EVALUATING ENVIRONMENTAL IMPACTS OF RURAL DEVELOPMENT PROJECTS

Discussions of "sustainable development" call attention to various dimensions of human well-being to be considered concomitantly with traditional financial and economic measures. The challenge of environmental impact analysis (EIA) is to encourage re-design of projects so that net benefits are maximized over some weighting of economic, environmental, and other criteria. To date, development organizations have been under attack by environmentalists for ignoring or conveniently overlooking environmental damages of development projects. Explanations for this include inadequate institutional commitment to link resource conservation with economic development, short time horizons, narrow evaluation criteria, problems of monetary valuation, and problems with implementation of EIAs. The future of EIAs will see a number of changes to correct for these deficiencies. Evaluation of project impacts in isolation may yield to a more comprehensive environmental assessment for entire regions. Projects will not be funded without the assurance of specific policy conditions for environmental management. The technology of EIA will advance with the assistance of geographic information systems and related tools for data management. Cost-benefit analysis of development projects will continue to integrate the work of project economists with engineers, agronomists, and other specialists with knowledge of environmental issues. Methods of multiple criteria evaluation represent an advance over the partial approaches of EIA and cost-benefit analysis. There is considerable support for moving towards longer project cycles and extended planning periods within the total cycle, meaning that EIA can be more extensive and continuous than in the past. Within the development organizations, reconsideration of personnel accountability and reward systems is one of the strategies to raise the prominence of environmental issues. Each year presents more case studies, videos, and other didactic materials for training in EIA. Finally, the question of improving EIA is a matter of demanding stronger institutions for proactive planning, technical analysis, and policy reforms favorable to environmental protection.Environmental Economics and Policy,

Assessment of “silent” restenosis and long-term follow-up after successful angioplasty in single vessel coronary artery disease: The value of quantitative exercise electrocardiography and quantitative coronary angiography

AbstractExercise electrocardiographic (ECG) testing during follow-up after coronary angioplasty is widely applied to evaluate the efficacy of angioplasty, even in asymptomatic patients. One hundred forty-one asymptomatic patients without previous myocardial infarction underwent quantitative exercise ECG testing and quantitative coronary angiography 1 to 6 months after successful angioplasty in single vessel coronary artery disease to 1) determine the value of exercise ECG testing to detect “silent” restenosis, and 2) assess the long-term prognostic value of exercise ECG testing and coronary angiography.The prevalence of restenosis (defined as ≥50% luminal narrowing at the dilation site) was 12% in this selected study group. Of 26 patients with an abnormal exercise ECG (ST segment depression ≥0.1 mV), only 4 (15%) showed recurrence of stenosis. Sensitivity and specificity for detection of restenosis were 24% and 82%, respectively.One hundred thirty-four patients (95%) were followed up 1 to 64 months (mean 35) after exercise ECG testing and coronary angiography. Thirty-two patients (24%) experienced a cardiac event: in 25 patients (78%) the initial event was recurrent angina pectoris (New York Heart Association class III or IV) and in 7 patients (22%) it was myocardial infarction, although cardiac death did not occur. The mean interval between exercise ECG testing and the initial cardiac events was 14 months (range 1 to 55), whereas 47% of the initial events took place ≤6 months after exercise ECG testing. An abnormal exercise test result and angiographic restenosis had, respectively, a predictive value of 36% and 41% and a relative risk of 1.7 and 1.9. Gender, age and extent of ST segment depression were not related to the occurrence of cardiac events.Thus, exercise ECG testing is not the technique of choice to detect silent restenosis after coronary angioplasty of single vessel coronary artery disease. An abnormal exercise test result and angiographic evidence of restenosis had only limited value in predicting long-term outcome in this patient group

Is quantitative analysis superior to visual analysis of planar thallium 201 myocardial exercise scintigraphy in the evaluation of coronary artery disease? - Analysis of a prospective clinical study

Quantitative analysis of myocardial exercise scintigraphy has been previously reported to be superior to visual image interpretation for detection of the presence and extent of coronary artery disease. Computer analysis of perfusion defects and washout rate of thallium 201 was performed on scintigrams from a group of 131 consecutive patients (prospective group), using criteria defined from a previous group of 72 patients (initial group), and compared with visual interpretation of scintigrams for detection and evaluation of coronary artery disease. The sensitivity of the quantitative technique with regard to overall detection of coronary artery disease was not significantly different from the visual method (69% and 74%, respectively), whereas the specificity was higher (86% and 68%). Quantitative analysis did not increase the sensitivity of thallium imaging over the visual method in the left anterior descending artery (46% vs 65%) and the right coronary artery (51% vs 72%) but did increase sensitivity in the left circumflex artery (75% vs 47%). Whereas in the initial group quantitative analysis resulted in a better identification of multivessel disease (sensitivity 81 % vs 57%), in the prospective group sensitivity decreased (54% vs 67%) without significant loss of specificity. The initial group had a 40% incidence of three-vessel disease and the prospective group, 22% (P < 0.05). One-vessel disease was higher in the prospective group (32% vs 11%, P < 0.05). Thus, assessing the quantitative technique in a larger prospective patient population, there was no improvement of detection of the presence and extent of coronary artery disease when compared with visual interpretation

