Understanding consumer demand for new transport technologies and services, and implications for the future of mobility

The transport sector is witnessing unprecedented levels of disruption. Privately owned cars that operate on internal combustion engines have been the dominant modes of passenger transport for much of the last century. However, recent advances in transport technologies and services, such as the development of autonomous vehicles, the emergence of shared mobility services, and the commercialization of alternative fuel vehicle technologies, promise to revolutionise how humans travel. The implications are profound: some have predicted the end of private car dependent Western societies, others have portended greater suburbanization than has ever been observed before. If transport systems are to fulfil current and future needs of different subpopulations, and satisfy short and long-term societal objectives, it is imperative that we comprehend the many factors that shape individual behaviour. This chapter introduces the technologies and services most likely to disrupt prevailing practices in the transport sector. We review past studies that have examined current and future demand for these new technologies and services, and their likely short and long-term impacts on extant mobility patterns. We conclude with a summary of what these new technologies and services might mean for the future of mobility.Comment: 15 pages, 0 figures, book chapte

Radiation therapy and photodynamic therapy for biliary tract and ampullary carcinomas

The purpose of radiation therapy for unresectable biliary tract cancer is to prolong survival or prolong stent patency, and to provide palliation of pain. For unresectable bile duct cancer, there are a number of studies showing that radiation therapy is superior to the best supportive care. Although radiation therapy is used in many institutions, no large randomized controlled trials (RCTs) have been performed to date and the evidence level supporting the superiority of this treatment is low. Because long-term relief of jaundice is difficult without using biliary stenting, a combination of radiation therapy and stent placement is commonly used. As radiation therapy, external-beam radiation therapy is usually performed, but combined use of intraluminal brachytherapy with external beam radiation therapy is more useful for making the treatment more effective. There are many reports demonstrating improved response rates as well as extended survival and time to recurrence achieved by this combination therapy. Despite the low level of the evidence, this combination therapy is performed at many institutions. It is expected that multiinstitutional RCTs will be carried out. Unresectable gallbladder cancer with a large focus is usually extensive, and normal organs with high radio sensitivity exist contiguously with it. Therefore, only limited anticancer effects are to be expected from external beam radiation therapy for this type of cancer. The number of reports on ampullary cancer is small and the role of radiation therapy in this cancer has not been established. Combination treatment for ampullary cancer consists of either a single use of intraoperative radiation therapy, postoperative external beam radiation therapy or intraluminal brachytherapy, or a combination of two or three of these therapies. Intraoperative radiation therapy is superior in that it enables precise irradiation to the target site, thereby protecting adjacent highly radiosensitive normal tissues from irradiation. There are reports showing extended survival, although not significant, in groups undergoing intraoperative or postoperative radiation therapy compared with groups without radiation therapy. To date, there are no reports of large RCTs focusing on the significance of radiation therapy as a postoperative adjuvant treatment, so its usefulness as a postoperative adjuvant treatment is not proven. An alternative treatment is photodynamic therapy. There is an RCT demonstrating that, in unresectable bile duct cancer, extended survival and improved quality of life (QOL) have been achieved through a combination of photodynamic therapy and biliary stenting, compared with biliary stenting alone. Results from large RCTs are desired

Flowcharts for the management of biliary tract and ampullary carcinomas

No strategies for the diagnosis and treatment of biliary tract carcinoma have been clearly described. We developed flowcharts for the diagnosis and treatment of biliary tract carcinoma on the basis of the best clinical evidence. Risk factors for bile duct carcinoma are a dilated type of pancreaticobiliary maljunction (PBM) and primary sclerosing cholangitis. A nondilated type of PBM is a risk factor for gallbladder carcinoma. Symptoms that may indicate biliary tract carcinoma are jaundice and pain in the upper right area of the abdomen. The first step of diagnosis is to carry out blood biochemistry tests and ultrasonography (US) of the abdomen. The second step of diagnosis is to find the local extension of the carcinoma by means of computed tomography (CT), magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP), percutaneous transhepatic cholangiography (PTC), and endoscopic retrograde cholangiopancreatography (ERCP). Because resection is the only way to completely cure biliary tract carcinoma, the indications for resection are determined first. In patients with resectable disease, the indications for biliary drainage or portal vein embolization (PVE) are checked. In those with nonresectable disease, biliary stenting, chemotherapy, radiotherapy, and/or best supportive care is selected

Photodynamic therapy of cholangiocarcinoma

Photodynamic therapy (PDT) is a local photochemical tumor treatment that consists of a photosensitizing agent in combination with laser irradiation of a distinct wavelength. In some case reports and small non-randomized pilot studies, PDT has proved feasible in patients with hilar bile duct cancer. Those studies showed an astonishing long survival time of the treated patients. In the yet published two randomized controlled studies, PDT showed a significant extension of survival compared to sole bile duct stenting. A possible explanation for this improved survival is a suspected anti-tumor immunological effect induced by PDT. PDT reaches the same level of survival time as incomplete resection. The main complication is a high risk of severe bacterial cholangitis and liver abscesses requiring peri-interventional antibiotics. Skin phototoxicity, which at the beginning of PDT was the most dreaded potential complication, seems to play an ancillary role using mild light protection. As the available photosensitizers, mainly hematoporphyrin derivative (HPD), are not very effective in terms of depth of tumor necrosis, newer photosensitizers with light absorption in the near infrared spectrum and therefore deeper penetration depth are currently under investigation

Tumours of the hepatic hilum : Radiochemotherapy and photodynamic therapy

La prise en charge thérapeutique des patients porteurs d'une tumeur du hile hépatique reste un défi pour tous les personnels soignants. La résection chirurgicale complète est la seule option de traitement. Cependant, au moment du diagnostic, la plupart de ces tumeurs ne peuvent plus être réséquées chirurgicalement. La durée médiane de survie des patients avec cholangiocarcinome du hile n'est que de 6 mois même après un drainage biliaire endoscopique ou percutané réussi. Un traitement palliatif doit alors être instauré pour ces patients. Les cancers des voies biliaires ne sont que modérément sensibles à la chimiothérapie avec des taux de réponse objective de 10 à 30 % dans les études de phase II uniquement. L'impact sur la survie reste à prouver. Le recours à la radiothérapie à rayon externe est limité en raison d'une possibilité de lésion des voies biliaires et d'une toxicité pouvant atteindre les tissus voisins. La brachythérapie appliquée grâce à des fils d'iridium peut s'avérer utile pour faciliter l'administration de doses plus fortes sur la zone tumorale mais ses effets en terme de survie sont contradictoires. Les données sur la combinaison radio-chimiothérapie sont limitées à des études plus petites sur des patients rigoureusement sélectionnés, par exemple avant transplantation orthotopique du foie. La photothérapie dynamique (PDT) est un nouveau mode de traitement des patients porteurs de cholangiocarcinomes du hile non résécables. Les résultats encourageants d'études prospectives de phase II sur un seul bras et un essai randomisé utilisant la photothérapie dynamique indiquent un bénéfice considérable sur la survie avec une bonne qualité de vie. Une étude récemment publiée sur un suivi à 5 ans de patients porteurs de tumeurs du hile hépatique traitées par PDT, confirme l'efficacité et la sécurité de ce traitement. Cependant, l'approche optimale des patients avec cholangiocarcinome du hile non résécable reste encore à définir. Le drainage endoscopique est considéré comme le traitement palliatif de premier choix. La PDT combinée à une approche endoscopique, semble offrir les meilleurs résultats de traitement avec un bénéfice prouvé sur la survie et une meilleure qualité de vie