The Green Infrastructure Transect: An Organizational Framework for Mainstreaming Adaptation Planning Policies

When considering the range of spatial planning actions that cities can take to adapt to climate change, many of them fall under the conceptual umbrella of green infrastructure (GI). GI has been defined as the spatial planning of landscape systems at multiple scales and within varying contexts to provide open space, safeguard natural systems, protect agricultural lands, and ensure ecological integrity for cultural, social, and ecosystem benefits (Benedict andMcMahon, Renew Resour J 20:12–17, 2002, Green infrastructure: linking landscape and communities. Island Press,Washington, DC, 2006; Ahern, Cities of the future. IWA Publishing, London, 2008). While the traditional definition of GI refers to areas of land that are least intervened by human action, in this expanded definition, we are deliberately including areas that are engineered to mimic natural processes and which provide cost-effective ecosystem services. Although climate adaptation is a fairly new policy goal for GI (Gill et al., Built Environ 33(1):115–133, 2007; CCAP, http://www.ccap.org/docs/resources/989/Green Infrastructure FINAL.pdf, 2011), three key characteristics qualify GI as a suitable tool for adaptation planning including multifunctionality (to match ecosystem benefits with adaptation needs), multi-scalar nature of the spatial elements, and a ‘no-regrets approach’. However, GI needs to be matched to the character of the urban environment and coordinated across jurisdictions and planning scales to become an effective adaptation policy. In this chapter, we present a policy framework, the green infrastructure transect, that can help planners and policymakers identify appropriate GI policies for different urban environments and describe how these policies can create a regional adaptation planning framework

International eDelphi Study to Reach Consensus on the Methotrexate Dosing Regimen in Patients With Psoriasis

Importance: A clear dosing regimen for methotrexate in psoriasis is lacking, and this might lead to a suboptimal treatment. Because methotrexate is affordable and globally available, a uniform dosing regimen could potentially optimize the treatment of patients with psoriasis worldwide. Objective: To reach international consensus among psoriasis experts on a uniform dosing regimen for treatment with methotrexate in adult and pediatric patients with psoriasis and identify potential future research topics. Design, Setting, and Participants: Between September 2020 and March 2021, a survey study with a modified eDelphi procedure that was developed and distributed by the Amsterdam University Medical Center and completed by 180 participants worldwide (55 [30.6%] resided in non-Western countries) was conducted in 3 rounds. The proposals on which no consensus was reached were discussed in a conference meeting (June 2021). Participants voted on 21 proposals with a 9-point scale (1-3 disagree, 4-6 neither agree nor disagree, 7-9 agree) and were recruited through the Skin Inflammation and Psoriasis International Network and European Academy of Dermatology and Venereology in June 2020. Apart from being a dermatologist/dermatology resident, there were no specific criteria for participation in the survey. The participants worked mainly at a university hospital (97 [53.9%]) and were experienced in treating patients with psoriasis with methotrexate (163 [91.6%] had more than 10 years of experience). Main Outcomes and Measures: In a survey with eDelphi procedure, we tried to reach consensus on 21 proposals. Consensus was defined as less than 15% voting disagree (1-3). For the consensus meeting, consensus was defined as less than 30% voting disagree. Results: Of 251 participants, 180 (71.7%) completed all 3 survey rounds, and 58 participants (23.1%) joined the conference meeting. Consensus was achieved on 11 proposals in round 1, 3 proposals in round 2, and 2 proposals in round 3. In the consensus meeting, consensus was achieved on 4 proposals. More research is needed, especially for the proposals on folic acid and the dosing of methotrexate for treating subpopulations such as children and vulnerable patients. Conclusions and Relevance: In this eDelphi consensus study, consensus was reached on 20 of 21 proposals involving methotrexate dosing in patients with psoriasis. This consensus may potentially be used to harmonize the treatment with methotrexate in patients with psoriasis. © 2022 American Medical Association. All rights reserved