Safety and Efficacy of 90Y Selective Internal Radiation Therapy Using Glass Microspheres in Hepatocellular Carcinoma: A Southeast Asian Single-Institution Initial Experience.

Our objective was to demonstrate primarily the safety and secondarily the efficacy of 90Y glass microspheres in selective internal radiation therapy (SIRT) for hepatocellular carcinoma (HCC) in a local Southeast Asian hospital. Methods: Eleven consecutive patients with small, unresectable, nonmetastatic HCC and referred for locoregional therapy with SIRT with a curative intention were followed up for 6 mo after the procedure by way of interviews, blood tests, and anatomic scans. Results: Although 5 patients had deranged liver function tests after the procedure, in only 1 patient did this constitute a grade 1 toxicity (in alkaline phosphatase) by the Common Terminology Criteria for Adverse Events. Half the patients showed a reduction in serum α-fetoprotein measurements, and 6 of 11 patients demonstrated an objective response (complete or partial) on imaging. Conclusion: SIRT with 90Y glass microspheres is a safe and efficacious locoregional therapy for unresectable HCC. There are similar articles published in the West; however, the patient population there comprises far fewer Asians and the underlying cause for HCC is different from that in the Asian population. Despite these differences, SIRT is an equally effective and safe option for such patients.

Safety and Efficacy of Extended Therapy with [177Lu]Lu-PSMA: A German Multicenter Study.

Prospective results have demonstrated favorable safety and efficacy of [177Lu]Lu-PSMA radiopharmaceutical therapy for up to 6 cycles in men with metastatic castration-resistant prostate cancer. However, no systematic data are available outlining the feasibility of extended therapy beyond 6 cycles. We aim to evaluate the safety and efficacy of extended [177Lu]Lu-PSMA radiopharmaceutical therapy in patients who have received more than 6 cycles. Methods: In total, 111 patients were included in this multicenter retrospective analysis. Based on individual decisions, patients underwent uninterrupted continuation of therapy (continuous treatment) or reexposure after a therapy break (rechallenge treatment) between 2014 and 2023. Overall survival, 50% prostate-specific antigen (PSA) decline (measured 8-12 wk after treatment initiation or rechallenge), PSMA PET response, and grades per Common Terminology Criteria for Adverse Events were assessed. χ2 tests, multivariable Cox regression analysis, and log-rank tests were applied for statistical analyses. Results: Patients received extended treatment with [177Lu]Lu-PSMA, either as a continuous treatment (43/111, 38.7%) or as a rechallenge (68/111, 61.3%) treatment, with median cumulative doses of 57.4 or 60.8 GBq, respectively. Overall survival from the initiation of [177Lu]Lu-PSMA was 31.3, 23.2, and 40.2 mo for the entire cohort, the continuous treatment group, and the rechallenge treatment group, respectively. The initial 50% PSA decline was significantly higher in the retreated group than in the continuous group (57/63 [90.4%] vs. 26/42 [61.9%]; P = 0.006). A 50% PSA decline was observed in 23 of 62 patients (37.1%) after the first rechallenge. The rate of grades 3-4 toxicity was comparable between continuous and rechallenge treatments (anemia, 7/43 [16.3%] vs. 13/68 [19.1%)], P = 0.6; leukocytopenia, 1/43 [2.3%] vs. 2/67 [3.0%], P = 0.3; thrombocytopenia, 3/43 [7.0%] vs. 3/68 [4.4%], P = 0.3; renal, 2/43 [4.7%] vs. 5/68 [7.4%], P = 0.2). Conclusion: Extended therapy with [177Lu]Lu-PSMA is safe and has not been associated with increased grades 3-4 toxicity. Patient candidates for extended treatment experienced a favorable median survival of 31.3 mo from the first administration. Response under [177Lu]Lu-PSMA rechallenge demonstrated preserved efficacy of [177Lu]Lu-PSMA after a treatment break.

Safety and Efficacy of 177 Lu-DOTATATE in Children and Young Adult Population : A Single-Center Experience.

