While new road lighting technologies, either LED or adaptive road lighting systems, offer a wide range of unique potential benefits (mainly in terms of energy savings), it is necessary to evaluate the safety impacts of these technologies on road users. The literature survey shows that providing light on previous unlit roads has a positive effect on traffic safety. Reducing the amount of light has the opposite effect. These studies are usually conducted by using crash numbers, which makes it impossible to draw conclusions on changes in driving behaviour. Driving behaviour analyses need special approaches and indicators. Therefore indirect indicators such as speed and safety relationship, jerky driving and traffic conflict parameters are presented. The individual character of such data is difficult to deal with and limits big scale analyses. In order to have a practical example of such indicators a case study is conducted. Floating car data collected in Vienna is used to analyse travel speeds of taxi drivers at two LED test sites. A simple before-after analysis is used with data from January 2011 to May 2012 in order to examine an expected increase in speed due to a better visual performance of LED light. However the results show either no changes at all or a trend in speed reduction of 1km/h in average. Unfavourable test site locations might limit the significance of the results.

As fontes radioativas seladas em desuso, descartadas como rejeito radioativo, constituem uma parcela dos rejeitos radioativos que merece atenção especial, por sua atividade possuir potencial para causar doses de radiação elevadas, em indivíduos inadvertidamente expostos. Já é significativo o volume desses rejeitos. Manter essas fontes armazenadas em depósitos provisórios, indefinidamente, seria transferir o problema às futuras gerações. O presente estudo propõe o uso de indicadores de segurança complementares à dose e risco para o desenvolvimento de uma metodologia de avaliação da segurança de depósitos finais destinados à deposição de fontes radioativas seladas que demonstre que o isolamento será suficientemente seguro pelo tempo necessário para obter a licença da instalação, com custo acessível aos países em desenvolvimento. / Disused sealed radioactive sources are a kind of radioactive waste that deserves especial attention because the radioactivity present in a relevant fraction of the number of sources is high enough to cause severe effects in accidentally exposed individuals. The present inventory of disused sources is of the order of tens of thousands. Keep these sources indefinitely under interim storage is bequeath the problem of final disposal to the future generations. The present study proposes the use of Safety Indicators as a contribution to the development of methodologies for the assessment of safety in a deep borehole repository for sealed sources. These methodologies are required to demonstrate the long-term safety at a cost affordable to developing countries.

As fontes radioativas seladas em desuso, descartadas como rejeito radioativo, constituem uma parcela dos rejeitos radioativos que merece atenção especial, por sua atividade possuir potencial para causar doses de radiação elevadas, em indivíduos inadvertidamente expostos. Já é significativo o volume desses rejeitos. Manter essas fontes armazenadas em depósitos provisórios, indefinidamente, seria transferir o problema às futuras gerações. O presente estudo propõe o uso de indicadores de segurança complementares à dose e risco para o desenvolvimento de uma metodologia de avaliação da segurança de depósitos finais destinados à deposição de fontes radioativas seladas que demonstre que o isolamento será suficientemente seguro pelo tempo necessário para obter a licença da instalação, com custo acessível aos países em desenvolvimento. / Disused sealed radioactive sources are a kind of radioactive waste that deserves especial attention because the radioactivity present in a relevant fraction of the number of sources is high enough to cause severe effects in accidentally exposed individuals. The present inventory of disused sources is of the order of tens of thousands. Keep these sources indefinitely under interim storage is bequeath the problem of final disposal to the future generations. The present study proposes the use of Safety Indicators as a contribution to the development of methodologies for the assessment of safety in a deep borehole repository for sealed sources. These methodologies are required to demonstrate the long-term safety at a cost affordable to developing countries.

Improving the role the nurse plays in health care delivery should be embodied in the performance improvement initiatives to successfully improve the quality of care that is delivered. The purpose of this evidence-based practice project was to collect performance improvement data and present it to staff who, in turn, used the information to improve practice and influence patient safety outcomes. The practice-focused question addressed what would occur if a tool that allowed frequent data trending was used to measure effectiveness of care and thereby influence key outcome measures. Duffy's quality caring model provided a framework for the study to support the need for the development of a dashboard for staff and to ensure that staff were informed as they developed interventions to improve patient outcomes. Publicly available data published by the Centers for Medicare/ Medicaid (CMS) for the Quality Star Report were explored to inform the project. Workgroups, comprised of volunteers from leadership and staff providing care at the bedside, were formed to implement practice changes based on the dashboard reports. By bringing the data to the attention of nurses within the organization, improvements were made in the overall score for safety of care from below national average (25th percentile of the reported 3,647 hospitals across the nation) to the same as national average (47th percentile) as reported by CMS. Through staff involvement, social change occurred as strategies were hardwired to improve categories of the Quality Star Report and ultimately patient care. The project showed that quality improvement tools can assist in empowering staff to understand the data needed to implement process improvement strategies.

