Understanding variation in impacts from private protected areas across regions and protection mechanisms to inform organizational practices.

Private land protection is an important and growing tool to address biodiversity loss and climate change. Thus, better empirical evidence on the effectiveness of private land protection and organizational practices, such as targeting of lands for protection and choice of protection mechanism (i.e., fee simple land acquisition and conservation easements), is needed. We addressed this gap by estimating the impacts of The Nature Conservancy's (TNC) (a large nongovernmental organization with relatively decentralized management) conservation land acquisitions and easements from 1988 to 2016 in three regions of the United States (Mid-Atlantic, New England and New York, and California). We estimated impact in terms of avoided conversion by comparing natural land cover on 3179 protected parcels with matched unprotected parcels. Nineteen of 21 ecoregional plans used threats of agriculture and development to identify priorities for protection. When regions and protection mechanisms were pooled, on average there was no evidence of avoided conversion from 1988 to 2016. Accounting for mechanisms, TNC land acquisitions avoided conversion and easements did not. TNC's easements on parcels acquired by conservation partners did avoid conversion. Limitations of these results include focus on a single measure of impact, inability to capture future avoided conversion, and low land cover change accuracy in California. Our results suggest that private land protection managers who seek to avoid land conversion in the near to medium term should increase focus on areas with higher threats. Special attention should be paid to strengthening accountability and the role of partners, improving or clarifying how easements are used, and facilitating the flow of resources to work with the greatest potential impact.

Comprensión de la variación en el impacto de las áreas protegidas privadas sobre las regiones y los mecanismos de protección para guiar las prácticas organizativas Resumen La protección de terreno privado es una herramienta importante, aunque su naturaleza voluntaria puede sesgar la protección hacia parcelas menos amenazadas­lo que resulta en que la conversión no se evite o se evite muy poco. Además, muchos programas de protección privada tienen una supervisión limitada y pocos reportes de sus resultados. Por lo tanto, se necesitan mejores evidencias empíricas de la efectividad de la protección en suelo privado y las prácticas organizativas, como el enfoque en tierras para protección y la selección de los mecanismos de protección (adquisición de terrenos a título oneroso y servidumbres de conservación). Abordamos esta brecha con la estimación de impactos de las adquisiciones de suelo de The Nature Conservancy (TNC, una gran organización no gubernamental con un manejo relativamente descentralizado) y las servidumbres implementadas entre 1988 y 2016 en tres regiones de los Estados Unidos: Atlántico Medio, Nueva Inglaterra y Nueva York, y California. Estimamos el impacto en términos de la conversión que se evitó al comparar la cobertura de suelo en 3,179 parcelas protegidas con parcelas desprotegidas equivalentes. Diecinueve de los 21 planes eco­regionales usaron las amenazas a la agricultura y al desarrollo para identificar las prioridades de protección. Cuando agrupamos las regiones y los mecanismos de protección, en promedio no hubo impacto alguno. Si se consideran los mecanismos, las adquisiciones de suelo de la TNC tuvieron un impacto mientras que las servidumbres no. Las servidumbres de la TNC en las parcelas adquiridas por socios de conservación sí tuvieron un impacto, aunque esta manera de proteger sólo se presentó en las regiones del Atlántico Medio y de Nueva Inglaterra y Nueva York. Nuestros resultados sugieren que la protección privada, especialmente mediante servidumbres, puede estar sesgada hacia suelos no amenazados. Los gestores que buscan evitar la conversión del suelo a mediano o corto plazo deberían enfocarse más en las áreas con más amenazas. Se debería prestar especial atención al fortalecimiento del papel y las responsabilidades de los socios, a la mejora o aclaración de cómo se usan las servidumbres y la facilitación del flujo de recursos para trabajar con el mayor impacto potencial.

No Evidence of Disease Activity (NEDA) as a Clinical Assessment Tool for Multiple Sclerosis: Clinician and Patient Perspectives [Narrative Review].

The emergence of high-efficacy therapies for multiple sclerosis (MS), which target inflammation more effectively than traditional disease-modifying therapies, has led to a shift in MS management towards achieving the outcome assessment known as no evidence of disease activity (NEDA). The most common NEDA definition, termed NEDA-3, is a composite of three related measures of disease activity: no clinical relapses, no disability progression, and no radiological activity. NEDA has been frequently used as a composite endpoint in clinical trials, but there is growing interest in its use as an assessment tool to help patients and healthcare professionals navigate treatment decisions in the clinic. Raising awareness about NEDA may therefore help patients and clinicians make more informed decisions around MS management and improve overall MS care. This review aims to explore the potential utility of NEDA as a clinical decision-making tool and treatment target by summarizing the literature on its current use in the context of the expanding treatment landscape. We identify current challenges to the use of NEDA in clinical practice and detail the proposed amendments, such as the inclusion of alternative outcomes and biomarkers, to broaden the clinical information captured by NEDA. These themes are further illustrated with the real-life perspectives and experiences of our two patient authors with MS. This review is intended to be an educational resource to support discussions between clinicians and patients on this evolving approach to MS-specialized care.

Recent progress in multiple sclerosis (MS) has led to the development of new treatments, known as high-efficacy therapies. Compared with previous treatments, high-efficacy therapies are better at managing visible inflammation of the central nervous system, a main cause of worsening symptoms early on in people living with MS. Treatment with high-efficacy therapies means many people with MS may achieve better outcomes than previously possible. One such outcome is the set of criteria known as no evidence of disease activity (NEDA). Achieving NEDA-3, the most commonly used NEDA criteria, means that people exhibit no clinical relapses, no worsening of physical symptoms, and no visible disease activity on a magnetic resonance imaging scan. Researchers have studied NEDA as an outcome in MS clinical trials, but it may be useful in clinical practice as a tool for doctors to measure a person's disease progression and response to treatment. This could help to inform important decisions around treatment selection and improve overall care for people with MS. This review explores the available information about NEDA to understand its potential to support clinical decision-making and patient evaluations. We discuss the barriers to NEDA being used in clinical practice and the ways the criteria may change to capture a broader range of clinical information from the patient. These topics are presented alongside the real-life perspectives and experiences of our two patient authors with MS. This review is meant to be an educational resource to assist conversations about NEDA between clinicians and patients in everyday clinical practice.