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Background: Accurate diagnosis and staging are crucial to ensure uniform allocation to the optimal treatment methods for non-small cell lung cancer (NSCLC) patients, but may differ among multidisciplinary tumor boards (MDTs). Discordance between clinical and pathologic TNM stage is particularly important for patients with locally advanced NSCLC (stage IIIA) because it may influence their chance of allocation to curative-intent treatment. We therefore aimed to study agreement on staging and treatment to gain insight into MDT decision-making. Research Question: What is the level of agreement on clinical staging and treatment recommendations among MDTs in stage IIIA NSCLC patients? Study Design and Methods: Eleven MDTs each evaluated the same 10 pathologic stage IIIA NSCLC patients in their weekly meeting (n = 110). Patients were selected purposively for their challenging nature. All MDTs received exactly the same clinical information and images per patient. We tested agreement in cT stage, cN stage, cM stage (TNM 8th edition), and treatment proposal among MDTs using Randolph's free-marginal multirater kappa. Results: Considerable variation among the MDTs was seen in T staging (κ, 0.55 [95% CI, 0.34-0.75]), N staging (κ, 0.59 [95% CI, 0.35-0.83]), overall TNM staging (κ, 0.53 [95% CI, 0.35-0.72]), and treatment recommendations (κ, 0.44 [95% CI, 0.32-0.56]). Most variation in T stage was seen in patients with suspicion of invasion of surrounding structures, which influenced such treatment recommendations as induction therapy and type. For N stage, distinction between N1 and N2 disease was an important source of discordance among MDTs. Variation occurred between 2 patients even regarding M stage. A wide range of additional diagnostics was proposed by the MDTs. Interpretation: This study demonstrated high variation in staging and treatment of patients with stage IIIA NSCLC among MDTs in different hospitals. Although some variation may be unavoidable in these challenging patients, we should strive for more uniformity.

International audience; This paper enacts a dialogue between planning literature on polycentric urban regions (PUR) and port geography literature on multi-port gateways. The main proposition is that polycentric systems are the emergent outcome of the interactions between three dimensions of polycentricity: morphological, functional and institutional. The focus is on the Dutch–Belgian Amsterdam–Rotterdam–Antwerp (ARA)port–industrial region: one of the world’s largest concentrations of oil refining and petrochemical activity. The central question is to what extent is the ARA region a polycentric system and what explains this observed polycentricity? Our analyses demonstrate a high degree of morphological and functional polycentricity with each of the constituent (firms located in) ports connected through flows and specialization in processing and trading oil (products). However, this is not the intended result of formalized spatial planning, nor did the ARA ever became a frame of reference among planning agencies. Rather, it is the result of self-organization in the oil industry that has culminated in the emergence of the ARA as an internationally recognized spot market, later institutionally formalized in delivery contracts (oil futures) traded on international commodity exchanges. We conclude that polycentric systems could be understood as emergent systems that obtained generative capacities, inturn influencing its different constituting dimensions.

STUDY OBJECTIVES: Limited evidence exists on the cost-effectiveness of mandibular advancement device (MAD) compared to continuous positive airway pressure (CPAP) therapy in moderate obstructive sleep apnea (OSA). Therefore, this study compares the clinical and cost-effectiveness of MAD therapy with CPAP therapy in moderate OSA. METHODS: In a multicentre randomized controlled trial, patients with an apnea-hypopnea index (AHI) of 15 to 30 events/h were randomized to either MAD or CPAP. Incremental cost-effectiveness and cost-utility ratios (ICER/ICUR, in terms of AHI reduction and quality-adjusted life-years [QALYs, based on the EuroQol Five-Dimension Quality of Life questionnaire]) were calculated after 12 months, all from a societal perspective. RESULTS: In the 85 randomized patients (n = 42 CPAP, n = 43 MAD), AHI reduction was significantly greater with CPAP (median reduction AHI 18.3 [14.8–22.6] events/h) than with MAD therapy (median reduction AHI 13.5 [8.5–18.4] events/h) after 12 months. Societal costs after 12 months were higher for MAD than for CPAP (mean difference €2.156). MAD was less cost-effective than CPAP after 12 months (ICER −€305 [−€3.003 to €1.572] per AHI point improvement). However, in terms of QALY, MAD performed better than CPAP after 12 months (€33.701 [−€191.106 to €562.271] per QALY gained). CONCLUSIONS: CPAP was more clinically effective (in terms of AHI reduction) and cost-effective than MAD. However, costs per QALY was better with MAD as compared to CPAP. Therefore, CPAP is the first-choice treatment option in moderate OSA and MAD may be a good alternative. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Identifier: NCT01588275. CITATION: de Vries GE, Hoekema A, Vermeulen KM, Claessen J, JacobsW, van derMaten J, van der Hoeven JH, Stegenga B, Kerstjens HAM,Wijkstra PJ. Clinicaland cost-effectiveness of a mandibular advancement device versus continuous positive airway pressure in moderate obstructive sleep apnea. J Clin Sleep Med. 2019;15(10):1477-1485.

