Mega-City-Regions: on Awareness and Value Chain Approach

Mega-City-Regions (MCR) as a new large-scale urban phenomenon have been gaining attention recently: In research, empirical studies address their functional consistency, and spatial planning policies underline the strategic role of MCRs for territorial competition of a country. But increasingly a tension between the functional logic of knowledge-intensive business activities and the territorial and normative approaches of public bodies begin to emerge. Typical conflicts of spatial development in MCRs occur for example when globally motivated investment decisions hit upon the local needs. This paper proposes an integrated view that can help to bridge the gap between the growing factual knowledge about MCRs and the still weak ability to use this knowledge for local and regional development and spatial planning purposes. The proposed integration draws on the one hand from the corporate-based value chain approach: The interaction of analysis of spatio-economic development, its adequate visualization and focussed communication towards stakeholders is apt to bring about the initiating momentum for beneficial spatial development. In the context of a diffuse perception of MCRs – whose mere size surpasses our common notions of space – analysis, visualization and communication as methodological components in the spatial planning process add value to sustainable spatial development. The process starts with creating awareness for the often invisible and complex functions, qualities and identities of the MCR spatial scale. New strategies of visualization and communication are needed to improve insight and motivation of the actors involved. On the other hand this value chain approach has to be adapted to the varying vertical levels of public bodies with their numerous policies. Thus, “multi-level-governance†is to be conceived as a concept to close the gap between the territorial and the functional logic of spatial development. The paper will study this dual approach with the case of the announced expansion of the international airport in Munich. This complex multi-level-governance process experiments with a consensus-oriented dialogue platform – the so called “neighbourhood conference†(NC) – bringing together actors with divers responsibilities and objectives. The NC sits at the interface of global and local objectives that are transformed on the spatial scale of the MCR of Munich. The paper concludes with recommendations for using the above described spatial value chain approach for more efficient multi-level-governance.

Mega-City-Regions: on Awareness and Value Chain Approach

Mega-City-Regions (MCR) as a new large-scale urban phenomenon have been gaining attention recently: In research, empirical studies address their functional consistency, and spatial planning policies underline the strategic role of MCRs for territorial competition of a country. But increasingly a tension between the functional logic of knowledge-intensive business activities and the territorial and normative approaches of public bodies begin to emerge. Typical conflicts of spatial development in MCRs occur for example when globally motivated investment decisions hit upon the local needs. This paper proposes an integrated view that can help to bridge the gap between the growing factual knowledge about MCRs and the still weak ability to use this knowledge for local and regional development and spatial planning purposes. The proposed integration draws on the one hand from the corporate-based value chain approach: The interaction of analysis of spatio-economic development, its adequate visualization and focussed communication towards stakeholders is apt to bring about the initiating momentum for beneficial spatial development. In the context of a diffuse perception of MCRs – whose mere size surpasses our common notions of space – analysis, visualization and communication as methodological components in the spatial planning process add value to sustainable spatial development. The process starts with creating awareness for the often invisible and complex functions, qualities and identities of the MCR spatial scale. New strategies of visualization and communication are needed to improve insight and motivation of the actors involved. On the other hand this value chain approach has to be adapted to the varying vertical levels of public bodies with their numerous policies. Thus, "multi-level-governance" is to be conceived as a concept to close the gap between the territorial and the functional logic of spatial development. The paper will study this dual approach with the case of the announced expansion of the international airport in Munich. This complex multi-level-governance process experiments with a consensus-oriented dialogue platform – the so called "neighbourhood conference" (NC) – bringing together actors with divers responsibilities and objectives. The NC sits at the interface of global and local objectives that are transformed on the spatial scale of the MCR of Munich. The paper concludes with recommendations for using the above described spatial value chain approach for more efficient multi-level-governance

Dynamic Spatial Coding within the Dorsal Frontoparietal Network during a Visual Search Task

To what extent are the left and right visual hemifields spatially coded in the dorsal frontoparietal attention network? In many experiments with neglect patients, the left hemisphere shows a contralateral hemifield preference, whereas the right hemisphere represents both hemifields. This pattern of spatial coding is often used to explain the right-hemispheric dominance of lesions causing hemispatial neglect. However, pathophysiological mechanisms of hemispatial neglect are controversial because recent experiments on healthy subjects produced conflicting results regarding the spatial coding of visual hemifields. We used an fMRI paradigm that allowed us to distinguish two attentional subprocesses during a visual search task. Either within the left or right hemifield subjects first attended to stationary locations (spatial orienting) and then shifted their attentional focus to search for a target line. Dynamic changes in spatial coding of the left and right hemifields were observed within subregions of the dorsal front-parietal network: During stationary spatial orienting, we found the well-known spatial pattern described above, with a bilateral hemifield representation in the right hemisphere and a contralateral preference in the left hemisphere. However, during search, the right hemisphere had a contralateral preference and the left hemisphere equally represented both hemifields. This finding leads to novel perspectives regarding models of visuospatial attention and hemispatial neglect

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Nowcasting Thunderstorm Hazards for Flight Operations: The CB WIMS Approach in FLYSAFE

This paper describes the development of the thunderstorm weather information management system “CB WIMS” within the European Integrated Project FLYSAFE and presents results from applications in case studies over the terminal manoeuvring area of airport Paris Charles de Gaulle