Multimodal, intermodal and terminals

The chapter looks at rail freight terminals, rail--sea interfaces, in particular, as part of a multimodal, or integrated transportation network. Terminals are key infrastructure for linking individual transport modes and governing and managing their interchange in a manner that creates a seamless and sustainable transportation system. Therefore, their performance is critical for maximising transport efficiency and modes integration. This chapter focused on how to measure the operational performance of rail freight terminals in a framework of integrated transportation network. In an increasingly competitive and commercialised world, there is an increasing demand to be able to rank transport options and routes in some way. Drawing on new material, this talk attempts to outline possible methods for how to measure the performance of rail terminals. It focuses on the identification of suitable methods to assess performance by key indicators. Intermodality demands for going beyond safeguarding the individual modes to ensuring the security of the intermodal inter-faces (terminals), the nodes that link and integrate passenger and freight flows. That demands for an integrated holistic approach built on the collaboration between international, national organisations and operators. The study put emphasis on the security challenges and threats to freight transport generally and in rail-sea interfaces more specifically. It moves onto the regulations already governing security in rail-sea interfaces. Finally, it focus on the role that infrastructure planning can play in improving security and offer some conclusions and recommendations for the futur

Watch and wait after neoadjuvant treatment in rectal cancer: comparison of outcomes in patients with and without a complete response at first reassessment in the International Watch & Wait Database (IWWD)

Background: In rectal cancer, watch and wait for patients with a cCR after neoadjuvant treatment has an established evidence base. However, there is a lack of consensus on the definition and management of a near-cCR. This study aimed to compare outcomes in patients who achieved a cCR at first reassessment versus later reassessment. Methods: This registry study included patients from the International Watch & Wait Database. Patients were categorized as having a cCR at first reassessment or at later reassessment (that is near-cCR at first reassessment) based on MRI and endoscopy. Organ preservation, distant metastasis-free survival, and overall survival rates were calculated. Subgroup analyses were done for near-cCR groups based on the response evaluation according to modality. Results: A total of 1010 patients were identified. At first reassessment, 608 patients had a cCR; 402 had a cCR at later reassessment. Median follow-up was 2.6 years for patients with a cCR at first reassessment and 2.9 years for those with a cCR at later reassessment. The 2-year organ preservation rate was 77.8 (95 per cent c.i. 74.2 to 81.5) and 79.3 (75.1 to 83.7) per cent respectively (P = 0.499). Similarly, no differences were found between groups in distant metastasis-free survival or overall survival rate. Subgroup analyses showed a higher organ preservation rate in the group with a near-cCR categorized exclusively by MRI. Conclusion: Oncological outcomes for patients with a cCR at later reassessment are no worse than those of patients with a cCR at first reassessment.info:eu-repo/semantics/publishedVersio