Coping with the disappointingrates of return on development projects that affect the environment

Lending institutions'initial appraisals often ignore the true costs of environmental impacts, and many development projects are launched despite returns that are often below the cost of capital and all too often actually negative. Most environmental impacts are negative, so approving a project with a low true rate of return is not only a financial waste but a gratuitous stress on the ecosystem. Ecosystems typically have a low tolerance for such impacts, so low-yielding projects entail serious ecosystem opportunity costs. The author explores why projects with environmental impacts so often have lower-than-anticipated rates of return, and what can be done to remedy the situation. Many observers are optimistic because there is more environmental awareness than there was in the 1970s and early 1980s and environmental screening is more a part of project evaluation. But, says the author, attention to environmental risk has not yet provoked the structural changes in government institutions that would allow for the development of incentives that give proper weight to environmental risks. The fundamental political economy of early commitment to grandiose projects of uncertain environmental consequences has not been overturned. It is also important to develop better appraisal methodologies and to hold those preparing initial project appraisals accountable for their appraisals. If post-project evaluations do not capture the most significant environmental costs, analysts conducting appraisals early in the project's life are unlikely to worry about being caught out by their unfounded optimism or their disregard for environmental consequences. The good news is that in policy reform and structural adjustment the movement is toward eliminating blatant risk-seeking and making government institutions accountable for the results of their own actions. Although the conditionalities imposed by international funding institutions can be helpful, the primary responsibility for designing and selecting appropriate projects that have an envrironmental impact still lies with the governments of the developing world.Health Economics&Finance,Poverty Monitoring&Analysis,Health Monitoring&Evaluation,Development Economics&Aid Effectiveness,ICT Policy and Strategies

Expanding the “Geography” of Policy Options to Reduce Greenhouse Gas Emissions: A Commentary on Hari Osofsky’s The Geography of Solving Global Environmental Problems

11 full imprès, b/n. Els fulls d’aquesta sèrie corresponen a la divisió 12 x 8 de la malla de distribució del Mapa topográfico nacional de España 1:50 000.80 x 60 cm1:5 000254 pp

Lessons learned from a 6-year clinical experience with superior vena cava Greenfield filters

AbstractPurpose: Therapy to prevent pulmonary embolism (PE) resulting from upper extremity deep venous thrombosis (UEDVT) remains controversial despite an increasing incidence of DVT of upper extremity origin. The purpose of this study was to evaluate the results of 72 superior vena cava Greenfield filters (SVC-GFs) placed in patients at risk for PE arising from UEDVT. Methods: During the past 78 months, we placed SVC-GFs in 72 patients with UEDVT in whom anticoagulation was either deemed contraindicated (n = 67) or proved ineffective in preventing recurrent PE (n = 4) or extension of the thrombus (n = 1). There were 25 male (35%) and 47 (65%) female patients whose ages ranged from 25 to 99 years (mean, 74 years). Follow-up ranged from 10 days to 78 months (mean, 7.8 months). Sequential chest radiographs revealed no filter migration or displacement in 26 patients. Results: Thirty-four patients died in the hospital of causes unrelated to the SVC filter or recurrent thromboembolism (mean time to death, 20 days). Follow-up of the surviving 38 patients ranged from 1 month to 78 months (mean, 22 months); none of these patients were seen with any evidence of PE. One SVC-GF was incorrectly discharged into the innominate vein and left in place. This vein remains patent 2 months after insertion without evidence of filter migration. Conclusions: We think that insertion of SVC-GFs is a safe, efficacious, and feasible therapy and may prevent recurrent thromboembolism in patients with UEDVT who are resistant to anticoagulation or have contraindications to anticoagulation. (J Vasc Surg 2000;32:881-7.

Medication adherence levels and differential use of mental-health services in the treatment of schizophrenia

<p>Abstract</p> <p>Background</p> <p>Adherence to antipsychotics for schizophrenia is associated with favorable clinical outcomes. This study compared annual mental-health service utilization by recent medication adherence levels for patients treated for schizophrenia, and assessed whether adherence levels change from pre- to post-psychiatric hospitalization.</p> <p>Methods</p> <p>We analyzed data from a large prospective, non-interventional study of patients treated for schizophrenia in the United States, conducted between 7/1997 and 9/2003. Detailed mental-health resource utilization was systematically abstracted from medical records and augmented with patients' self report. Medication possession ratio (MPR) with any antipsychotic in the 6 months prior to enrollment was used to categorize patients as: adherent (MPR ≥ 80%, N = 1758), partially adherent (MPR ≥ 60% < 80%, N = 36), or non-adherent (MPR < 60%, N = 216). Group comparisons employed propensity score-adjusted bootstrap re-sampling methods with 1000 iterations, adjusting for baseline patient demographic and clinical characteristics identified a priori.</p> <p>Results</p> <p>Adherent patients had a lower rate of psychiatric hospitalization compared with partially adherent and non-adherent patients (p < 0.001) and were more likely than non-adherent to engage in group therapy, individual therapy, and medication management. Most patients (92.0%) who were adherent in the 6 months prior to hospital admission continued to be adherent 6 months following hospitalization. However, 75.0% of previously partially adherent became adherent, and 38.7% of previously non-adherent became adherent following hospitalization.</p> <p>Conclusion</p> <p>Adherence is associated with lower utilization of acute care services and greater engagement in outpatient mental-health treatment. Adherence is a potentially dynamic phenomenon, which may improve, at least temporarily, following patients' psychiatric hospitalizations.</p

Interpretable machine learning to model biomass and waste gasification

Machine learning has been regarded as a promising method to better model thermochemical processes such as gasification. However, their black box nature can limit how much one can trust and learn from the developed models. Here seven different machine learning methods have been adopted to model the gasification of biomass and waste across a wide range of operating conditions. Gradient boosting regression has been found to outperform the other model types with a coefficient of determination (R2) of 0.90 when averaged across ten key gasification outputs. Global and local model interpretability methods have been used to illuminate the developed black box models. The studied models were most strongly influenced by the feedstock’s particle size and the type of gasifying agent employed. By combining global and local interpretability methods, the understanding of black box models has been improved. This allows policy makers and investors to make more educated decisions about gasification process design