Arguably one of the most successful planning concepts of the Dutch Randstad is the mainport Policy which began in the 1980s. This policy proposed national advocacy for economic growth through the support for the upgrading of the infrastructure of the port of Rotterdam and Amsterdam Schiphol Airport. Dutch (public) support for the hub and transit functions of the mainports continued to weaken, more so since 2010. This chapter traces the political history of the notion of the mainport, from its conception into discourse and how it relates to our understanding of the Randstad. Since the 1980s the national spatial-economic planning policy with regard to Randstad Holland has been very much interlinked with a so-called ‘mainport’ or ‘gateway strategy’. The various initiatives have already culminated in a mutual Maritime Capital of Europe Agenda endorsed by the Rotterdam Maritime Board that represents executives from the wider port community in order to create momentum for Rotterdam as a dynamic port-city ecosystem.

Background Although most newly presenting patients with pulmonary hypertension ( PH ) have elevated pulmonary artery wedge pressure, identification of so‐called postcapillary PH can be challenging. A noninvasive tool predicting elevated pulmonary artery wedge pressure in patients with incident PH may help avoid unnecessary invasive diagnostic procedures. Methods and Results A combination of clinical data, ECG, and echocardiographic parameters was used to refine a previously developed left heart failure risk score in a retrospective cohort of pre‐ and postcapillary PH patients. This updated score (renamed the OPTICS risk score) was externally validated in a prospective cohort of patients from 12 Dutch nonreferral centers the OPTICS network. Using the updated OPTICS risk score, the presence of postcapillary PH could be predicted on the basis of body mass index ≥30, diabetes mellitus, atrial fibrillation, dyslipidemia, history of valvular surgery, sum of SV 1 (deflection in V1 in millimeters) and RV 6 (deflection in V6 in millimeters) on ECG, and left atrial dilation. The external validation cohort included 81 postcapillary PH patients and 66 precapillary PH patients. Using a predefined cutoff of >104, the OPTICS score had 100% specificity for postcapillary PH (sensitivity, 22%). In addition, we investigated whether a high probability of heart failure with preserved ejection fraction, assessed by the H 2 FPEF score (obesity, atrial fibrillation, age >60 yrs, ≥2 antihypertensives, E/e' >9, and pulmonary artery systolic pressure by echo >35 mmHg), similarly predicted the presence of elevated pulmonary artery wedge pressure. High probability of heart failure with preserved ejection fraction (H 2 FPEF score ≥6) was less specific for postcapillary PH . Conclusions In a community setting, the OPTICS risk score can predict elevated pulmonary artery wedge pressure in PH patients without clear signs of left‐sided heart disease. The OPTICS risk score may be used to tailor the decision to perform invasive diagnostic testing.

Commodities are the lifeblood of the world economy. They are shipped globally in enormous quantities in both volume and value. Yet what is often ignored by transport geographers and (maritime) economists alike is the way commodity markets themselves function and how the performance of these markets influences the demand for freight and, as such, the geography of waterborne transportation. In this chapter we argue that the waterborne transportation of commodities is nested in a complex system; one that is defined by price movements and by transactions across manifold agents that engage in some form of risk in the physical supply of essential production inputs. Based upon a complexity perspective on commodities trading, we present an alternative mode of analysis about the functioning of waterborne shipping of commodities in increasingly volatile markets defined according to optionality and risk.

OBJECTIVE: Chemotherapy in the last month of life for patients with metastatic lung cancer is often considered as aggressive end-of-life care. Targeted therapy with Tyrosine Kinase Inhibitors (TKIs) is a relatively new treatment of which not much is known yet about use in the last month of life. We examined what percentage of patients received chemotherapy or TKIs in the last month of life in the Netherlands. METHODS: Patient files were drawn from 10 hospitals across the Netherlands. Patients had to meet the following eligibility criteria: metastatic lung cancer; died between June 1, 2013 and July 31, 2015. RESULTS: From the included 1,322 patients, 39% received no treatment for metastatic lung cancer, 52% received chemotherapy and 9% received TKIs. A total of 232 patients (18%) received treatment in the last month of life (11% chemotherapy, 7% TKIs). From the patients who received chemotherapy, 145 (21%) received this in the last month of life and 79 (11%) started this treatment in the last month of life. TKIs were given and started more often in the last month of life: from the patients who received TKIs, 87 (72%) received this treatment in the last month of life and 15 (12%) started this treatment in the last month of life. CONCLUSION: A substantial percentage of patient received and even started chemotherapy or TKIs in the last month of life. For chemotherapy, this might be seen as aggressive care. TKIs are said to have less side effects, do not lead to many hospital visits and due to the rapid response, are considered good palliation. However, it is not known, yet possible that, when patients still receiving treatment until shortly before death, this might influence preparing for death in a negative way. ispartof: EUROPEAN JOURNAL OF CANCER CARE vol:29 issue:2 ispartof: location:England status: published