The recent reports by Institute of Medicine, `To Err is Human' and `Crossing Quality Chasm', revealed a large prevalence of medical errors and substandard care in US hospitals. Since then there has been a substantial increase in the efforts to measure and improve quality of care. The objective of this study was to compare the quality of care across hospitals using available performance indicators and examine the association between organizational factors and hospital performance. The main focus of this study was on important structural attributes of hospitals, namely - teaching status, location and market competition. The Nationwide Inpatient Sample for years 2003 and 2005, and the State Inpatient Database for years 2004 to 2006 were used for analyses. Two types of hospital performance indicators were examined to compare quality of care - Patient safety indicators developed by Agency for Healthcare Research and Quality, and process of care indicators developed by Centers for Medicare and Medicaid services. Multivariable regression analyses were performed using generalized estimating equations and random effects regression models. Several organizational factors as well as patient characteristics were included in the multivariable models as control variables. Overall, the results from this study showed an inconsistent relationship between teaching status, location of hospitals or market competition and quality of care in hospitals. In addition, the results demonstrated that isolating potential effects of hospital structure on outcomes requires controlling for the variation in patient characteristics, such as age and comorbidities, which increase patients' risk for incurring patient safety events. The findings from this study provide useful insight into the areas where the patient safety and quality initiatives should be focused. Moreover, the results identified the organizational factors that are relevant to certain types of hospitals and which should be considered before evaluating quality of care and enacting any policies about publicly reporting of performance or payment initiatives that are relevant to these hospitals.

In order to achieve sustainable long-term transport infrastructure development, there is a growing need for fast, reliable and effective methods to evaluate and predict the impact of traffic safety measures. Recognising this need, and the need for an active traffic safety approach, this thesis focuses on traffic safety assessment and prediction based on the use of safety indicators that measure the spatial and/or temporal proximity of safety critical events. The main advantage of such measures is that they occur more frequently than accidents, and therefore require relatively short periods of study to establish values that can later be used for comparison, or for accident prediction purposes. There are a number of more generally accepted safety indicators including: Time-to-Accident, Time-to-Collision, and Post-Encroachment Time. These are based on different underlying principles and measurement techniques, including both on-site subjective estimation, and objective photometric measures. A major part of the work presented in this thesis, concerns identifying the potential and limitations of the different safety indicators with regard to their validity and reliability, and practical use for safety assessment and prediction purposes. This is done in conjunction with field studies in the urban and suburban environment, at both signalised and unsignalised intersections. Results from these studies indicate that on-site observation methods provide useful quantitative and qualitative information relatively quickly and efficiently, provided that they are used correctly. On the other hand, the methods based on photometric measurement (video-analysis) proved arduous and time-consuming. Furthermore, there are questions regarding the abilities of the Time-to-Collision and Post-Encroachment Time safety indicators to adequately represent interaction severity, suggesting possible flaws in fundamental concepts related to construct validity. Importantly, results showed that the relationship between safety indicators and traffic accidents is complex and equivocal, where many different factors and processes can impose a significant influence on safety. This makes generalised predictive modelling a particularly difficult task for safety analysts. The potential of micro-simulation for traffic safety and performance estimation based on the use of safety indicators was investigated in the second part of this thesis. Microscopic traffic simulation has become increasingly popular among transport planners, due to the fact that it serves as a safe and flexible off-line test environment for the estimation of dynamic and complex traffic system effects. It is useful and cost-effective in relation to the evaluation of issues concerning roadway design, and technological systems that influence road-user behaviour and vehicle performance. For reasons related to modelling fidelity and data quality, simulation has seldom been used for traffic safety estimation. Simulation model development is however, undergoing rapid development and the area of ‘safety-simulation’ and is recognised as having a high potential in the field of transport planning and traffic engineering. As part of the work in this thesis, practical simulation experiments were carried out to investigate this potential, and identify limitations. Based on the data from one of the earlier studies, and knowledge regarding important safety-influencing factors and behavioural processes, one of the simulation experiments showed evidence to suggest that realistic safety critical events could be generated and measured using safety indicators in a simulation environment, without making unnecessary and unrealistic behavioural assumptions. Furthermore, a second application of this methodology revealed the safety potential of a rear-end incident-reduction function used in standard vehicle actuated signalling. While both of these simulation studies highlighted the potential of this type of approach, the need for more flexible and realistic models of interactive behavioural processes could be identified in addition to the general need for greater active research into the field of safety simulation. / QC 20100830

Quality assessment of healthcare systems is considered to be the basic tool of developing strategic concepts in healthcare quality improvement and has a great impact on quality of life. The thesis' main focus is on possibilities of quality assessment on international quality model level and its transformation into national structures. It includes teoretical points of quality and economic evaluation of quality in healthcare. The objective is to assess the participation of czech hospitals in healthcare quality evaluation systems.