PURPOSE: This single-center retrospective study explores the safety and efficacy of 177 Lu-DOTATATE in children and young adult population with metastatic/inoperable neuroendocrine tumors (NETs). PATIENTS AND METHODS: This study is a retrospective analysis of all children and young adult patients (≤29 years) with advanced inoperable/metastatic epithelial or nonepithelial NETs who were administered a median of 4 cycles of 177 Lu-DOTATATE therapy and low-dose oral capecitabine as a radiosensitizer every 8-12 weeks, except 2 patients who received CAPTEM chemotherapy. The radiological response was assessed using RECIST 1.1 on interim and end-of-treatment 68 Ga-DOTANOC PET/CT. The primary endpoint was objective response rate, whereas disease control rate, toxicity profile, progression-free survival, and overall survival were secondary endpoints. RESULTS: Nineteen biopsy-proven NET patients (median age, 22 ± 10 years) with 8 of them adolescents (10-18 years) and the remaining young adults (19-29 years) were included. Fourteen patients had gastroenteropancreatic neuroendocrine tumor (pancreas being most common primary site), whereas the rest had non-gastroenteropancreatic neuroendocrine tumor. A total of 65 cycles of 177 Lu-DOTATATE (range, 1-6 cycles) were administered with a median cumulative activity of 600 mCi (range, 100-1000 mCi). The objective response rate and disease control rate were 41% and 94%, respectively. Grade 1 and 2 adverse events were observed in 14 (74%) and 5 (26%) of 19 patients, respectively. In a total of 8 events (42%), 4 events each of disease progression and death occurred during a median follow-up of 80.1 months with an estimated 5-year progression-free survival and overall survival of 54% (95% confidence interval, 30-78) and 63% (95% confidence interval, 39-87), respectively. CONCLUSIONS: 177 Lu-DOTATATE appears safe and effective in children and young adults with metastatic/inoperable NETs. Large prospective trials are required to validate these results.

["Wider Den Nächtlichen Unfug"-Bielefeld's Street Lighting from 1853 to the 1880s as a Securatization Infrastructure and Tool for Self-Discipline]. / "Wider den nächtlichen Unfug" ­ Die Bielefelder Straßenbeleuchtung von 1853 bis in die 1880er Jahre als versicherheitlichende Infrastruktur und Mittel der Selbstdisziplinierung.

This article deals with the change in safety requirements and technological possibilities in the course of industrialization by looking at the establishment of street lighting in Bielefeld in the 19th century. As will be shown, the development from oil to gas lanterns coincided with a change in the security needs of the urban middle class. It was the technical possibilities of gas lighting to penetrate the urban space at night that made marginalized groups of people who were perceived as a security risk visible. This, together with the bourgeois internalization of the disciplinary effects of light, made this infrastructure possible in Bielefeld. While the urban populations of the pre-modern and early 19th century were still skeptical or dismissive of lanterns, by the mid-19th century their installation was already part of decidedly urban bourgeois demands for more safety in the areas of personal, economic and traffic safety. The lantern thus changed from an instrument of pre-modern visibility to an instrument of constant visibility in the modern age, which at the same time led to new lines of conflict when the expansion and extension of lighting was not as comprehensive as demanded by the urban bourgeoisie. In addition to the changes and conjunctures of security needs in the course of industrialization, Bielefeld also shows that an internalization of the concept of sovereignty by no means meant the absence of conflict. On the basis of administrative acts and petitions, the history of Bielefeld's street lighting is placed in a larger transformation of security, technology and urban spatial design from the perspective of historical security research, drawing on Foucoult's concept of gouvernmentalité. The results show that the history of technology and infrastructure can significantly deepen and contextualize the findings of historical security research. The use and expectations of technology were an essential part of a new understanding of security, as well as the socially segmented organization of urban space through a sometimes precarious alliance of different groups of actors.

Major Traffic Safety Reform and Road Traffic Injuries Among Low-Income New York Residents, 2009-2021.