The aim of this paper is to operationalize a relational approach to the study of port-city interfaces. A relational approach allows for the analysis of how actors are connected, transact, and assign meaning and value to regional development. Much of the literature on port-city interfaces has primarily focussed on late 20th-century transformation processes at the urban waterfront. This fails to appreciate the often-continued presence of port activity within cities and falls short in understanding how the development agendas of port cities are relationally constituted. In this paper, first we argue that the port-city interface is a relational geometry through which heterogeneous flows of actors, assets, and structures are coupled. Second, we present an analytical framework capable of operationalizing such relational approach. The contemporary relational geometries in the bio-based sectors within the port cities of Amsterdam and Ghent are taken as starting points. Analysing these reveal how different coupling mechanisms result in particular development trajectories of the port city, setting the scene for future coupling mechanisms. This paper concludes with a discussion on the value of a relational approach to the study of port-city interfaces.

Context. Metastatic lung cancer is an incurable disease that results in a high burden of symptoms, a poor quality of life, and an expected prognosis of less than one year after diagnosis. Treatment shortly before death may result in potential burdensome and inappropriate hospital admissions and hospital deaths. Dying at home is, at a population level, considered a quality for good end-of-life care.Objectives. We examined what percentage of patients with metastatic lung cancer died inside the hospital and if hospital death, or other characteristics of the patient, oncologist or health care, were associated with treatment in the last month of life.Methods. This retrospective cohort study evaluated the medical records of 1322 patients with metastatic lung cancer who received care at one of 10 hospitals across The Netherlands and died between 1/6/2013 and 31/7/2015. Demographic and clinical characteristics were obtained from the medical records.Results. In total, 18% of the patients died during a hospital admission. This percentage was higher for patients who received chemotherapy (42%) or targeted therapy with tyrosine kinase inhibitors (25%) in the last month of life. Patients younger than 60 years of age, patients who received chemotherapy in the last month of life, and patients in whom tyrosine kinase inhibitors were started in the last month of life were more likely to die inside the hospital.Conclusion. In The Netherlands, fewer than one in five patients with metastatic lung cancer died in the hospital and in-hospital death was associated with the relatively late use of chemotherapy or targeted therapy. Careful selection of patients for disease-modifying therapy might enhance the opportunity for patients to die at their preferred place. (C) 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

This chapter is about understanding the role that commodity traders play in the world city network. Commodity trade is crucial in shaping economic globalization, both in the form of physical exchange of goods and in the form of financial transactions. Some older geographical thoughts on the role of traders and trade in shaping urban fortunes, most notably the work of James Vance (1970), are presented. These insights are confronted with a detailed overview of the contemporary practices of commodity traders in coordinating global supply chains and transactions, effectively linking various markets and places across time and space. The main hypothesis we induce is that in order for commodity traders to act as global agents they prefer the concentrated agglomeration benefits offered by (world) cities.

Exclusion of pulmonary hypertension secondary to left-sided heart disease (left heart failure (LHF)) is pivotal in the diagnosis of pulmonary arterial hypertension (PAH). In case of doubt, invasive measurements are recommended. The aim of the present study was to investigate whether it is possible to diagnose LHF using noninvasive parameters in a population suspected of PAH.300 PAH and 80 LHF patients attended our pulmonary hypertension clinic before August 2010, and were used to build the predictive model. 79 PAH and 55 LHF patients attended our clinic from August 2010, and were used for prospective validation.A medical history of left heart disease, S deflection in V1 plus R deflection in V6 in millimetres on ECG, and left atrial dilation or left valvular heart disease that is worse than mild on echocardiography were independent predictors of LHF. The derived risk score system showed good predictive characteristics: R2=0.66 and area under the curve 0.93. In patients with a risk score ≥72, there is 100% certainty that the cause of pulmonary hypertension is LHF. Using this risk score system, the number of right heart catheterisations in LHF may be reduced by 20%.In a population referred under suspicion of PAH, a predictive model incorporating medical history, ECG and echocardiography data can diagnose LHF noninvasively in a substantial percentage of cases.

Regulation of economic activity takes place through a complex web of rules, (property) rights, laws, institutional arrangements and coordination mechanisms. The regulation of economic activity forms the superstructure upon which modern capitalist societies are built. It is through this superstructure that markets are governed as it constrains and enables economic transactions, the allocation of resources and the distribution of wealth within and among societies. The rules governing capitalist relations are created by ‘the public’ (Lindblom, 2001) and enforced by the state through the political and legal systems in place that are historically embedded within the deeper social, cultural and geographical characteristics of that particular society (North, 1990, Amin and Thrift, 1994, Martin, 2000). Regulation as such has been the prime responsibility of nation-states, being the dominant form of political-economic organization of much of the twentieth century. This explains the ‘variety of capitalisms’– or the different forms of regulation, economic governance and business organization models – observed around the world (Whitley, 1999, Hall and Soskice 2001). [...]

