Collaborative quality improvement to manage pain in acute care hospitals.

Objective. Collaborative quality improvement programs have been successfully used to manage chronic diseases in adults and acute lung complications in premature infants. Their effectiveness to improve pain management in acute care hospitals is currently unknown. The purpose of this study was to determine whether a collaborative quality improvement program implemented at hospital level could improve pain management and overall pain relief. Design.To assess the effectiveness of the program, we performed a before-after trial comparing patient's self-reported pain management and experience before and after program implementation. We included all adult patients hospitalized for more than 24 hours and discharged either to their home or to a nursing facility, between March 1, 2001 and March 31, 2001 (before program implementation) and between September 15, 2005 and October 15, 2005 (after program implementation). Setting.A teaching hospital of 2,096 beds in Geneva, Switzerland. Patients.All adult patients hospitalized for more than 24 hours and discharged between 1 to 31 March 2001 (before program) and 15 September to 15 October 2005 (after program implementation). Interventions.Implementation of a collaborative quality improvement program using multifaceted interventions (staff education, opinion leaders, patient education, audit, and feedback) to improve pain management at hospital level. Outcome Measures.Patient-reported pain experience, pain management, and overall hospital experience based on the Picker Patient Experience questionnaire, perceived health (SF-36 Health survey). Results.After implementation of the program only 2.3% of the patients reported having no pain relief during their hospital stay (vs 4.5% in 2001, P = 0.05). Among nonsurgical patients, improvements were observed for pain assessment (42.3% vs 27.9% of the patients had pain intensity measured with a visual analog scale, P = 0.012), pain management (staff did everything they could to help in 78.9% vs 67.9% of cases P = 0.003), and pain relief (70.4% vs 57.3% of patients reported full pain relief P = 0.008). In surgical patients, pain assessment also improved (53.7.3% vs 37.6%) as well as pain treatment. More patients received treatments to relieve pain regularly or intermittently after program implementation (95.1% vs 91.9% P = 0.046). Conclusion.Implementation of a collaborative quality improvement program at hospital level improved both pain management and pain relief in patients. Further studies are needed to determine the overall cost-effectiveness of such programs.

Collaborative explicit plasticity framework: a conceptual scheme for the generation of plastic and group-aware user interfaces

The advent of new advances in mobile computing has changed the manner we do our daily work, even enabling us to perform collaborative activities. However, current groupware approaches do not offer an integrating and efficient solution that jointly tackles the flexibility and heterogeneity inherent to mobility as well as the awareness aspects intrinsic to collaborative environments. Issues related to the diversity of contexts of use are collected under the term plasticity. A great amount of tools have emerged offering a solution to some of these issues, although always focused on individual scenarios. We are working on reusing and specializing some already existing plasticity tools to the groupware design. The aim is to offer the benefits from plasticity and awareness jointly, trying to reach a real collaboration and a deeper understanding of multi-environment groupware scenarios. In particular, this paper presents a conceptual framework aimed at being a reference for the generation of plastic User Interfaces for collaborative environments in a systematic and comprehensive way. Starting from a previous conceptual framework for individual environments, inspired on the model-based approach, we introduce specific components and considerations related to groupware.

Promoting Metacognitive Skills in a CSCL environment: implications for instructional and technology design

This paper aims to better understand the development of students’ learning processes when participating actively in a specific Computer Supported Collaborative Learning system called KnowCat. To this end, a longitudinal case study was designed, in which eighteen university students took part in a 12-month (two semesters) learning project. During this time period, the students followed an instructional process, using some elements of KnowCat (KnowCat key features) design to support and improve their interaction processes, especially peer learning processes. Our research involved both supervising the students’ collaborative learning processes throughout the learning project and focusing our analysis on the qualitative evolution of the students’ interaction processes and on the development of metacognitive learning processes. The results of the current research reveal that the instructional application of the CSCL-KnowCat system may favour and improve the development of the students’ metacognitive learning processes. Additionally, the implications of the design of computer supported collaborative learning networks and pedagogical issues are discussed in this paper.