Objectives. To evaluate the effects of a comprehensive traffic safety policy-New York City's (NYC's) 2014 Vision Zero-on the health of Medicaid enrollees. Methods. We conducted difference-in-differences analyses using individual-level New York Medicaid data to measure traffic injuries and expenditures from 2009 to 2021, comparing NYC to surrounding counties without traffic reforms (n = 65 585 568 person-years). Results. After Vision Zero, injury rates among NYC Medicaid enrollees diverged from those of surrounding counties, with a net impact of 77.5 fewer injuries per 100 000 person-years annually (95% confidence interval = -97.4, -57.6). We observed marked reductions in severe injuries (brain injury, hospitalizations) and savings of $90.8 million in Medicaid expenditures over the first 5 years. Effects were largest among Black residents. Impacts were reversed during the COVID-19 period. Conclusions. Vision Zero resulted in substantial protection for socioeconomically disadvantaged populations known to face heightened risk of injury, but the policy's effectiveness decreased during the pandemic period. Public Health Implications. Many cities have recently launched Vision Zero policies and others plan to do so. This research adds to the evidence on how and in what circumstances comprehensive traffic policies protect public health. (Am J Public Health. 2024;114(6):633-641. https://doi.org/10.2105/AJPH.2024.307617).

An enhanced method for evaluating the effectiveness of protective devices for road safety application.

This paper presents an enhanced probabilistic approach to estimate the real-world safety performance of new device concepts for road safety applications from the perspective of Powered Two-Wheeler (PTW) riders who suffer multiple injuries in different body regions. The proposed method estimates the overall effectiveness of safety devices for PTW riders by correlating computer simulations with various levels of actual injuries collected worldwide from accident databases. The study further develops the methodology initially presented by Johnny Korner in 1989 by introducing a new indicator, Global Potential Damage (GPD), that overcomes the limitations of the original method, encompassing six biomechanical injury indices estimated in five body regions. A Weibull regression model was fit to the field data using the Maximum Likelihood Method with boundaries at the 90% confidence level for the construction of novel injury risk curves for PTW riders. The modified methodology was applied for the holistic evaluation of the effectiveness of a new safety system, the Belted Safety Jacket (BSJ), in head-on collisions across multiple injury indices, body regions, vehicle types, and speed pairs without sub-optimizing it at specific crash severities. A virtual multi-body environment was employed to reproduce a selected set of crashes. The BSJ is a device concept comprising a vest with safety belts to restrict the rider's movements relative to the PTW during crashes. The BSJ exhibited 59% effectiveness, with an undoubted benefit to the head, neck, chest, and lower extremities. The results show that the proposed methodology enables an overall assessment of the injuries, thus improving the protection of PTW users. The novel indicator supports a robust evaluation of safety systems, specifically relevant in the context of PTW accidents.

Safety in higher level automated vehicles: Investigating edge cases in crashes of vehicles equipped with automated driving systems.

With emerging Automated Driving Systems (ADS) representing Automated Vehicles (AVs) of Level 3 or higher as classified by the Society of Automotive Engineers, several AV manufacturers are testing their vehicles on public roadways in the U.S. The safety performance of AVs has become a major concern for the transportation industry. Several ADS-equipped vehicle crashes have been reported to the National Highway Traffic Safety Administration (NHTSA) in recent years. Scrutinizing these crashes can reveal rare or complex scenarios beyond the normal capabilities of AV technologies called "edge cases." Investigating edge-case crashes helps AV companies prepare vehicles to handle these unusual scenarios and, as such, improves traffic safety. Through analyzing the NHTSA data from July 2021 to February 2023, this study utilizes an unsupervised machine learning technique, hierarchical clustering, to identify edge cases in ADS-equipped vehicle crashes. Fifteen out of 189 observations are identified as edge cases, representing 8 % of the population. Injuries occurred in 10 % of all crashes (19 out of 189), but the proportion rose to 27 % for edge cases (4 out of 15 edge cases). Based on the results, edge cases could be initiated by AVs, humans, infrastructure/environment, or their combination. Humans can be identified as one of the contributors to the onset of edge-case crashes in 60 % of the edge cases (9 out of 15 edge cases). The main scenarios for edge cases include unlawful behaviors of crash partners, absence of a safety driver within the AV, precrash disengagement, and complex events challenging for ADS, e.g., unexpected obstacles, unclear road markings, and sudden and unexpected changes in traffic flow, such as abrupt road congestion or sudden stopped traffic from a crash. Identifying and investigating edge cases is crucial for improving transportation safety and building public trust in AVs.