Chinese national fiscal reforms and the transfer of power from the central government to local governments impact the governance of inland waterway transport (IWT). In this paper we argue that the development of IWT on the Yangtze River is strongly influenced by institutional changes at different levels of government in line with the path dependent transformation of the Chinese centrally planned economy. This paper deduces how institutional change of IWT on the Yangtze fails to fulfil its purposes because of institutional legacies and conflicts of interests among the various levels of government and the persistent interwovenness of the state with private enterprises (via SOEs). In order to further stimulate IWT on the Yangtze more institutional changes are on the cards, in particular a need for more (foreign) private involvement and more independent SOEs, but these changes will not necessarily break out of the development path.

This Windows on the Netherlands addresses the economic geography of commodity trade by providing insights from two Dutch port cities: Rotterdam and Amsterdam. It is argued that commodity traders provide an empirical site for uncovering the missing links between research on world cities on the one hand, and global commodity chains on the other. Commodity trading is compelling as it is linked both with the financial sector (financing and paper trade) and with the production and distribution of commodities (storage and transportation). However, these two activities do not necessarily need to be in geographical proximity. Rotterdam and Amsterdam handle large volumes of commodities flowing through their ports, but the trading desks of the large commodity houses handle the trade transactions. There is a strong presence of the world’s largest commodity traders in the Netherlands, which include not only the port-based physicaloperational functions but also the trading desks, treasuries and holding companies. The paper concludes with an overview of avenues for further research.

This paper deals with path dependence in seaport governance. A central notion in this respect is lock-in. Economic geographers have recently started to reconsider the deterministic perspective on lock-in and developed the concept of institutional plasticity. Such plasticity is the result of actions of actors to purposefully 'recombine and convert or reinterpret institutions for their new objectives or transfer institutions to different contexts' (Strambach, 2010). This concept is applied to seaports, where so far, path dependence and lock-in have not been studied in detail. Our main conclusion is that a process of institutional stretching takes place when port authorities see a need to develop new capabilities and activities. In this process new layers are added to existing arrangements, gradually leading to a formalised governance reform but without breaking out of the existing path of development. (c) 2012 Elsevier Ltd. All rights reserved.

Introduction: While signs of pulmonary hypertension (PH) are frequently noted during routine echocardiography, the incidence of different subtypes of PH in Dutch peripheral hospitals is presently unknown. Aims: The Optimizing Pulmonary Hypertension Diagnostic Network 1 (OPTIEK1) study aims to (1) gain insight in the incidence of subtypes of PH and referral patterns in a non-referral setting and to (2) obtain an external validation cohort for a recently validated risk-score to predict group 2 PH (Jacobs et al. Eur Respir J 2015; 46:422-430). Methods: This is a national, prospective, multi-center registry, collecting clinical data from adult PH cases in non-referral hospitals. All incident patients with suspected or confirmed PH (diagnosed by echocardiography or during right heart catheterization (RHC)) without a LVEF Results: After a pilot phase, the network currently comprises of 11 participating hospitals. 97 patients are included and group 2 PH accounts for the largest group (57%). At diagnosis, mean age is 72 years, 35% of patients are male and most patients are in NYHA functional class II/III (73%). In 24% of the patients a RHC was performed, confirming the presence of precapillary PH in 54% and combined pre- and postcapillary-PH in 10%. Conclusion: This study will provide epidemiological and clinical data of patients with newly diagnosed PH in a non-referral setting. This registry will provide a unique cohort to be used for both the improvement of referral patterns as well as for (future) research purposes.

