Global city-region ambition in the Netherlands: From Randstad to Deltametropolis

The recent renaming of the Dutch Randstad into 'DeltaMetropolis' can be seen as part of a broader strategy to capitalise upon the region's metropolitan and economic potentials and to strengthen its international competitive position. This strategy was first presented by the national planning authorities at the end of the 1980s as a key element of spatial policy in the Fourth National Memorandum on Spatial Planning and it is now prolonged in the recently launched Fifth National Memorandum on Spatial Planning (Fifth Memorandum). An essential difference with 15 years ago is the fact that the current policy strategy for the Randstad is the result of a clear 'give-and-go' between Randstad-based local and regional stakeholders on the one hand and the national (planning) authorities on the other. At the end of the 1990s, local and regional stakeholders in the Randstad joined forces in a broad coalition (which is still growing) to pursue the objective of developing the Randstad into a metropolitan entity named 'DeltaMetropolis'. By turning this highly urbanised region into a thinly populated metropolis a better position in the international inter-urban and inter-regional competitive arena was (and is) aspired to. While this objective fit in with the broad strategy followed by the national government, the DeltaMetropolis coalition had to lobby hard during the preparatory stages of the Fifth Memorandum to make sure that the Randstad in the same document was conceptualised as a single urban network rather than three or four separate 'network cities'. The lobby succeeded and even the long-standing name of the Randstad was traded in for the new name proposed by the coalition. With these developments, which may also be judged as the Randstad having become the subject of a project involving the 'establishment' of the region as an actor in a wider (political) context, the region seems to qualify increasingly well as an illustrative case for the recently presented global city-region thesis (Scott et al., 2001). This thesis expands upon the global city thesis by combining important elements from both the 'new regionalism' school and the 'Los Angeles' approach to urban and regional economics. It stresses the growing importance of so-called 'global city-regions' as both political actors and regional economic motors in the emerging global economy as the result of a wide range of forces of political, technological and economical origin. The aim of the present paper is mainly to explore the extent to which recent developments regarding the Randstad/DeltaMetropolis are indeed compatible with the global city-region thesis (both in political and economic terms). The paper presents a summary of the global city-region thesis and a brief outline of recent developments regarding the Randstad/DeltaMetropolis. In addition, an analysis of the (potential) qualities of the Randstad/DeltaMetropolis as a political actor and a regional economic motor is presented. In conclusion some instructive elements are derived from the global city-region thesis for the DeltaMetropolis project. Reference: Scott, A.J., J. Agnew, E.W. Soja and M. Storper (2001) Global City-Regions, in: A.J. Scott (ed.) Global City-Regions: Trends, Theory, Policy, pp. 11-32. Oxford: Oxford University Press.

Geographies of Knowledge Formation in Mega-City Regions: Some Evidence from the Dutch Randstad