Evaluating the safety and efficiency impacts of forced lane change with negative gaps based on empirical vehicle trajectories.

A lane-changing (LC) maneuver may cause the follower in the target lane (new follower) to decelerate and give up space, potentially affecting crash risk and traffic flow efficiency. In congested flow, a more aggressive LC maneuver occurs where the lane changer is partially next to the new follower and creates negative gaps, namely negative gap forced LC (NGFLC). Although NGFLC forms the foundation of sideswipe crashes, little has been done to address its impacts and the contributing factors. To tackle this issue, a total of 15,810 LC trajectory samples are extracted from three drone videos at different locations. These samples are categorized into NGFLC and normal LC groups for comparative analysis. Five commonly used conflict indicators are extended into two-dimensional to evaluate the crash risk of LC maneuver. The change of time gaps during LC maneuver are examined to quantify the impact of LC on traffic flow efficiency. We find that NGFLCs significantly increase crash risk, reflected by the number of hazardous LC events and potential crash areas compared to normal LC. Additionally, results reveal that both the lane changer and the new follower tend to maintain a larger time gap after NGFLCs. Factors including time headway, relative speed, and historical gaps in the target lane significantly affect NGFLC incidence. Once the movement of the leader in the original lane is taken into account, the prediction accuracy improves from 81% to 91%. The transferability tests indicate that the findings about the negative impact of NGFLC and the accuracy of its prediction model are consistent across different locations. These findings hold implications for driving assistance systems to better predict and mitigate NGFLCs.

Pre-crash scenarios for safety testing of autonomous vehicles: A clustering method for in-depth crash data.

Autonomous vehicles (AVs) provide an opportunity to enhance traffic safety. However, AVs market penetration is still restricted due to their safety concerns and dependability. For widespread adoption, it is crucial to thoroughly assess the safety response of AVs in various high-risk scenarios. To achieve this objective, a clustering method was used to construct typical testing scenarios based on the China In-depth Mobility Safety Study-Traffic Accident (CIMSS-TA) database. Initially, 222 car-to-powered two-wheelers (PTWs) crashes and 180 car-to-car crashes were reconstructed from CIMSS-TA database. Second, six variables were extracted and analyzed, including the motion of the two vehicles involved, relative movement, lighting condition, road condition, and visual obstruction. Third, these variables were clustered using the k-medoids algorithm, identifying five typical pre-crash scenarios for car-to-PTWs and seven for car-to-car. Additionally, we extracted the velocities and surrounding environmental information of the crash-involved parties to enrich the scenario description. The approach used in this study used in-depth case review and thus provided more insightful information for identifying and quantifying representative high-risk scenarios than prior studies that analyzed overall descriptive variables from Chinese crash databases. Furthermore, it is crucial to separately test car-to-car scenarios and car-to-PTWs scenarios due to their distinct motion characteristics, which significantly affect the resulting typical scenarios.

Advanced Bayesian study on inland navigational risk of remotely controlled autonomous ship.

The arise of autonomous ships has necessitated the development of new risk assessment techniques and methods. This study proposes a new framework for navigational risk assessment of remotely controlled Maritime Autonomous Surface Ships (MASS). This framework establishes a set of risk influencing factors affecting safety of navigation of a remotely-controlled MASS. Next, model parameters are defined based on the risk factors, and the model structure is developed using Bayesian Networks. To this end, an extensive literature survey is conducted, enhanced with the domain knowledge elicited from the experts and improved by the experimental data obtained during representative MASS model trials carried out in an inland river. Conditional Probability Tables are generated using a new function employing expert feedback regarding Interval Type 2 Fuzzy Sets. The developed Bayesian model yields the expected utilities results representing an accident's probability and consequence, with the results visualized on a dedicated diagram. Finally, the developed risk assessment model is validated by conducting three axiom tests, extreme scenarios analysis, and sensitivity analysis. Navigational environment, natural environment, traffic complexity, and shore-ship collaboration performance are critical from the probability and consequence perspective for inland navigational accidents to a remotely controlled MASS. Lastly, important nodes to Shore-Ship collaboration performance include autonomy of target ships, cyber risk, and transition from other remote control centers.