Wiki-supported collaborative learning in primary education. How a dialogic space is created for thinking together

This paper explores how wikis may be used to support primary education students’ collaborative interaction and how such an interaction process can be characterised. The overall aim of this study is to analyse the collaborative processes of students working together in a wiki environment, in order to see how primary students can actively create a shared context for learning in the wiki. Educational literature has already reported that wikis may support collaborative knowledge-construction processes, but in our study we claim that a dialogic perspective is needed to accomplish this. Students must develop an intersubjective orientation towards each others’ perspectives, to co-construct knowledge about a topic. For this purpose, our project utilised a ‘Thinking Together’ approach to help students develop an intersubjective orientation towards one another and to support the creation of a ‘dialogic space’ to co-construct new understanding in a wiki science project. The students’ asynchronous interaction process in a primary classroom -- which led to the creation of a science text in the wiki -- was analysed and characterised, using a dialogic approach to the study of CSCL practices. Our results illustrate how the Thinking Together approach became embedded within the wiki environment and in the students’ collaborative processes. We argue that a dialogic approach for examining interaction can be used to help design more effective pedagogic approaches related to the use of wikis in education and to equip learners with the competences they need to participate in the global knowledge-construction era.

DFM(A)- aspects for a microwave waveguide ring resonator design

In this research manufacturability analysis is made for an E-plane waveguide ring resonator. About the electrical characteristics of the waveguide ring resonator is discussed. Possibilities to utilize concurrent engineering method both for designing and making manufacturability analysis for MW- and RF-components are discussed. For helping to establish the necessary guidelines for easy manufacturing and assembly of the waveguide ring resonator a specialised DFM(A)-questionnaire is generated. The questionnaire gives also new information for collaborative designing approach in MW-/RF- engineering. The advantages and disadvantages of the concurrent engineering design method are evaluated in the research.

Assessment of facilitators' design thinking

Meeting design is one of the most critical prerequisites of the success of facilitated meetings but how to achieve the success is not yet fully understood. This study presents a descriptive model of the design of technology supported meetings based on literature findings about the key factors contributing to the success of collaborative meetings, and linking these factors to the meeting design steps by exploring how facilitators consider the factors in practice in their design process. The empirical part includes a multiple-case study conducted among 12 facilitators. The case concentrates on the GSS laboratory at LUT, which has been working on facilitation and GSS for the last fifteen years. The study also includes ‘control’ cases from two comparable institutions. The results of this study highlight both the variances and commonalities among facilitators in how they design collaboration processes. The design thinking of facilitators of all levels of experience is found to be largely consistent wherefore the key design factors as well as their role across the design process can be outlined. Session goals, group composition, supporting technology, motivational aspects, physical constraints, and correct design practices were found to outline the key factors in design thinking. These factors are further categorized into three factor types of controllable, constraining, and guiding design factors, because the study findings indicate the factor type to have an effect on the factor’s importance in design. Furthermore, the order of considering these factors in the design process is outlined.

Towards increased productivity and quality in software development using agile, lean and collaborative approaches