Impact of percutaneous coronary intervention timing on 5-year outcome in patients with non-ST-segment elevation acute coronary syndromes. The ‘wait a day’ approach might be safer

Background The OPTIMA trial was a randomised multicentre trial exploring the influence of the timing of percutaneous coronary intervention (PCI) on patient outcomes in an intermediate to high risk non-ST-elevation acute coronary syndrome (NSTE-ACS) population. In order to decide the best treatment strategy for patients presenting with NSTEACS, long-term outcomes are essential. Methods Five-year follow-up data from 133 of the 142 patients could be retrieved (94 %). The primary endpoint was a composite of death and spontaneous myocardial infarction (MI). Spontaneous MI was defined as MI occurring more than 30 days after randomisation. Secondary endpoints were the individual outcomes of death, spontaneous MI or re-PCI. Results No significant difference with respect to the primary endpoint was observed (17.8 vs. 10.1 %; HR 1.55, 95 % CI: 0.73–4.22, p = 0.21). There was no significant difference in mortality rate. However, spontaneous MI was significantly more common in the group receiving immediate PCI (11.0 vs. 1.4 %; HR 4.46, 95 % CI: 1.21–16.50, p = 0.02). We did not find a significant difference between the groups with respect to re-PCI rate. Conclusion There was no difference in the composite of death and spontaneous MI. The trial suggests an increased long-term risk of spontaneous MI for patients treated with immediate PCI

The bilirubin albumin ratio in the management of hyperbilirubinemia in preterm infants to improve neurodevelopmental outcome: A randomized controlled trial - BARTrial

Background and Objective: High bilirubin/albumin (B/A) ratios increase the risk of bilirubin neurotoxicity. The B/A ratio may be a valuable measure, in addition to the total serum bilirubin (TSB), in the management of hyperbilirubinemia. We aimed to assess whether the additional use of B/A ratios in the management of hyperbilirubinemia in preterm infants improved neurodevelopmental outcome. Methods: In a prospective, randomized controlled trial, 615 preterm infants of 32 weeks' gestation or less were randomly assigned to treatment based on either B/A ratio and TSB thresholds (consensus-based), whichever threshold was crossed first, or on the TSB thresholds only. The primary outcome was neurodevelopment at 18 to 24 months' corrected age as assessed with the Bayley Scales of Infant Development III by investigators unaware of treatment allocation. Secondary outcomes included complications of preterm birth and death. Results: Composite motor (100±13 vs. 101±12) and cognitive (101±12 vs. 101±11) scores did not differ between the B/A ratio and TSB groups. Demographic characteristics, maximal TSB levels, B/A ratios, and other secondary outcomes were similar. The rates of death and/or severe neurodevelopmental impairment for th

Government Policies Affecting Forests in Latin America: An Agenda for Discussion

This paper identifies policy issues that affect the extent, distribution, and condition of forests in Latin America. Forest management policies are only one element in the framework; policies related to agricultural development and land tenure can have potentially negative consequences for forests. Mineral exploration, hydroelectric reservoirs, highway projects, and urban expansion also have impacts on forest conversion. Finally, macroeconomic policies affect forests through their impact on investment, public spending, foreign trade, and other economic variables that have consequences for land use. Examples of the Bank's lending for forests as integrated with agricultural structural adjustment loans (AGSALs) in Honduras, Nicaragua, and Peru are presented

EVALUATING ENVIRONMENTAL IMPACTS OF RURAL DEVELOPMENT PROJECTS

Discussions of "sustainable development" call attention to various dimensions of human well-being to be considered concomitantly with traditional financial and economic measures. The challenge of environmental impact analysis (EIA) is to encourage re-design of projects so that net benefits are maximized over some weighting of economic, environmental, and other criteria. To date, development organizations have been under attack by environmentalists for ignoring or conveniently overlooking environmental damages of development projects. Explanations for this include inadequate institutional commitment to link resource conservation with economic development, short time horizons, narrow evaluation criteria, problems of monetary valuation, and problems with implementation of EIAs. The future of EIAs will see a number of changes to correct for these deficiencies. Evaluation of project impacts in isolation may yield to a more comprehensive environmental assessment for entire regions. Projects will not be funded without the assurance of specific policy conditions for environmental management. The technology of EIA will advance with the assistance of geographic information systems and related tools for data management. Cost-benefit analysis of development projects will continue to integrate the work of project economists with engineers, agronomists, and other specialists with knowledge of environmental issues. Methods of multiple criteria evaluation represent an advance over the partial approaches of EIA and cost-benefit analysis. There is considerable support for moving towards longer project cycles and extended planning periods within the total cycle, meaning that EIA can be more extensive and continuous than in the past. Within the development organizations, reconsideration of personnel accountability and reward systems is one of the strategies to raise the prominence of environmental issues. Each year presents more case studies, videos, and other didactic materials for training in EIA. Finally, the question of improving EIA is a matter of demanding stronger institutions for proactive planning, technical analysis, and policy reforms favorable to environmental protection