A game-theoretic approach for modelling pedestrian-vehicle conflict resolutions in uncontrolled traffic environments.

The interactions of motorised vehicles with pedestrians have always been a concern in traffic safety. The major threat to pedestrians comes from the high level of interactions imposed in uncontrolled traffic environments, where road users have to compete over the right of way. In the absence of traffic management and control systems in such traffic environments, road users have to negotiate the right of way while avoiding conflict. Furthermore, the high level of movement freedom and agility of pedestrians, as one of the interactive parties, can lead to exposing unpredictable behaviour on the road. Traffic interactions in uncontrolled mixed traffic environments will become more challenging by fully/partially automated driving systems' deployment, where the intentions and decisions of interacting agents must be predicted/detected to avoid conflict and improve traffic safety and efficiency. This study aims to formulate a game-theoretic approach to model pedestrian interactions with passenger cars and light vehicles (two-wheel and three-wheel vehicles) in uncontrolled traffic settings. The proposed models employ the most influencing factors in the road user's decision and choice of strategy to predict their movements and conflict resolution strategies in traffic interactions. The models are applied to two data sets of video recordings collected in a shared space in Hamburg and a mid-block crossing area in Surat, India, including the interactions of pedestrians with passenger cars and light vehicles, respectively. The models are calibrated using the identified conflicts between users and their conflict resolution strategies in the data sets. The proposed models indicate satisfactory performances considering the stochastic behaviour of road users - particularly in the mid-block crossing area in India - and have the potential to be used as a behavioural model for automated driving systems.

Child passenger safety: Implementation and evaluation of a virtual educational intervention for parents and caregivers.

OBJECTIVE: The objective of this project was to determine how a virtual educational intervention on Child Passenger Safety (CPS) impacts post-intervention knowledge and self-efficacy levels. METHODS: The intervention included watching a video related to CPS and completing a virtual car seat check with a certified Child Passenger Safety Technician (CPST). A quantitative pre- and post-test project design was utilized. Self-efficacy was measured using a confidence assessment and knowledge level was measured with a comprehension test. Participants were included if they had access to the internet, were English speaking, and parents or caregivers of children aged 12 years or younger. The program was active between February and April of 2021. Out of 58 individuals who expressed interest in participating in the program, the completion rate was 41 %. There were 24 participants who completed all steps of the intervention with a range in days to completion of 59 days. RESULTS: A video-based education intervention combined with completing a virtual car seat check with a CPST was shown to have a statistically significant impact on the knowledge and self-efficacy levels surrounding the use and installation of Child Safety Seats (CSSs) by parents and caregivers. There were a total of 34 car seats that were assessed during the virtual car seat checks and results showed that 65.6% of the car seats that were assessed on arrival had at least 1 error present. In whole, there were 34 car seat errors identified by the CPSTs throughout this project timeline. CONCLUSIONS: A video-based educational intervention combined with a virtual car seat check with a certified CPST has a positive impact on the knowledge and self-efficacy levels of participants. The data analysis shows the project was a successful and meaningful intervention to promote improvements in the field of CPS. This study design allows for the implementation of additional resources and supports for CPS within rural areas and at-risk populations and can help to address public health issues related to a lack of resources based on geographic location.

A freeway vehicle early warning method based on risk map: Enhancing traffic safety through global perspective characterization of driving risk.