Jacobs W., van Rietbergen T., Atzema O., van Grunsven L. and van Dongen F. The impact of multinational enterprises (MNEs) on knowledge-intensive business services (KIBS) start-ups: empirical evidence from the Dutch Randstad, Regional Studies. This paper focuses on the impact of multinational enterprises (MNEs) on the level of entrepreneurship in knowledge-intensive business services (KIBS) in metropolitan regions. Large globalizing metropolitan regions or world cities' are generally considered prime office locations for MNEs and KIBS alike. Certain locations in these metropolitan regions or world cities provide multifarious benefits of being co-agglomerated. Yet the impact of local MNEs, whether domestic or foreign, on successful local entrepreneurship in related KIBS has hardly been conceptually or empirically addressed in the literature. This paper presents evidence from the Dutch Randstad based on a questionnaire given to 2,000 KIBS firms founded in 2001-08 and supported by interviews with major international KIBS. The main conclusion is that MNEs in KIBS firms spawn successful entrepreneurship in KIBS. Implications for regional development policy are also addressed. Jacobs W., van Rietbergen T., Atzema O., van Grunsven L. and van Dongen F. ????(MNE)??????????(KIBS)????????????????(Randstad)????,????????????(MNE) ????????????????(KIBS)???????????????,?????????? ???,? MNE ? KIBS ???????????????????????????,???????????????????????????,???????????? MNE,????? KIBS ???????????????,?????????????????????2001??2008???KIBS??????????,?????????KIBS??????,??????????(Randstad)???????????KIBS ??? MNE,??? KIBS ????????????????????????? Jacobs W., van Rietbergen T., Atzema O., van Grunsven L. et van Dongen F., L'impact des entreprises multinationales sur les services aux entreprises en demarrage a forte intensite de connaissance: des preuves empiriques provenant de la Randstad neerlandaise, Regional Studies. Cet article porte sur l'impact des entreprises multinationales (a savoir, les MNE) sur l'esprit d'entreprise des services aux entreprises a forte densite de connaissances (a savoir les KIBS) dans les regions metropolitaines. En regle generale, on considere les grandes regions metropolitaines mondialisees, autrement dit les grandes villes du monde', comme des emplacements de premier ordre pour les bureaux des MNE et des KIBS, tous les deux. Certains emplacements dans ces regions metropolitaines ou dans ces grandes villes du monde offrent de nombreux avantages de co-agglomeration. Toujours est-il que, dans la documentation, on n'a guere aborde d'un point de vue conceptuel ou empirique l'impact des MNE locales, soit nationales, soit internationales, sur l'esprit d'entreprise reussi des KIBS apparentes. Cet article presente des resultats provenant de la Randstad neerlandaise fondes sur une questionnaire aupres de 2000 KIBS etablis entre 2001 et 2008 completee par des interviews aupres d'importants KIBS internationaux. La principale conclusion est la suivante: les MNE parmi les KIBS donnent naissance a un esprit d'entreprise reussi dans les KIBS. On aborde aussi les consequences pour la politique d'amenagement du territoire. Jacobs W., van Rietbergen T., Atzema O., van Grunsven L. und van Dongen F. Auswirkung von multinationalen Unternehmen auf Firmengrundungen im Bereich der wissensintensiven Geschaftsdienste: Belege aus der niederlandischen Randstad, Regional Studies. Im Mittelpunkt dieses Beitrags stehen die Auswirkungen von multinationalen Unternehmen auf den Umfang des Unternehmertums in wissensintensiven Geschaftsdiensten in Metropolitanregionen. Gro ss e globalisierende Metropolitanregionen oder Weltstadte' gelten generell als erstklassige Standorte fur gewerbliche Immobilien fur multinationale Unternehmen und wissensintensive Geschaftsdienste. Bestimmte Standorte in diesen Metropolitanregionen oder Weltstadten bieten aufgrund ihres gemeinsamen Ballungsraums vielfaltige Vorteile. Allerdings wurde die Auswirkung von lokalen multinationalen Unternehmen (egal ob im in- oder auslandischen Besitz) auf erfolgreiches lokales Unternehmertum in zugehorigen wissensintensiven Geschaftsdiensten in der Literatur bisher noch kaum konzeptuell oder empirisch untersucht. In diesem Beitrag stellen wir Belege der niederlandischen Randstad vor, die mithilfe eines Fragebogens erfasst wurden, der an 2000 im Zeitraum von 2001 bis 2008 gegrundete Firmen fur wissensintensive Geschaftsdienste ausgegeben und durch Interviews mit wichtigen internationalen Firmen fur wissensintensive Geschaftsdienste erganzt wurde. Die wichtigste Schlussfolgerung lautet, dass multinationale Unternehmen im Bereich der wissensintensiven Geschaftsdienste erfolgreiches Unternehmertum fur wissensintensive Geschaftsdienste hervorbringen. Ebenso werden die Konsequenzen fur die Regionalentwicklung erortert. Jacobs W., van Rietbergen T., Atzema O., van Grunsven L. y van Dongen F. El impacto de las empresas multinacionales en la creacion de empresas para servicios a empresas intensivos en conocimiento (SEIC): evidencia empirica de Randstad en los Paises Bajos, Regional Studies. Este articulo trata sobre el impacto de las empresas multinacionales en el nivel de interes empresarial de los servicios a empresas intensivos en conocimiento (SEIC) en regiones metropolitanas. Las grandes regiones metropolitanas globalizadas o ciudades del mundo' se consideran en general lugares principales de inmuebles de uso comercial para empresas multinacionales y SEIC. Determinados lugares en estas regiones metropolitanas o ciudades del mundo ofrecen diversos beneficios gracias a su aglomeracion conjunta. Sin embargo, el impacto de las empresas multinacionales locales, ya sean nacionales o extranjeras, en el exito del empresariado local en los SEIC relacionados apenas se ha abordado desde un punto de vista conceptual o empirico en la bibliografia. En este articulo presentamos datos de la region neerlandesa Randstad a partir de un cuestionario que se entrego a 2.000 empresas de SEIC fundadas entre 2001 y 2008, junto con entrevistas a las principales empresas de SEIC internacionales. La principal conclusion es que las empresas multinacionales en los servicios a empresas intensivos en conocimiento generan exito empresarial en estos servicios. Tambien explicamos las implicaciones para la politica de desarrollo regional.

