Towards urban resilience through Sustainable Drainage Systems: A multi-objective optimisation problem.

The necessity of incorporating a resilience-informed approach into urban planning and its decision-making is felt now more than any time previously, particularly in low and middle income countries. In order to achieve a successful transition to sustainable, resilient and cost-effective cities, there is a growing attention given to more effective integration of nature-based solutions, such as Sustainable Drainage Systems (SuDS), with other urban components. The experience of SuDS integration with urban planning, in developed cities, has proven to be an effective strategy with a wide range of advantages and lower costs. The effective design and implementation of SuDS requires a multi-objective approach by which all four pillars of SuDS design (i.e., water quality, water quantity, amenity and biodiversity) are considered in connection to other urban, social, and economic aspects and constraints. This study develops a resilience-driven multi-objective optimisation model aiming to provide a Pareto-front of optimised solutions for effective incorporation of SuDS into (peri)urban planning, applied to a case study in Brazil. This model adopts the SuDS's two pillars of water quality and water quantity as the optimisation objectives with its level of spatial distribution as decision variables. Also, an improved quality of life index (iQoL) is developed to re-evaluate the optimal engineering solutions to encompass the amenity and biodiversity pillars of SuDS. Rain barrels, green roofs, bio-retention tanks, vegetation grass swales and permeable pavements are the suitable SuDS options identified in this study. The findings show that the most resilient solutions are costly but this does not guarantee higher iQoL values. Bio-retention tanks and grass swales play effective roles in promotion of water quality resilience but this comes with considerable increase in costs. Permeable pavements and green roofs are effective strategies when flood resilience is a priority. Rain barrel is a preferred solution due to the dominance of residential areas in the study area and the lower cost of this option.

Missed opportunities in the way medical schools evaluate the ethical domain in clerkship rotations.

BACKGROUND: Several lines of evidence indicate that medical schools have been failing to adequately nurture empathy and the ethical dimension in their graduates, the lack of which may play a central role in the genesis of medical errors, itself a major source of avoidable deaths, incapacity and wasted resources. It has been widely proposed that medical schools should adopt evaluation strategies as a means to promote a culture of respectful relationships. However, it is not clear if evaluation strategies in medical schools have addressed key domains related to that aim, such as ethics, through the perspective of their students. Hence, we conducted a national survey of instruments used by Brazilian medical schools to assess clerkship rotations from the perspective of students, with a main focus on the ethical domain. METHODS: The authors invited 121 randomly selected institutions to participate in the study. Key informants answered a questionnaire about clerkship rotations and sent copies of any instrument used to assess the quality of clerkship rotations according to the students' perspectives. RESULTS: Twenty-six (53%) of 49 participating schools used an instrument to assess the quality of clerkship rotations according to the perspective of students. Just 13 (27%) schools had instruments containing at least one question encompassing the ethical domain. Only 2 (4%) schools asked students specifically about the occurrence of any negative experience concerning the ethical domain during rotations. Merely 1 (2%) school asked students about having witnessed patient mistreatment and none asked about mistreatment against students themselves. CONCLUSIONS: There are several missed opportunities in the way medical schools assess the quality of clerkship rotations regarding the ethical domain. Closing the gap between usual institutional discourses regarding ethics and how that dimension is assessed within clerkship rotations might represent an important step towards the improvement of medical education and healthcare systems.