Habersham County Growth Management and Conservation Strategies

CP 6055 Studio, School of City and Regional PlanningGeorgia's land cover change over the past 50 years has been documented in an unprecedented study conducted by the Georgia Conservancy and the Georgia Tech Center for Spatial Planning and Visualization (CSPAV). This study has resulted in Georgia Now and Forever initiative, an ambitious undertaking to educate key decision-makers across Georgia as to the study's findings with a message that intentional, thoughtful decisions around the use of Georgia's remaining undeveloped land are inextricably linked to Georgia's future ecological and economic sustainability. item_description: Georgia's land cover change over the past 50 years has been documented in an unprecedented study conducted by the Georgia Conservancy and the Georgia Tech Center for Spatial Planning and Visualization (CSPAV). This study has resulted in Georgia Now and Forever initiative, an ambitious undertaking to educate key decision-makers across Georgia as to the study's findings with a message that intentional, thoughtful decisions around use of Georgia's remaining undeveloped land are inextricably linked to Georgia's future ecological and economic sustainability. Unsurprisingly, but important to have clearly documented, is the role low density development has played in the significant acreage conversion from agricultural land, forested land, and wetlands. These findings from past development patterns have allowed for the identification of plausible future landcover change trends, assuming business-as-usual development approaches. North Georgia is clearly in the path of major landcover change to low density developed land as metro Atlanta proceeds to "move" northward. This is also an area of significant ecological and carbon assets in the form of our mountain and valley forests, as well as agricultural lands. There is keen community interest in welcoming development-especially diverse and affordable housing choices-but alongside serious advancement in the conservation of the natural landscape. Representatives from the Habersham County, the City of Clarkesville and the property manager of a large conservation tract in the area that includes two riverfront miles of the Soquee River requested assistance from the Georgia Conservancy and Georgia Tech to consider how and where development and conservation can and should occur across their home county of Habersham. There is an understanding among this group that the very conditions that draw new residents to the area-the forests, mountains, streams-are at risk without a concerted effort to include conservation alongside land-efficient development. Given the larger situation in Georgia, the public and political will in the Clarkesville/Habersham area to pursue a larger joint development and conservation priority led to this planning process of identifying strategies for managing local resources in a sustainable way.Habersham CountyCity of Clarksvill

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline

Initial invasive or conservative strategy for stable coronary disease

BACKGROUND Among patients with stable coronary disease and moderate or severe ischemia, whether clinical outcomes are better in those who receive an invasive intervention plus medical therapy than in those who receive medical therapy alone is uncertain. METHODS We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible) and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. A key secondary outcome was death from cardiovascular causes or myocardial infarction. RESULTS Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group. At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points; 95% confidence interval [CI], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, 121.8 percentage points; 95% CI, 124.7 to 1.0). Results were similar with respect to the key secondary outcome. The incidence of the primary outcome was sensitive to the definition of myocardial infarction; a secondary analysis yielded more procedural myocardial infarctions of uncertain clinical importance. There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32). CONCLUSIONS Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years. The trial findings were sensitive to the definition of myocardial infarction that was used