Dagens programvaruindustri står inför alltmer komplicerade utmaningar i en värld där programvara är nästan allstädes närvarande i våra dagliga liv. Konsumenten vill ha produkter som är pålitliga, innovativa och rika i funktionalitet, men samtidigt också förmånliga. Utmaningen för oss inom IT-industrin är att skapa mer komplexa, innovativa lösningar till en lägre kostnad. Detta är en av orsakerna till att processförbättring som forskningsområde inte har minskat i betydelse. IT-proffs ställer sig frågan: “Hur håller vi våra löften till våra kunder, samtidigt som vi minimerar vår risk och ökar vår kvalitet och produktivitet?” Inom processförbättringsområdet finns det olika tillvägagångssätt. Traditionella processförbättringsmetoder för programvara som CMMI och SPICE fokuserar på kvalitets- och riskaspekten hos förbättringsprocessen. Mer lättviktiga metoder som t.ex. lättrörliga metoder (agile methods) och Lean-metoder fokuserar på att hålla löften och förbättra produktiviteten genom att minimera slöseri inom utvecklingsprocessen. Forskningen som presenteras i denna avhandling utfördes med ett specifikt mål framför ögonen: att förbättra kostnadseffektiviteten i arbetsmetoderna utan att kompromissa med kvaliteten. Den utmaningen attackerades från tre olika vinklar. För det första förbättras arbetsmetoderna genom att man introducerar lättrörliga metoder. För det andra bibehålls kvaliteten genom att man använder mätmetoder på produktnivå. För det tredje förbättras kunskapsspridningen inom stora företag genom metoder som sätter samarbete i centrum. Rörelsen bakom lättrörliga arbetsmetoder växte fram under 90-talet som en reaktion på de orealistiska krav som den tidigare förhärskande vattenfallsmetoden ställde på IT-branschen. Programutveckling är en kreativ process och skiljer sig från annan industri i det att den största delen av det dagliga arbetet går ut på att skapa något nytt som inte har funnits tidigare. Varje programutvecklare måste vara expert på sitt område och använder en stor del av sin arbetsdag till att skapa lösningar på problem som hon aldrig tidigare har löst. Trots att detta har varit ett välkänt faktum redan i många decennier, styrs ändå många programvaruprojekt som om de vore produktionslinjer i fabriker. Ett av målen för rörelsen bakom lättrörliga metoder är att lyfta fram just denna diskrepans mellan programutvecklingens innersta natur och sättet på vilket programvaruprojekt styrs. Lättrörliga arbetsmetoder har visat sig fungera väl i de sammanhang de skapades för, dvs. små, samlokaliserade team som jobbar i nära samarbete med en engagerad kund. I andra sammanhang, och speciellt i stora, geografiskt utspridda företag, är det mera utmanande att införa lättrörliga metoder. Vi har nalkats utmaningen genom att införa lättrörliga metoder med hjälp av pilotprojekt. Detta har två klara fördelar. För det första kan man inkrementellt samla kunskap om metoderna och deras samverkan med sammanhanget i fråga. På så sätt kan man lättare utveckla och anpassa metoderna till de specifika krav som sammanhanget ställer. För det andra kan man lättare överbrygga motstånd mot förändring genom att introducera kulturella förändringar varsamt och genom att målgruppen får direkt förstahandskontakt med de nya metoderna. Relevanta mätmetoder för produkter kan hjälpa programvaruutvecklingsteam att förbättra sina arbetsmetoder. När det gäller team som jobbar med lättrörliga och Lean-metoder kan en bra uppsättning mätmetoder vara avgörande för beslutsfattandet när man prioriterar listan över uppgifter som ska göras. Vårt fokus har legat på att stöda lättrörliga och Lean-team med interna produktmätmetoder för beslutsstöd gällande så kallad omfaktorering, dvs. kontinuerlig kvalitetsförbättring av programmets kod och design. Det kan vara svårt att ta ett beslut att omfaktorera, speciellt för lättrörliga och Lean-team, eftersom de förväntas kunna rättfärdiga sina prioriteter i termer av affärsvärde. Vi föreslår ett sätt att mäta designkvaliteten hos system som har utvecklats med hjälp av det så kallade modelldrivna paradigmet. Vi konstruerar även ett sätt att integrera denna mätmetod i lättrörliga och Lean-arbetsmetoder. En viktig del av alla processförbättringsinitiativ är att sprida kunskap om den nya programvaruprocessen. Detta gäller oavsett hurdan process man försöker introducera – vare sig processen är plandriven eller lättrörlig. Vi föreslår att metoder som baserar sig på samarbete när processen skapas och vidareutvecklas är ett bra sätt att stöda kunskapsspridning på. Vi ger en översikt över författarverktyg för processer på marknaden med det förslaget i åtanke.

Performance measurement and management in a collaborative network

This study concerns performance measurement and management in a collaborative network. Collaboration between companies has been increased in recent years due to the turbulent operating environment. The literature shows that there is a need for more comprehensive research on performance measurement in networks and the use of measurement information in their management. This study examines the development process and uses of a performance measurement system supporting performance management in a collaborative network. There are two main research questions: how to design a performance measurement system for a collaborative network and how to manage performance in a collaborative network. The work can be characterised as a qualitative single case study. The empirical data was collected in a Finnish collaborative network, which consists of a leading company and a reseller network. The work is based on five research articles applying various research methods. The research questions are examined at the network level and at the single network partner level. The study contributes to the earlier literature by producing new and deeper understanding of network-level performance measurement and management. A three-step process model is presented to support the performance measurement system design process. The process model has been tested in another collaborative network. The study also examines the factors affecting the process of designing the measurement system. The results show that a participatory development style, network culture, and outside facilitators have a positive effect on the design process. The study increases understanding of how to manage performance in a collaborative network and what kind of uses of performance information can be identified in a collaborative network. The results show that the performance measurement system is an applicable tool to manage the performance of a network. The results reveal that trust and openness increased during the utilisation of the performance measurement system, and operations became more transparent. The study also presents a management model that evaluates the maturity of performance management in a collaborative network. The model is a practical tool that helps to analyse the current stage of the performance management of a collaborative network and to develop it further.

