low, with current patient usage at just 0.4% (3/844), and patient intention to use online patient feedback in the future at 17.8% (150/844). Furthermore, only 4.0-5.0% of those who would consider leaving feedback about a GP in the future selected doctor rating websites as their most preferred method; more than half of patients said they would consider leaving feedback about GPs using another method, but not using an online patient feedback website. CONCLUSIONS The findings suggest that online patient feedback websites may not be an effective channel for collecting feedback on patient experience in general practice. Feedback on online patient feedback websites is not likely to be representative of the patient experience in the near future, challenging the use of online patient feedback not just as a mode for collecting patient experience data, but for patient choice and monitoring too. We recommend the National Health Service channels its investment and resources towards providing more direct and private feedback methods in general practice (such as opportunities for face-to-face feedback, email-based feedback, and web-based private feedback forms), as these are currently much more likely to be used by the majority of patients in England.

This study was designed to provide an evaluation of two types of train seat displays (OLED and E-ink), from a user-centred perspective. Numerous factors influence the decisions on which display to use, such as costs or energy use. It is also important to consider human factors aspects like readability and user preferences. To provide some real-world insights into these issues we designed a pilot study to compare both displays. Participants were asked to give their impressions and respond to questions during a semi-structured interview process, when they were presented with both displays. Results show that participants favour the OLED display overall as it is easily noticeable in different light conditions. However, some aspects of the E-ink are preferred: it is easier to read and understand. We conclude that research with real users is extremely important when designing and defining hardware to be used during the implementation of intelligent transport systems.