How do seaports evolve in relation to each other? Recent studies in port economics and transport geography have been focused on how supply-chain integration has structurally changed the competitive landscape in which individual ports and port actors operate. Port regionalization has been addressed as the corresponding new phase in the spatial and functional evolution of port systems. However, these studies lack theoretical foundations that allow us to assess empirically the role either of the institutional context or of strategic agency in the competitive (spatial and functional) evolution of regional (integrated) port systems. The authors present an evolutionary framework to analyze the development of seaports in a regional context by making use of the concept of ‘windows of opportunity’. The role of seaport-based evolution in the processes aimed at positioning market players and ports on the container scene in the Rhine–Scheldt Delta is examined.

Within research on world cities, much attention has been paid to advanced producer services (APS) and their role within both global urban hierarchies and network formation between cities. What is largely ignored is that these APS provide services to firms operating in a range of different sectors. Does sector-specific specialisation of advanced producer services influence the economic geography of corporate networks between cities? If so, what factors might explain this geographical pattern? This paper investigates these theoretical questions by empirically focusing on those advanced producer services related to the port and maritime sector. The empirical results show that the location of AMPS is correlated with maritime localisation economies, expressed in the presence of shipowners and port-related industry as well as APS in general, but not by throughput flows of ports. Based upon the findings, policy recommendations are addressed. © 2010 Urban Studies Journal Limited.

Hall P. V. and Jacobs W. Shifting proximities: the maritime ports sector in an era of global supply chains, Regional Studies. Economic geographers argue that spatial and non-spatial dimensions of proximity are central to innovation and collective action. The various dimensions of proximity in relation to maritime ports are examined. Global supply chains represent a shift in organizational and cognitive proximities between seaports and among port users. In the process, extra-local relationships have become even more influential in maritime port development. As organizational proximity between dominant port users has increased through vertical and horizontal integration, territorially based institutional and social proximities, especially as regards stable and shared regulatory systems, are increasingly important as a counterbalance to ensure openness to innovation and upgrading. Hall P. V. et Jacobs W. Des proximites en pleine evolution: les ports maritimes en periode de chaines d'approvisionnement mondial...

An earlier version of this paper can be found as GaWC Research Bulletin 298 (http://www.lut.ac.uk/gawc/rb/rb298.html) and the paper was published in the following book: Derudder B. and Witlox F. (Eds.) (2010) Commodity Chains and World Cities, Wiley-VCH.; International audience; This paper analyses the location patterns of firms that provide specialized advanced producer services (APS) to international commodity chains that move through seaports. Such activities can take place in world cities or in port cities. The analysis of APS location patterns in port cities provides a good opportunity to integrate the study of world cities into the framework of global production networks. Based upon our empirical findings, we conclude that while port-related APS activities predominantly follow the world city hierarchy, a number of port cities stand out because they act as nodes in global commodity flows and as centres of advanced services related to shipping and port activities. Based upon these empirical findings we address future avenues of research

This paper focuses on the process of institutional change at the leading ports of the United States: Los Angeles and Long Beach. In order to do so, it makes use of the structure of provision-approach and the concept of regime politics which allows for a systematic analysis and comparison. Key questions are: how are both ports institutionally structured? How do they evolve in relation to each other? And what is the role of agency in this process? The paper reveals how both ports remain institutionally different in spite of competition. This persistent institutional diversity can be explained by that fact that institutions represent territorially rooted structures of power in which competitive performance will not always be the decisive interest.

Recent academic debates about port competition have centered on the strategic responses of port authorities, operators, managers and owners to the emergence of global supply chains. The competitive performance of a port authority or operator, given the rise of the integrated logistics sector, depends increasingly on its strategic relationship to these supply chains and rather less on traditional port competition factors such as hinterland size and physical infrastructure. However, there are few empirical studies investigating the degree to which particular port actors are capable of inserting themselves into global supply chains. In this article we ask what factors condition the supply chain strategies of port actors. We hypothesize that the strategic supply chain choices of a port authority or operator are conditioned by the territorialized institutional framework in which the dominant actors in a port operate. We apply these insights through a case study of the transformation of Dubai Port Authority, and the rise of Dubai Ports World (DPW).

Since the early 1990s, planning theory has focused on the issue of institutional change. Not only does institutional change have clear bearings on processes of spatial planning, it is also, increasingly, seen as an object of planning. A core concept in the literature is the juxtaposition of ‘institutional design’ and ‘institutional evolution’. Yet, in understanding processes and the role of institutional change, this dichotomy does not appear to be very helpful. We therefore propose a more encompassing perspective that includes both ‘design’ and ‘evolution’ dimensions, invoking various components from theories of policy change, inspired by the work of Kingdon. We try to unravel, in particular, why, under seemingly comparable conditions, some cases show substantive institutional transformations while others do not. We briefly discuss two cases from the Netherlands to illustrate this point, namely the thwarted process of establishing city regions within the scalar fabric of territorial governance, and some instrumental changes in land policy.