Designing gamification for collaborative learning in group work

Computer Supported Collaborative Learning (CSCL) is a teaching and learning approach which is widely adopted. However there are still some problems can be found when CSCL takes place. Studies show that using game-like mechanics can increase motivation, engagement, as well as modelling behaviors of players. Gamification is a rapid growing trend by applying the same mechanics. It refers to use game design elements in non-game contexts. This thesis is about combining gamification concept and computer supported collaborative learning together in software engineering education field. And finally a gamified prototype system is designed.

Collaborative learning in a Japanese as a foreign language classroom /

This study examined the influence of training on Asian learners' beliefs, interaction, and attitudes during collaborative learning (CL) and explored the processes of their CL in pairs. The literature contains few studies on the effect of collaborative training in language learning. In addition, it shows gaps between SLA theory and practice resulting from learners' cultural differences. Although second/subsequent language acquisition (SLA) theory assumes that CL contributes to language learning, implementing CL in a multicultural classroom is often considered to be unsuccessful by teachers. The research questions designed to address this gap explore: (a) the extent to which tra~ng affects Asian learners' attitudes towards and interaction during CL; (b) how Asian learners accomplish collaborative tasks in pairs. In the quasi-experimental research design, the learners in the treatment group received special training in CL for 5 weeks while the learners in the comparison group did not receive similar training. Data were collected from 45 McMaster University students through pre- and posttests, pre- and postintervention questionnaires, student information, and informal classroom observations. To detennine the influence of training, the frequency of communication units (c-units), Language Related Episodes (LREs), Collaborative Dialogue (CD) from audio-taped data, and the fmal draft scores were compared between pre- and posttests. The learners' pre- and postintervention questionnaires were also compared. Transcripts from audio-taped data, students' information, their responses and comments from questionnaires, and informal observations served to investigate the processes of Asian learners' CL. Overall, this study found that training had significant influence on the frequency of c-units and CD, and considerable impact on the draft scores, although little influence on the frequency of LREs was observed. The results from the questionnaires in the treatment group showed positive changes in the learners' beliefs on pair work after training. On the other hand, analyses of the transcription data showed that the learners did not conduct enough discussion for a resolution of problems with peers. In conclusion, results suggested the need for teacher intervention, a longer period of collaborative training, and an implementation of self-evaluation into the course grade to encourage the learners to succeed in collaborative learning.

Exploring the Design Process and Components of an Elementary Literacy Guide in an Ontario School Board Initiative

The skill to identify and use best practices in literacy to promote achievement for students of all abilities cannot be underestimated by elementary educators. This qualitative case study investigates 1 year of a literacy initiative for primary and junior educators organized by a southern Ontario school board. The goals of the initiative were to design a literacy guide for teachers while building teacher capacity with literacy practices. Data were culled and analyzed from an examination of the guide, the meetings’ field notes and artifacts, as well as interviews with the educators at the end of the year. Several themes from the results emerged. The educators perceived the design process as unclear but the collaborative components were deemed valuable. The guide’s incompletion led to mixed reactions from the educators about the guide and its structure. Overall, the first year of the 3-year initiative acted as a catalyst for professional learning on literacy. The findings of this study accentuated the value of training educators to use empirical research to support their practices and professional knowledge. Also, the significance of promoting strong leadership with a comprehensive layout consisting of coherent tangible goals for professional development is highlighted.

Design, implementation and application of a generic framework for integrated regional land-use modeling

