Analyzing USDA Forest Service Appeals: Phase I, the Database

A full accounting of the current administrative appeals process would begin with some basic questions: who, what, where, and when. The database we have compiled begins to answer some of these questions, especially 1) who files appeals, 2) what types of projects are appealed, 3) where the most appeals are filed, and 4) when most appeals are decided. It is important to note that there really was no easy way to answer these questions prior to construction of this database

Designing a framework for evaluating the impacts and outcomes of Forest Service appeals

USDA Forest Service administrative appeals have recently been a focus of considerable political debate. Congressional legislation and new administrative rules to change the appeals process and exclude certain fuel reductions projects from environmental review and appeal are under consideration. Meanwhile, there has been little systematic analysis of the claims and counterclaims being put forward about the ecological, social, economic, and administrative impacts of appeals. The workshop, Designing a Framework for Evaluating the Impacts and Outcomes of Forest Service Appeals, engaged researchers, agency representatives, and various affected interests who use appeals, or are affected by their use, to discuss development of a framework by which the impacts and outcomes of Forest Service appeals can be systematically documented and analyzed. Participants identified what is important to evaluate about the appeals process, and discussed how to realistically conduct such evaluations so that results are credible to all. The purpose of the workshop was to focus research and analysis on critical issues surrounding the appeals process to better inform ongoing policy debates

A Imigração Brasileira Na França: Do Tipo Histórico às Modalidades Migratórias Contemporâneas

The current scenario of intense capital mobility has been accompanied by increasing international population displacements. Social changes experienced in recent decades have introduced greater complexity in the phenomenon of international migration, which takes place under a “new logic”, particularly the expansion of the world market, and the dispersion of industry and the production of goods and services. In this context, this article reflects on Brazilian immigration in France after 1980, considering the different migratory modalities that make up this flow. These modalities are redefining the logic of Brazil’s insertion in the international migration framework. The multifaceted character of emigration of Brazilians to France reveals that, beyond the historical linkages between the two countries, the new logic of migration on the world geopolitical scenario of this century will result in a more diversified flow of Brazilians toward France. Field research conducted in France in 2012 with eighty two Brazilians immigrants showed a diversity of migrants and migratory modalities profiles. These migratory modalities were engendered from an analysis of migratory projects and reconstructed through semi-structured interviews with immigrants. © 2016, Associacao Brasileira de Estudos Populacionais. All rights reserved.33112915

Denervação simpática renal em pacientes com cardiodesfibrilador implantável e tempestade elétrica

ResumoIntroduçãoCardiodesfibriladores implantáveis (CDIs) são geralmente indicados para pacientes com arritmias malignas considerados de alto risco. A hiperatividade simpática desempenha um papel crítico no desenvolvimento, na manutenção e no agravamento de arritmias ventriculares. Novas opções de tratamento nessa população representam uma necessidade clínica. Nosso objetivo foi relatar os resultados de pacientes com CDIs e tempestade elétrica submetidos à denervação simpática renal para controle da arritmia.MétodosOito pacientes com CDIs internados por tempestade elétrica refratária ao tratamento médico otimizado foram submetidos à denervação simpática renal. Condições subjacentes foram: doença de Chagas (n = 6), cardiomiopatia dilatada não isquêmica (n = 1) e cardiomiopatia isquêmica (n = 1). As informações sobre o número de taquicardias ventriculares/fibrilações ventriculares e episódios de terapias antitaquicardia na última semana pré‐procedimento e nos 30 dias pós‐tratamento foram obtidas por meio de interrogação dos CDIs.ResultadosAs medianas dos episódios de taquicardias ventriculares/fibrilações ventriculares, sobre‐estimulação e choques na semana que antecedeu a denervação simpática renal foram de 29 (9 a 106), 23 (2 a 94) e 7,5 (1 a 88), sendo significativamente reduzidas para 0 (0 a 12), 0 (0 a 30) e 0 (0 a 1), respectivamente, 1 mês após o procedimento (p = 0,002; p = 0,01; p = 0,003). Nenhum paciente morreu durante o acompanhamento. Não ocorreram complicações maiores relacionadas ao procedimento.ConclusõesEm pacientes com CDIs e tempestade elétrica refratária ao tratamento médico otimizado, a denervação simpática renal reduziu significativamente a carga de arritmia e, consequentemente, as sobre‐estimulações e os choques. Ensaios clínicos randomizados, no contexto de denervação simpática renal para controle de arritmias cardíacas refratárias, são necessários para trazer maior robustez aos nossos achados.AbstractBackgroundImplantable cardioverter‐defibrillators (ICDs) are usually indicated for patients with malignant arrhythmias considered as high risk. Sympathetic hyperactivity plays a critical role in the development, maintenance, and worsening of ventricular arrhythmias. New treatment options in this population represent a clinical necessity. This study's objective was to report the outcomes of patients with ICDs and electrical storm submitted to renal sympathetic denervation for arrhythmia control.MethodsEight patients with ICDs admitted for electrical storm refractory to optimal medical therapy underwent renal sympathetic denervation. Underlying diseases included Chagas disease (n = 6), non‐ischemic dilated cardiomyopathy (n = 1), and ischemic cardiomyopathy (n = 1). Information on the number of episodes of ventricular tachycardia/ventricular fibrillation and antitachycardia therapies in the week before the procedure and 30 days after treatment were obtained through interrogation of the ICDs.ResultsThe median numbers of episodes of ventricular tachycardia/ventricular fibrillation, antitachycardia pacing, and shocks in the week before renal sympathetic denervation were 29 (9 to 106), 23 (2 to 94), and 7.5 (1 to 88), and significantly reduced to 0 (0 to 12), 0 (0 to 30), and 0 (0 to 1), respectively, 1 month after the procedure (p = 0.002; p = 0.01; p = 0.003, respectively). No patients died during follow‐up. There were no major complications related to the procedure.ConclusionsIn patients with ICDs and electrical storm refractory to optimal medical treatment, renal sympathetic denervation significantly reduced arrhythmia load and, consequently, antitachycardia pacing and shocks. Randomized clinical trials in the context of renal sympathetic denervation to control refractory cardiac arrhythmias are needed to further support these findings