In the era of rapid advancements in intelligent transportation, utilizing vehicle operating data to evaluate the risk of freeway vehicles and study on vehicle early warning methods not only lays a theoretical foundation for improving the active safety of vehicles, but also provides the technical support for reducing accident rate. This paper proposes a freeway vehicle early warning method based on risk map to enhance vehicle safety. Firstly, Modified Time-to-Collision (MTTC), a two-dimensional indicator that describes the risk of inter-vehicle travel, is used as an indicator of road traffic risk. This paper designs a transformation function to probabilistically transform MTTC into Risk Indicators (RI). The single-vehicle risk map is generated based on the mapping relationship between the risk values and the corresponding roadway segments. These single-vehicle risk maps of all vehicles on the road are superimposed to construct the risk map, which is used to describe the risk distribution in the freeway. Then, a vehicle early warning framework is built based on the risk map. The risk values in the risk map are compared with predefined early warning thresholds to alert the vehicle when it enters a high-risk state. Finally, VISSIM is used to carry out simulation experiments. The experiment simulates a freeway accident stopping situation. This scenario includes sub-scenarios such as unplanned stopping and lane-changing, continuous lane-changing, and adjacent lane overtaking. We analyze the risk map and vehicle warning results in different sub-scenarios, evaluate the risk changes of the vehicles before and after receiving the warning, and compare the warning results of the method in this paper with other alternative methods. The method is applied to 17 vehicles in the simulation to adjust their motion states. The results show that the total warning time is reduced by 29.6% and 73.3% of vehicles change lanes away from the accident vehicle. The overall results validate the effectiveness of the vehicle early warning method based on risk map proposed in this paper.

Safety-in-Numbers for route choice of bicycle trips: A choice experiment approach for commuters.

Safety-in-Numbers (SiN) implies that the risk of collision per road user is less when there are more road users. Although the available literature has confirmed the existence of SiN as an objective measure of safety, the effect on perceived safety, especially in the context of bicycle riders, has received much less attention. This study investigates the SiN effect on the perceived safety of bicycle riders that influences route choice behavior. A stated preference survey was performed in the South Delhi district of Delhi. The effect of attributes like posted speed limit, the volume of motorized traffic, bicycle infrastructure, and bicycle traffic/ crowding on route choice behavior was investigated. A binary logit model was developed to quantify the effect of these attributes on route choice. The results indicate that, in general, riders prefer routes with more bicycle traffic, hence validating SiN. But the effect does not always hold. For some riders, in the presence of dedicated bicycle infrastructure, when the perceived safety is higher, the presence of more bicycle traffic acts as crowding and demotivates riders to choose that route. The study also reveals that riders prefer routes with a low volume of motorized traffic and dedicated bicycle infrastructure. The outcomes suggest that a policy that encourages infrastructural development to provide lateral separation will encourage more people, hence increasing bicycle mode share as well as the perceived safety of riders.

Enhancing rail safety through real-time defect detection: A novel lightweight network approach.

The rapid detection of internal rail defects is critical to maintaining railway safety, but this task faces a significant challenge due to the limited computational resources of onboard detection systems. This paper presents YOLOv8n-LiteCBAM, an advanced network designed to enhance the efficiency of rail defect detection. The network designs a lightweight DepthStackNet backbone to replace the existing CSPDarkNet backbone. Further optimization is achieved through model pruning techniques and the incorporation of a novel Bidirectional Convolutional Block Attention Module (BiCBAM). Additionally, inference acceleration is realized via ONNX Runtime. Experimental results on the rail defect dataset demonstrate that our model achieves 92.9% mAP with inference speeds of 136.79 FPS on the GPU and 38.36 FPS on the CPU. The model's inference speed outperforms that of other lightweight models and ensures that it meets the real-time detection requirements of Rail Flaw Detection (RFD) vehicles traveling at 80 km/h. Consequently, the YOLOv8n-LiteCBAM network is with some potential for industrial application in the expedited detection of internal rail defects.

Evaluating the reliability of automatically generated pedestrian and bicycle crash surrogates.