Land use is a crucial link between human activities and the natural environment and one of the main driving forces of global environmental change. Large parts of the terrestrial land surface are used for agriculture, forestry, settlements and infrastructure. Given the importance of land use, it is essential to understand the multitude of influential factors and resulting land use patterns. An essential methodology to study and quantify such interactions is provided by the adoption of land-use models. By the application of land-use models, it is possible to analyze the complex structure of linkages and feedbacks and to also determine the relevance of driving forces. Modeling land use and land use changes has a long-term tradition. In particular on the regional scale, a variety of models for different regions and research questions has been created. Modeling capabilities grow with steady advances in computer technology, which on the one hand are driven by increasing computing power on the other hand by new methods in software development, e.g. object- and component-oriented architectures. In this thesis, SITE (Simulation of Terrestrial Environments), a novel framework for integrated regional sland-use modeling, will be introduced and discussed. Particular features of SITE are the notably extended capability to integrate models and the strict separation of application and implementation. These features enable efficient development, test and usage of integrated land-use models. On its system side, SITE provides generic data structures (grid, grid cells, attributes etc.) and takes over the responsibility for their administration. By means of a scripting language (Python) that has been extended by language features specific for land-use modeling, these data structures can be utilized and manipulated by modeling applications. The scripting language interpreter is embedded in SITE. The integration of sub models can be achieved via the scripting language or by usage of a generic interface provided by SITE. Furthermore, functionalities important for land-use modeling like model calibration, model tests and analysis support of simulation results have been integrated into the generic framework. During the implementation of SITE, specific emphasis was laid on expandability, maintainability and usability. Along with the modeling framework a land use model for the analysis of the stability of tropical rainforest margins was developed in the context of the collaborative research project STORMA (SFB 552). In a research area in Central Sulawesi, Indonesia, socio-environmental impacts of land-use changes were examined. SITE was used to simulate land-use dynamics in the historical period of 1981 to 2002. Analogous to that, a scenario that did not consider migration in the population dynamics, was analyzed. For the calculation of crop yields and trace gas emissions, the DAYCENT agro-ecosystem model was integrated. In this case study, it could be shown that land-use changes in the Indonesian research area could mainly be characterized by the expansion of agricultural areas at the expense of natural forest. For this reason, the situation had to be interpreted as unsustainable even though increased agricultural use implied economic improvements and higher farmers' incomes. Due to the importance of model calibration, it was explicitly addressed in the SITE architecture through the introduction of a specific component. The calibration functionality can be used by all SITE applications and enables largely automated model calibration. Calibration in SITE is understood as a process that finds an optimal or at least adequate solution for a set of arbitrarily selectable model parameters with respect to an objective function. In SITE, an objective function typically is a map comparison algorithm capable of comparing a simulation result to a reference map. Several map optimization and map comparison methodologies are available and can be combined. The STORMA land-use model was calibrated using a genetic algorithm for optimization and the figure of merit map comparison measure as objective function. The time period for the calibration ranged from 1981 to 2002. For this period, respective reference land-use maps were compiled. It could be shown, that an efficient automated model calibration with SITE is possible. Nevertheless, the selection of the calibration parameters required detailed knowledge about the underlying land-use model and cannot be automated. In another case study decreases in crop yields and resulting losses in income from coffee cultivation were analyzed and quantified under the assumption of four different deforestation scenarios. For this task, an empirical model, describing the dependence of bee pollination and resulting coffee fruit set from the distance to the closest natural forest, was integrated. Land-use simulations showed, that depending on the magnitude and location of ongoing forest conversion, pollination services are expected to decline continuously. This results in a reduction of coffee yields of up to 18% and a loss of net revenues per hectare of up to 14%. However, the study also showed that ecological and economic values can be preserved if patches of natural vegetation are conservated in the agricultural landscape. -----------------------------------------------------------------------

Collaborative recommender agents based on case-based reasoning and trust

La comunitat científica que treballa en Intel·ligència Artificial (IA) ha dut a terme una gran quantitat de treball en com la IA pot ajudar a les persones a trobar el que volen dins d'Internet. La idea dels sistemes recomanadors ha estat extensament acceptada pels usuaris. La tasca principal d'un sistema recomanador és localitzar ítems, fonts d'informació i persones relacionades amb els interessos i preferències d'una persona o d'un grup de persones. Això comporta la construcció de models d'usuari i l'habilitat d'anticipar i predir les preferències de l'usuari. Aquesta tesi està focalitzada en l'estudi de tècniques d'IA que millorin el rendiment dels sistemes recomanadors. Inicialment, s'ha dut a terme un anàlisis detallat de l'actual estat de l'art en aquest camp. Aquest treball ha estat organitzat en forma de taxonomia on els sistemes recomanadors existents a Internet es classifiquen en 8 dimensions generals. Aquesta taxonomia ens aporta una base de coneixement indispensable pel disseny de la nostra proposta. El raonament basat en casos (CBR) és un paradigma per aprendre i raonar a partir de la experiència adequat per sistemes recomanadors degut als seus fonaments en el raonament humà. Aquesta tesi planteja una nova proposta de CBR aplicat al camp de la recomanació i un mecanisme d'oblit per perfils basats en casos que controla la rellevància i edat de les experiències passades. Els resultats experimentals demostren que aquesta proposta adapta millor els perfils als usuaris i soluciona el problema de la utilitat que pateixen el sistemes basats en CBR. Els sistemes recomanadors milloren espectacularment la qualitat dels resultats quan informació sobre els altres usuaris és utilitzada quan es recomana a un usuari concret. Aquesta tesi proposa l'agentificació dels sistemes recomanadors per tal de treure profit de propietats interessants dels agents com ara la proactivitat, la encapsulació o l'habilitat social. La col·laboració entre agents es realitza a partir del mètode de filtratge basat en la opinió i del mètode col·laboratiu de filtratge a partir de confiança. Els dos mètodes es basen en un model social de confiança que fa que els agents siguin menys vulnerables als altres quan col·laboren. Els resultats experimentals demostren que els agents recomanadors col·laboratius proposats milloren el rendiment del sistema mentre que preserven la privacitat de les dades personals de l'usuari. Finalment, aquesta tesi també proposa un procediment per avaluar sistemes recomanadors que permet la discussió científica dels resultats. Aquesta proposta simula el comportament dels usuaris al llarg del temps basat en perfils d'usuari reals. Esperem que aquesta metodologia d'avaluació contribueixi al progrés d'aquesta àrea de recerca.