Lambregts B. Geographies of knowledge formation in mega-city regions: some evidence from the Dutch Randstad, Regional Studies. An important source of competitiveness for mega-city regions results from their capacity to combine a strong local knowledge capital base with high levels of connectivity to similar regions elsewhere in the global economy. Globally networked advanced producer services firms are presumed to play a key role in transferring knowledge between local and global circuits. But how does this actually work? Which kinds of knowledge may be acquired through global networks and which others not? An in-depth analysis of the practices of knowledge production by advanced producer services firms in the mega-city region of the Dutch Randstad provides some answers. [image omitted] Lambregts B. Des geographies de la formation de la connaissance dans des megalopoles: des preuves provenant de la Hollande Randstad, Regional Studies. Une source importante de competitivite pour les megalopoles provient de leur capacite a combiner une base de connaissance locale forte avec des niveaux de connectivite aux regions similaires quelque part ailleurs dans l'economie mondialisee. Les societes de services avances a l'industrie qui sont en reseau sur le plan mondial sont censees jouer un role cle dans le transfert de la connaissance entre des circuits locaux et mondiaux. Mais il faut se poser les questions suivantes. Comment est-ce que cela se deroule dans la realite? Quelle connaissance est-ce que on peut ou est-ce qu'on ne peut pas acquerir par le canal des reseaux mondialises? Une analyse approfondie des methodes de production de la connaissance par les societes de services avances a l'industrie situees dans les megalopoles de la Randstad fournit quelques reponses. Megalopoles Rapports de connaissance Services avances a l'industrie Societes a bureaux multiples Competitivite regionale Randstad Lambregts B. Geografien der Wissensbildung in Megastadtregionen: Belege aus der Randstad in Holland, Regional Studies. Ein wichtiger Faktor der Wettbewerbsfahigkeit von Megastadtregionen liegt in ihrer Kapazitat begrundet, eine starke lokale Wissenskapitalbasis mit einem hohen Mass an Verknupfung mit ahnlichen Regionen an anderen Orten der globalen Wirtschaft zu kombinieren. Es wird angenommen, dass weltweit vernetzte Wirtschaftsdienstleister bei der Ubertragung von Wissen zwischen lokalen und globalen Kreislaufen eine zentrale Rolle spielen. Doch wie funktioniert dies in der Praxis? Welche Arten von Wissen lassen sich uber globale Netzwerke erwerben und welche anderen nicht? Eine intensive Analyse der Praktiken der Wissensproduktion durch Wirtschaftsdienstleister in der Megastadtregion Randstad liefert einige Antworten. Megastadtregionen Wissensbeziehungen Wirtschaftsdienstleistungen Firmen mit mehreren Filialen Regionale Wettbewerbsfahigkeit Randstad Lambregts B. Geografias de la formacion de conocimiento en las regiones mega-ciudad: algunos ejemplos del Randstad en Holanda, Regional Studies. Un factor importante de la competitividad de las regiones mega-ciudades radica en la capacidad de combinar una base solida de capital de conocimientos locales con altos niveles de conectividad para regiones similares en otras partes de la economia global. Se supone que las empresas de los servicios avanzados de productores con redes en todo el mundo desempenan un papel fundamental en transferir conocimientos entre circuitos locales y globales. Pero �como funciona esto en la practica? �Que tipos de conocimientos podrian adquirirse a traves de redes globales y cuales no? Un analisis exhaustivo de los metodos de produccion de conocimientos por parte de empresas de servicios avanzados al productor en la region mega-ciudad de Randstad nos ofrece algunas respuestas. Regiones mega-ciudad Relaciones de conocimiento Servicios avanzados de productores Empresas con varias oficinas Competitividad regional El RandstadMega-city regions, Knowledge relationships, Advanced producer services, Multi-office firms, Regional competitiveness, The Randstad,

MRI and diffusion-weighted MRI to diagnose a local tumour regrowth during long-term follow-up of rectal cancer patients treated with organ preservation after chemoradiotherapy

OBJECTIVES: To assess the value of MRI and diffusion-weighted imaging (DWI) for diagnosing local tumour regrowth during follow-up of organ preservation treatment after chemoradiotherapy for rectal cancer. METHODS: Seventy-two patients underwent organ preservation treatment (chemoradiotherapy + transanal endoscopic microsurgery or "wait-and-see") and were followed with MRI including DWI (1.5 T) every 3 -months during the first year and 6 months during following years. Two readers scored each MRI for local regrowth using a confidence level, first on standard MRI, then on standard MRI+DWI. Histology and clinical follow-up were the standard reference. Receiver operating characteristic curves were constructed and areas under the curve (AUC) and corresponding accuracy figures calculated on a per-scan basis. RESULTS: Four hundred and forty MRIs were assessed. Twelve patients developed local regrowth. AUC/sensitivity/specificity for standard MRI were 0.95/58 %/98 % (R1) and 0.96/58 % /100 % (R2). For standard MRI+DWI, these numbers were 0.86/75 %/97 % (R1) and 0.98/75 %/100 % (R2). After adding DWI, the number of equivocal scores decreased from 22 to 7 (R1) and from 40 to 20 (R2). CONCLUSIONS: Although there was no overall improvement in diagnostic performance in terms of AUC, adding DWI improved the sensitivity of MRI for diagnosing local tumour regrowth and lowered the rate of equivocal MRIs. KEY POINTS: * DWI improves sensitivity for detecting local tumour regrowth after organ preservation treatment. * In particular, DWI can aid in detecting small local recurrence. * DWI reduces the number of equivocal scores