Vulnerable Road Users (VRUs), such as pedestrians and bicyclists, are at a higher risk of being involved in crashes with motor vehicles, and crashes involving VRUs also are more likely to result in severe injuries or fatalities. Signalized intersections are a major safety concern for VRUs due to their complex dynamics, emphasizing the need to understand how these road users interact with motor vehicles and deploy evidence-based safety countermeasures. Given the infrequency of VRU-related crashes, identifying conflicts between VRUs and motorized vehicles as surrogate safety indicators offers an alternative approach. Automatically detecting these conflicts using a video-based system is a crucial step in developing smart infrastructure to enhance VRU safety. However, further research is required to enhance its reliability and accuracy. Building upon a study conducted by the Pennsylvania Department of Transportation (PennDOT), which utilized a video-based event monitoring system to assess VRU and motor vehicle interactions at fifteen signalized intersections in Pennsylvania, this research aims to evaluate the reliability of automatically generated surrogates in predicting confirmed conflicts without human supervision, employing advanced data-driven models such as logistic regression and tree-based algorithms. The surrogate data used for this analysis includes automatically collectable variables such as vehicular and VRU speeds, movements, post-encroachment time, in addition to manually collected variables like signal states, lighting, and weather conditions. To address data scarcity challenges, synthetic data augmentation techniques are used to balance the dataset and enhance model robustness. The findings highlight the varying importance and impact of specific surrogates in predicting true conflicts, with some surrogates proving more informative than others. Additionally, the research examines the distinctions between significant variables in identifying bicycle and pedestrian conflicts. These findings can assist transportation agencies to collect the right types of data to help prioritize infrastructure investments, such as bike lanes and crosswalks, and evaluate their effectiveness.

Safety effects of bypass lanes at unsignalized three-leg junctions.

Bypass lanes are a low-cost measure to increase capacity at unsignalized T-junctions without left-turn lanes that allow through-traffic to pass left-turning vehicles on the right. There is very limited knowledge about the safety effects of bypass lanes. We found six previous studies that could be summarized by means of meta-analysis, and the results show an average accident reduction of 10 percent. However, the results from previous studies are inconsistent and may be biased. Therefore, the present study has estimated safety effects of by-pass lanes in Norway, based on a sample of 2,227 T-junctions (incl. 94 with bypass-lanes) for which relevant data was available for a period of up to 10 years. We developed accident prediction models and conducted before-after analyses. The accident prediction models show that junctions with bypass lanes have 82 percent more accidents than junctions without bypass lanes, when controlling for endogeneity. Endogeneity occurs when the implementation of a measure is conditional on the frequency of crashes, as has been the case with bypass lanes. The before-after analysis shows that average accident numbers decrease after the installation of bypass lanes. However, when controlling for regression-to-the-mean (RTM), average accident numbers increase. RTM means that accident numbers would have been likely to decrease even without any measure because they had been exceptionally high in the before period. The control for potential biases in our study is likely to contribute to the discrepancy between results from our study and previous studies, most of which have not controlled for the same potential biases. We conclude therefore that bypass lanes, although favorable for capacity, are likely to be unfavorable for safety when compared to other unsignalized T-junctions without left-turn lanes. Unfavorable safety effects may partly be due to site specific conditions, such as road alignment and sight conditions, that contribute to rear-end collision risk or inappropriate driver behavior. However, this does not necessarily mean that bypass lanes never should be used. For example, at junctions where a bypass lane may solve capacity problems, and where site-specific conditions are favorable, bypass lanes may still be an acceptable solution.

A simulator study assessing the effectiveness of training and warning systems on drivers' response performance to vehicle cyberattacks.

Modern vehicles are vulnerable to cyberattacks and the consequences can be severe. While technological efforts have attempted to address the problem, the role of human drivers is understudied. This study aims to assess the effectiveness of training and warning systems on drivers' response behavior to vehicle cyberattacks. Thirty-two participants completed a driving simulator study to assess the effectiveness of training and warning system according to their velocity, deceleration events, and count of cautionary behaviors. Participants, who held a valid United States driving license and had a mean age of 20.4 years old, were equally assigned to one of four groups: control (n = 8), training-only (n = 8), warning-only (n = 8), training and warning groups (n = 8). For each drive, mixed ANOVAs were implemented on the velocity variables and Poisson regression was conducted on the normalized time with large deceleration events and cautionary behavior variables. Overall, the results suggest that drivers' response behaviors were moderately affected by the training programs and the warning messages. Most drivers who received training or warning messages responded safely and appropriately to cyberattacks, e.g., by slowing down, pulling over, or performing cautionary behaviors, but only in specific cyberattack events. Training programs show promise in improving drivers' responses toward vehicle cyberattacks, and warning messages show rather moderate improvement but can be further refined to yield consistent behavior.

