A New Field Protocol for Monitoring Forest Degradation

Forest degradation leads to the gradual reduction of forest carbon stocks, function, and biodiversity following anthropogenic disturbance. Whilst tropical degradation is a widespread problem, it is currently very under-studied and its magnitude and extent are largely unknown. This is due, at least in part, to the lack of developed and tested methods for monitoring degradation. Due to the relatively subtle and ongoing changes associated with degradation, which can include the removal of small trees for fuelwood or understory clearance for agricultural production, it is very hard to detect using Earth Observation. Furthermore, degrading activities are normally spatially heterogeneous and stochastic, and therefore conventional forest inventory plots distributed across a landscape do not act as suitable indicators: at best only a small proportion of plots (often zero) will actually be degraded in a landscape undergoing active degradation. This problem is compounded because the metal tree tags used in permanent forest inventory plots likely deter tree clearance, biasing inventories toward under-reporting change. We have therefore developed a new forest plot protocol designed to monitor forest degradation. This involves a plot that can be set up quickly, so a large number can be established across a landscape, and easily remeasured, even though it does not use tree tags or other obvious markers. We present data from a demonstration plot network set up in Jalisco, Mexico, which were measured twice between 2017 and 2018. The protocol was successful, with one plot detecting degradation under our definition (losing greater than 10% AGB but remaining forest), and a further plot being deforested for Avocado (Persea americana) production. Live AGB ranged from 8.4 Mg ha–1 to 140.8 Mg ha–1 in Census 1, and from 0 Mg ha–1 to 144.2 Mg ha–1 Census 2, with four of ten plots losing AGB, and the remainder staying stable or showing slight increases. We suggest this protocol has great potential for underpinning appropriate forest plot networks for degradation monitoring, potentially in combination with Earth Observation analysis, but also in isolation

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Comparison of international normalized ratio audit parameters in patients enrolled in GARFIELD-AF and treated with vitamin K antagonists

Vitamin K antagonist (VKA) therapy for stroke prevention in atrial fibrillation (AF) requires monitoring of the international normalized ratio (INR). We evaluated the agreement between two INR audit parameters, frequency in range (FIR) and proportion of time in the therapeutic range (TTR), using data from a global population of patients with newly diagnosed non-valvular AF, the Global Anticoagulant Registry in the FIELD\u2013Atrial Fibrillation (GARFIELD-AF). Among 17\ua0168 patients with 1-year follow-up data available at the time of the analysis, 8445 received VKA therapy (\ub1antiplatelet therapy) at enrolment, and of these patients, 5066 with 653 INR readings and for whom both FIR and TTR could be calculated were included in the analysis. In total, 70\ua0905 INRs were analysed. At the patient level, TTR showed higher values than FIR (mean, 56\ub70% vs 49\ub78%; median, 59\ub77% vs 50\ub70%). Although patient-level FIR and TTR values were highly correlated (Pearson correlation coefficient [95% confidence interval; CI], 0\ub7860 [0\ub7852\u20130\ub7867]), estimates from individuals showed widespread disagreement and variability (Lin's concordance coefficient [95% CI], 0\ub7829 [0\ub7821\u20130\ub7837]). The difference between FIR and TTR explained 17\ub74% of the total variability of measurements. These results suggest that FIR and TTR are not equivalent and cannot be used interchangeably