<p>Models based on micro-simulation of traffic flows have proven to be useful tools in the study of various traffic systems. Today, there is a wealth of traffic microsimulation models developed for freeway and urban street networks. The road mileage is however in many countries dominated by rural highways. Hence, there is a need for rural road traffic simulation models capable of assessing the performance of such road environments. This thesis introduces a versatile traffic micro-simulation model for the rural roads of today and of the future. The developed model system considers all common types of rural roads including effects of intersections and roundabouts on the main road traffic. The model is calibrated and validated through a simulation study comparing a two-lane highway to rural road designs with separated oncoming traffic lanes. A good general agreement between the simulation results and the field data is established.</p><p>The interest in road safety and the environmental impact of traffic is growing. Recent research has indicated that traffic simulation can be of use in these areas as well as in traditional capacity and level-of-service studies. In the road safety area more attention is turning towards active safety improving countermeasures designed to improve road safety by reducing the number of driver errors and the accident risks. One important example is Advanced Driver Assistance Systems (ADAS). The potential to use traffic simulation to evaluate the road safety effects of ADAS is investigated in the last part of this thesis. A car-following model for simulation of traffic including ADAS-equipped vehicles is proposed and the developed simulation framework is used to study important properties of a traffic simulation model to be used for safety evaluation of ADAS. Driver behavior for ADAS-equipped vehicles has usually not been considered in simulation studies including ADAS-equipped vehicles. The work in this thesis does however indicate that modeling of the behavior of drivers in ADAS-equipped vehicles is essential for reliable conclusions on the road safety effects of ADAS.</p> / Report code: LiU-Tek-Lic-2005:60.

Models based on micro-simulation of traffic flows have proven to be useful tools in the study of various traffic systems. Today, there is a wealth of traffic microsimulation models developed for freeway and urban street networks. The road mileage is however in many countries dominated by rural highways. Hence, there is a need for rural road traffic simulation models capable of assessing the performance of such road environments. This thesis introduces a versatile traffic micro-simulation model for the rural roads of today and of the future. The developed model system considers all common types of rural roads including effects of intersections and roundabouts on the main road traffic. The model is calibrated and validated through a simulation study comparing a two-lane highway to rural road designs with separated oncoming traffic lanes. A good general agreement between the simulation results and the field data is established. The interest in road safety and the environmental impact of traffic is growing. Recent research has indicated that traffic simulation can be of use in these areas as well as in traditional capacity and level-of-service studies. In the road safety area more attention is turning towards active safety improving countermeasures designed to improve road safety by reducing the number of driver errors and the accident risks. One important example is Advanced Driver Assistance Systems (ADAS). The potential to use traffic simulation to evaluate the road safety effects of ADAS is investigated in the last part of this thesis. A car-following model for simulation of traffic including ADAS-equipped vehicles is proposed and the developed simulation framework is used to study important properties of a traffic simulation model to be used for safety evaluation of ADAS. Driver behavior for ADAS-equipped vehicles has usually not been considered in simulation studies including ADAS-equipped vehicles. The work in this thesis does however indicate that modeling of the behavior of drivers in ADAS-equipped vehicles is essential for reliable conclusions on the road safety effects of ADAS. / <p>Report code: LiU-Tek-Lic-2005:60.</p>

The dissertation deals with the analysis of roundabout design elements and their impact on accidents. The analysis objective was to identify the important elements of roundabouts that have impact on accidents. In order to achieve this goal, the multifactorial statistical safety assessment method was used on the basis of a representative sample of data, by developing several safety performance functions, verifying them and interpreting the result. Several design elements, which from the point of view of the traffic accident mechanism belong to the infrastructure factor, have been identified: AADT, average diameter, entrance width, entry angle, direct passage angle, location and many others. The original sample contained about 1200 roundabouts, which were reduced to 200 based on data availability. Accident frequencies were monitored between 2009 and 2016, i.e. for eight years, resulting in total 2674 roundabouts accidents. The result is an accident prediction model, developer based on roundabout approach design elements, and map of critical roundabouts, identified based on empirical Bayes estimate of accident frequency. Following approach parameters were identified: AADT, entry angle, distance between collision points, deviation of angles between approaches, presence of apron, presence of bypass, entry type, presence of pedestrian crossing and surrounding area type.