The influence of water safety knowledge on adolescents' drowning risk behaviors: a framework of risk-protect integrated and KAP theory.

Introduction: Although previous research has examined the risk factors for drowning behavior among adolescents, it is unclear whether this association is influenced by water safety knowledge. This study aimed to examine whether water safety knowledge is associated with adolescents' drowning risk behaviors and whether drowning risk perceptions and attitudes could have a chain mediating role in the association between water safety knowledge and adolescents' drowning risk behaviors. Methods: This study included 7,485 adolescents from five Chinese provinces and cities. We used the Drowning Risk Behaviors Scales (DRBS) to evaluate the risk of drowning behaviors. The Water Safety Knowledge Scale (WSKS) was used to evaluate the competence level of water safety knowledge. The Drowning Risk Perceptions Scale (DRPS) was used to evaluate the risk level of perceptions, and the Drowning Risk Attitudes Scale (DRAS) was used to evaluate the risk level of attitudes. Results: The results of the mediating effect test showed that water safety knowledge (WSK) affected drowning risk behaviors (DRB) through three indirect paths. Drowning risk perceptions (DRP) and attitudes (DRA) have significantly mediated the association between WSK and DRB. In conclusion, DRP and DRA can act as mediators between WSK and DRB, not only individually, but also as chain mediators, where the direct effect is-0.301, the total indirect effect is-0.214, and the total mediated indirect effect is 41.5%. Discussion: Water safety knowledge negatively predicts adolescents' drowning risk behaviors; water safety knowledge has an inhibitory effect on drowning risk perceptions. Water safety knowledge can directly influence adolescents' drowning risk perceptions and indirectly affect drowning risk behaviors through the mediation of drowning risk perceptions and attitudes comprising three paths: (1) the drowning risk perceptions mediation path, (2) the drowning risk attitudes mediation path, and (3) the drowning risk perceptions and attitudes mediation paths.

The efficacy of hazard perception training and education: A systematic review and meta-analysis.

BACKGROUND: Hazard perception (HP) has been argued to improve with experience, with numerous training programs having been developed in an attempt to fast track the development of this critical safety skill. To date, there has been little synthesis of these methods. OBJECTIVE: The present study sought to synthesise the literature for all road users to capture the breadth of methodologies and intervention types, and quantify their efficacy. DATA SOURCES: A systematic review of both peer reviewed and non-peer-reviewed literature was completed. A total of 57 papers were found to have met inclusion criteria. RESULTS: Research into hazard perception has focused primarily on drivers (with 42 studies), with a limited number of studies focusing on vulnerable road users, including motorcyclists (3 studies), cyclists (7 studies) and pedestrians (5 studies). Training was found to have a large significant effect on improving hazard perception skills for drivers (g = 0.78) and cyclists (g = 0.97), a moderate effect for pedestrians (g = 0.64) and small effect for motorcyclists (g = 0.42). There was considerable heterogeneity in the findings, with the efficacy of training varying as a function of the hazard perception skill being measured, the type of training enacted (active, passive or combined) and the number of sessions of training (single or multiple). Active training and single sessions were found to yield more consistent significant improvements in hazard perception. CONCLUSIONS: This study found that HP training improved HP skill across all road user groups with generally moderate to large effects identified. HP training should employ a training method that actively engages the participants in the training task. Preliminary results suggest that a single session of training may be sufficient to improve HP skill however more research is needed into the delivery of these single sessions and long-term retention. Further research is also required to determine whether improvements in early-stage skills translate to improvements in responses on the road, and the long-term retention of the skills developed through training.