Contains fulltext : 131853.pdf (Publisher’s version ) (Closed access) Strategic coupling refers to the process of matching local assets with global network demands. Although the concept has benefited from an increase in relational thinking, several critical issues remain unresolved. In this article, we identify and discuss three such issues – the characteristics of the entities involved in strategic coupling, the way in which the ‘local’ is conceptualized in the context of ‘global’ positioning, and the understanding of strategic action. To address these issues, we use Cox’s notion of ‘spaces of dependence and engagement’ in combination with Ball’s concept of the ‘structure of provision’. The case of the port of Rotterdam demonstrates the value of our perspective in elucidating the process of ‘strategic coupling’ within global networks of containerized traffic. 19 p.

Port research is not a new field of interest for human geographers, evidenced by numerous conceptual models and empirical cases of port evolution and development in the literature. However, several critical questions remain unanswered, notably the exact position of port geography as a subdiscipline within human geography in the past, present and future. Based on a pluralistic approach, the paper analyzes the changing waves and development of port geography as a sub-discipline of human geography, with a special focus on whether port geography has experienced a paradigm shift and, if so, when, why, and how. Also, through analyzing the major terrains of port geography research from the macro perspective, it brings a new lease of life to port geography in this rapidly changing world.

Este trabalho aborda as carregadas relações entre o comércio de mercadorias, o desenvolvimento econômico urbano e o meio ambiente na maior reserva de floresta tropical do mundo, em forma de narrativa histórica. A estrutura conceitual na qual posicionamos esta narrativa é fornecida por Hesse (2010) nas dimensões de “local” e “situação” da interação entre locais ou localidades, por um lado, e o fluxo de materiais ou cadeias globais de valor por outro. Argumenta-se que a assemblage do local e da situação, que forma as riquezas das cidades. O estudo de caso de Manaus e Belém mostra como a rápida urbanização da Amazônia é acompanhada pelo crescimento do transporte conforme “novas” mercadorias estão sendo extraídos no interior da selva. This paper addresses the fraught relationships among commodity trade, urban economic development and the environment in the world’s largest rainforest reserve, in a historical narrative fashion. The conceptual framework in which we position this narrative is provided by Hesse (2010), in the “site” and “situation” dimensions of the interaction between places or locales on the one hand, and material flows or global value chains on the other. It is argued that the assemblage of both site and situation is what shapes the wealth of cities. The case study of Manaus and Belém shows how the rapid urbanization of the Amazon rainforest is accompanied by the growth of shipping as “new” commodities are being extracted from the jungle interior.

Pulmonary arterial hypertension is a progressive disease of the pulmonary vasculature, ultimately leading to right heart failure and death. Current treatment is aimed at targeting three different pathways: the prostacyclin, endothelin and nitric oxide pathways. These therapies improve functional class, increase exercise capacity and improve haemodynamics. In addition, data from a meta-analysis provide compelling evidence of improved survival. Despite these treatments, the outcome is still grim and the cause of death is inevitable – right ventricular failure. One explanation for this paradox of haemodynamic benefit and still worse outcome is that the right ventricle does not benefit from a modest reduction in pulmonary vascular resistance. This article describes the physiological concepts that might underlie this paradox. Based on these concepts, we argue that not only a significant reduction in pulmonary vascular resistance, but also a significant reduction in pulmonary artery pressure is required to save the right ventricle. Haemodynamic data from clinical trials hold the promise that these haemodynamic requirements might be met if upfront combination therapy is used.

Background: Stroke volume is probably the best hemodynamic parameter because it reflects therapeutic changes and contains prognostic information in pulmonary hypertension (PH). Stroke volume directly reflects right ventricular function in response to its load, without the correction of compensatory increased heart rate as is the case for cardiac output. For this reason, stroke volume, which can be measured noninvasively, is an important hemodynamic parameter to monitor during treatment. However, the extent of change in stroke volume that constitutes a clinically significant change is unknown. The aim of this study was to determine the minimal important difference (MID) in stroke volume in PH. Methods: One hundred eleven patients were evaluated at baseline and after 1 year of follow-up with a 6-min walk test (6MWT) and cardiac MRI. Using the anchor-based method with 6MWT as the anchor, and the distribution-based method, the MID of stroke volume change could be determined. Results: After 1 year of treatment, there was, on average, a significant increase in stroke volume and 6MWT. The change in stroke volume was related to the change in 6MWT. Using the anchor-based method, an MID of 10 mL in stroke volume was calculated. The distribution-based method resulted in an MID of 8 to 12 mL. Conclusions: Both methods showed that a 10-mL change in stroke volume during follow-up should be considered as clinically relevant. This value can be used to interpret changes in stroke volume during clinical follow-up in PH. © 2011 American College of Chest Physicians.

How do seaports evolve in relation to each other? Recent studies in port economics and transport geography focused on how supply chain integration has structurally changed the competitive landscape in which individual ports and port actors operate. Port regionalization has been addressed as the corresponding new phase in the spatial and functional evolution of port systems. However, these studies lack theoretical foundations that allow us to empirically assess both the role of the institutional context and of strategic agency in the competitive (spatial and functional) evolution of regional (integrated) port systems. The paper presents a theoretical framework to analyze and understand the co- evolution of seaports in a regional context by making use of the concept of windows of opportunity. The empirical part will unravel the role of seaport-based co-evolution in the processes aimed at positioning market players and ports on the container scene in the Rhine-Scheldt Delta.