Collaborative eLearning Assistant Network: caring agents are conscious agents

Would a research assistant - who can search for ideas related to those you are working on, network with others (but only share the things you have chosen to share), doesn’t need coffee and who might even, one day, appear to be conscious - help you get your work done? Would it help your students learn? There is a body of work showing that digital learning assistants can be a benefit to learners. It has been suggested that adaptive, caring, agents are more beneficial. Would a conscious agent be more caring, more adaptive, and better able to deal with changes in its learning partner’s life? Allow the system to try to dynamically model the user, so that it can make predictions about what is needed next, and how effective a particular intervention will be. Now, given that the system is essentially doing the same things as the user, why don’t we design the system so that it can try to model itself in the same way? This should mimic a primitive self-awareness. People develop their personalities, their identities, through interacting with others. It takes years for a human to develop a full sense of self. Nobody should expect a prototypical conscious computer system to be able to develop any faster than that. How can we provide a computer system with enough social contact to enable it to learn about itself and others? We can make it part of a network. Not just chatting with other computers about computer ‘stuff’, but involved in real human activity. Exposed to ‘raw meaning’ – the developing folksonomies coming out of the learning activities of humans, whether they are traditional students or lifelong learners (a term which should encompass everyone). Humans have complex psyches, comprised of multiple strands of identity which reflect as different roles in the communities of which they are part – so why not design our system the same way? With multiple internal modes of operation, each capable of being reflected onto the outside world in the form of roles – as a mentor, a research assistant, maybe even as a friend. But in order to be able to work with a human for long enough to be able to have a chance of developing the sort of rich behaviours we associate with people, the system needs to be able to function in a practical and helpful role. Unfortunately, it is unlikely to get a free ride from many people (other than its developer!) – so it needs to be able to perform a useful role, and do so securely, respecting the privacy of its partner. Can we create a system which learns to be more human whilst helping people learn?

Radon in homes and risk of lung cancer: collaborative analysis of individual data from 13 European case-control studies

Objective: To determine the risk of lung cancer associated with exposure at home to the radioactive disintegration products of naturally Occurring radon gas. Design: Collaborative analysis of individual data from 13 case-control studies of residential radon and lung cancer. Setting Nine European countries. Subjects 7148 cases Of lung cancer and 14 208 controls. Main outcome measures: Relative risks of lung cancer and radon gas concentrations in homes inhabited during the previous 5-34 years measured in becquerels (radon disintegrations per second) per cubic incite (Bq/m(3)) Of household air. Results: The mean measured radon concentration in homes of people in tire control group was 97 Bq/m(3), with 11% measuring > 200 and 4% measuring > 400 Bq/m(3). For cases of lung cancer the mean concentration was 104 Bq/m(3). The risk of lung cancer increased by 8.4% (95% confidence interval 3.0% to 15.8%) per 100 Bq/m(3) increase in measured radon (P = 0.0007). This corresponds to an increase of 16% (5% to 31%) per 100 Bq/m(3) increase in usual radon-that is, after correction for the dilution caused by random uncertainties in measuring radon concentrations. The dose-response relation seemed to be linear with no threshold and remained significant (P=0.04) in analyses limited to individuals from homes with measured radon < 200 Bq/m(3). The proportionate excess risk did not differ significantly with study, age, sex, or smoking. In the absence of other causes of death, the absolute risks of lung cancer by age 75 years at usual radon concentrations of 0, 100, and 400 Bq/m(3) would be about 0.4%, 0.5%, and 0.7%, respectively, for lifelong non-smokers, and about 25 times greater (10%, 12%, and 16%) for cigarette smokers. Conclusions: Collectively, though not separately, these studies show appreciable hazards from residential radon, particularly for smokers and recent ex-smokers, and indicate that it is responsible for about 2% of all deaths from cancer in Europe.