Impact of Routine Use of Drug-eluting Stents in Contemporary Interventional Cardiology at a Tertiary Center: One-decade Experience of the DESIRE Registry

ABSTRACTBackgroundDrug-eluting stents (DES) have changed contemporary interventional cardiology practice, enabling the approach of increasingly more complex clinical and angiographic scenarios. The objective of this study was to demonstrate the changes observed in the last 10 years in the indication and practice of percutaneous coronary intervention (PCI) at a tertiary private hospital in the State of São Paulo.MethodsDESIRE is a single-center prospective registry aiming at following the acute and late outcomes of consecutive patients treated by DES.ResultsFrom 2002 to 2011, 4,299 patients were included, with mean age of 64.3±11.2years, 23% were female and 30.5 were diabetic. The total number of lesions treated was 6,518 of which 61.5% were type B2/C. During the course of the study, DES were progressively more used, reaching a penetration of 88.4% in 2011. The complexity of PCIs has increased and in the past year 1.76 lesions per patient were treated with an average of 1.89 DES. The SYNTAX score increased from 12.3±4.4 (2002-2006) to 15.7±4.7 (2007-2011). Clinical follow-up was obtained in 98.2% of the patients, with a median of 5.2years, and during this period target-lesion revascularization rate was 5%, myocardial infarction was 6.7% and cardiovascular death was 4.1%. Stent thrombosis was observed in 2.4% of the cases.ConclusionsOur results showed a marked increment in the complexity profile of patients treated in the last 10 years and at the same time confirm the long-term effectiveness of DES, despite the clinical and angiographic profile of patients

Impact of Side Branch Predilation on Percutaneous Coronary Intervention in Complex Coronary Bifurcation Lesions

ABSTRACTBackgroundThe treatment of coronary bifurcation lesions with single stenting in the main vessel and provisional side branch stenting may be limited by the degree of anatomical/morphological complexity. Side branch predilation, a procedural step that is typically avoided, may be required to maintain side branch patency. The impact of side branch predilation on the immediate results of percutaneous coronary intervention in complex coronary bifurcation lesions was investigated.MethodsBetween May, 2008 and August, 2009, 59 patients with single coronary bifurcation lesions and significant involvement of the main and side branches were included in the study. The main exclusion criteria were the involvement of the left main coronary artery, ST-elevation acute myocardial infarction (< 72 hours) and in-stent restenosis.ResultsThe mean age of patients was 61.2±11 years, 25.4% were female, and 30.1% had diabetes mellitus. Lesions were most prevalent in the left anterior descending artery/diagonal branch (86.4%). During the procedure, 8.5% (5/59) of lesions had unsuccessful side branch predilation, and four of these bifurcations were treated with two stents. In the multivariate model, side branch stenosis at baseline was the only significant predictor of unsuccessful side branch predilation (odds ratio 1.15, 95%CI: 1.01–1.30; P=0.04), and side branch stenosis > 87.6% was identified as the most accurate cut-off value to predict failure in the receiver operating characteristic (ROC) curve.ConclusionsSide branch predilation was associated with immediate side branch failure in < 10% of cases, and the only significant predictor in the multivariate model was side branch stenosis severity (> 85%) at baseline