Background The aim of this study was to describe the long-term outcomes in idiopathic pulmonary arterial hypertension (IPAH) treated with first-line bosentan or intravenous (IV) epoprostenol, and additional therapy as needed. Methods In a single-center, retrospective, longitudinal cohort, data on right heart catheterization, 6-minute walk distance (6MWD), disease progression and mortality were collected. Outcomes were assessed in first-line bosentan and first-line epoprostenol patients. To reduce selection bias due to differences between groups, two independent analyses were performed. First, a comparison was made of World Health Organization (WHO) Functional Class (FC) III patients. Second, to control for disease severity, a matched-pairs analysis was performed, with matching according to baseline cardiac output and exercise capacity and irrespective of FC at baseline. Results Thirty-seven IPAH patients initiated first-line bosentan treatment and 37 first-line IV epoprostenol. Twenty-nine of the bosentan patients and 16 of the IV epoprostenol patients were in WHO FC III; demographic profiles were similar, although hemodynamic measurements and 6MWD suggested more severe disease in the IV epoprostenol group at treatment initiation. At 1 and 3 years, median change in 6MWD for patients initiating bosentan was +54 m (95% confidence interval: −3 to 76) and +71 m (−123 to 116), respectively, and +92 m (17 to 128) and +142 m (−6 to 242) for those on IV epoprostenol. Absence of disease progression of WHO FC III at 1 and 3 years was 72% and 45% with bosentan and 75% and 44% with IV epoprostenol, respectively. Survival at 1 and 3 years was 93% and 89% with bosentan and 94% and 75% with IV epoprostenol, respectively. Results were confirmed in matched-pairs analysis of 16 bosentan and 16 IV epoprostenol patients with similar disease severity. Conclusions First-line epoprostenol treatment may lead to greater improvement in exercise capacity than first-line bosentan. However, these greater exercise improvements did not translate into longer time to disease progression or survival.

Aims In pulmonary arterial hypertension (PAH), the exercise-induced increase in stroke volume (SV) is limited by the increase in pulmonary artery pressure. In left heart failure (LHF), systemic arterial pressure increases little during exercise, and the SV increase is limited by the left ventricle itself. These differences might be reflected by a dissimilar SV and heart rate (HR) response to exercise, which could have important therapeutic implications, for example in beta-blocker therapy. Therefore, we tested the hypothesis that SV and HR responses during exercise are different between PAH and LHF patients. Methods and results We included 28 PAH and 18 LHF patients (recruited from the heart failure unit) matched on a maximal oxygen uptake of

Pulmonary arterial hypertension (PAH) is a devastating disease leading to right heart failure and death in a relatively young patient population. In recent years novel PAH specific therapies have become available.To determine the place of epoprostenol in current PAH treatment strategies.An extensive Medline search was performed to evaluate the use of epoprostenol in PAH. Data from both human and animal studies were reviewed.Epoprostenol is an effective and potent treatment in pulmonary arterial hypertension and has greatly improved survival, exercise capacity, PAH symptoms, pulmonary haemodynamics and disease progression. A main disadvantage is that it can only be delivered through a continuous intravenous pump infusion.

The aim of our study was to describe the efficacy of addition of intravenous or subscutaneous prostanoids in idiopathic pulmonary arterial hypertension (PAH) patients deteriorating on bosentan or on bosentan-sildenafil.PAH treatment at our hospital is standardized with first-line oral therapy in New York Heart Association class III patients followed by addition of prostanoids on clinical worsening.Mean improvement in 6-minute walk distance after 4 months of prostanoids was 86 m (p0.01) in the bosentan group versus 41 m (p0.05) in the bosentan-sildenafil group, and these improvements persisted at long-term follow-up.From these results we conclude that addition of subcutaneous or intravenous prostanoids can be efficacious in PAH deteriorating on oral therapy.

Despite ongoing transformations in the maritime transportation industry and the rise of global supply chain systems, most of the world’s important container ports remain urban. Ports continue to occupy urban spaces, are embedded in localized knowledge systems, draw on urban labour markets and infrastructure and are subject to local politics and policy concerns. We identify contemporary geographic theories which help us understand the often increasingly urban attachment of core economic activities despite globalization. We explore how these theories may apply to port studies, highlighting both how they have been used by maritime scholars to this point and also why further development and application are warranted. We argue that a central concern of these geographic theories is the articulation of place- and sector-specific processes operating at a variety of spatial scales. This is in contrast to most maritime studies which continue to be dominated by perspectives which emphasize the global logic of the transportation industry and the analysis of space in generalized and abstract terms. We conclude that a re-appreciation in maritime studies of urban economic processes, informed by geographical theory, will provide policy-makers and others with more understanding of why deep connections between ports and urban places still matter.