Using local clinical and microbiological data to develop an institution specific carbapenem-sparing strategy in sepsis: a nested case-control study

Abstract Background From a stewardship perspective it is recommended that antibiotic guidelines are adjusted to the local setting, accounting for the local epidemiology of pathogens. In many settings the prevalence of Gram-negative pathogens with resistance to empiric sepsis therapy is increasing. How and when to escalate standard sepsis therapy to a reserve antimicrobial agent, is a recurrent dilemma. The study objective was to develop decision strategies for empiric sepsis therapy based on local microbiological and clinical data, and estimate the number needed to treat with a carbapenem to avoid mismatch of empiric therapy in one patient (NNTC). Methods We performed a nested case control study in patients (> 18 years) with Gram-negative bacteremia in 2013–2016. Cases were defined as patients with Gram-negative bacteremia with in vitro resistance to the combination 2nd generation cephalosporin AND aminoglycoside (C-2GC + AG). Control patients had Gram-negative bacteremia with in vitro susceptibility to cefuroxime AND/OR gentamicin, 1:2 ratio. Univariate and multivariable analysis was performed for demographic and clinical predictors of resistance. The adequacy rates of empiric therapy and the NNTC were estimated for different strategies. Results The cohort consisted of 486 episodes of Gram-negative bacteremia in 450 patients. Median age was 66 years (IQR 56–74). In vitro resistance to C-2GC + AG was present in 44 patients (8.8%). Independent predictors for resistance to empiric sepsis therapy were hematologic malignancy (adjusted OR 4.09, 95%CI 1.43–11.62, p < 0.01), previously cultured drug resistant pathogen (adjusted OR 3.72. 95%CI 1.72–8.03, p < 0.01) and antibiotic therapy during the preceding 2 months (adjusted OR 12.5 4.08–38.48, p < 0.01). With risk-based strategies, an adequacy rate of empiric therapy of 95.2–99.3% could be achieved. Compared to treating all patients with a carbapenem, the NNTC could be reduced by 82.8% (95%CI 78.5–87.5%) using the targeted approaches. Conclusions A risk-based approach in empiric sepsis therapy has the potential to better target the use of reserve antimicrobial agents aimed at multi-resistant Gram-negative pathogens. A structured evaluation of the expected antimicrobial consumption and antibiotic adequacy rates is essential to be able to weigh the costs and benefits of potential antibiotic strategies and select the most appropriate approach

Socio-economic stratification of English in globalized landscapes: a market-oriented perspective

Globalization has dramatically altered the urban societies of Amsterdam and Brussels over recent decades, with intensified socio-economic inequality, unprecedented levels of multilingualism and the increasing importance of English. In this paper, I examine the use of English in the linguistic landscape of socio-economically stratified commercial shopping streets in these two second-tier global cities. I adopt a market-oriented, contextualized approach to quantitative and qualitative variability in howEnglish emerges in these particular commercial linguistic markets'. McDonaldization in midscale shopping streets occurs alongside downscaleand upscale uses of English which are more susceptible to local commercial dynamics, in particular in Brussels. As such, global English in these single city contexts emerges as a heterogeneous and scaled phenomenon shaped by specific local commercial and linguistic market conditions. Globalisering heeft de stedelijke gemeenschappen van Amsterdam en Brussel drastisch veranderd tijdens de voorbije decennia met toegenomen socio-economische ongelijkheid, ongeziene gradaties van meertaligheid en een groter belang van het Engels. In dit artikel bekijk ik het gebruik van het Engels in het talige landschap van sociaal-gestratificeerde commerciele winkelstraten in deze twee secundaire wereldsteden. Ik hanteer een marktgeorienteerd en gecontextualiseerd perspectief op de kwantitatieve en kwalitatieve verschillen in hoe Engels wordt gebruikt in deze specifieke commerciele linguistische markten'. McDonaldisering in middenklasse-winkelstraten komt voor naast hoger en lager gestratificeerd gebruik van het Engels dat vooral in Brussel meer onderhevig is aan lokale commerciele dynamieken. Op basis hiervan toont het lokale gebruik van het Engels zich als een heterogeen en geschaald fenomeen binnen een stad dat beinvloed wordt door specifieke lokale commerciele en talige marktcondities