Connecting the Dots: Quality, Antitrust, and Medicine

Antitrust applies to healthcare. Questioning the wisdom of this universal truth, medical professionals actively insisted and still insist on professional discretion, self-regulations and other practices that violate the antitrust laws. What do medical professionals aim to achieve by resisting the application of antitrust into their profession? What do antitrust enforcers aim to achieve by applying antitrust law to the medical profession? The answer is simple. Among others, both antitrust enforcers and medical professionals aim to ensure quality. Interestingly, albeit their goal is identical, their approach is different. Why? This essay explores this enigma by analyzing some seminal healthcare antitrust cases. It concludes that the U.S. antitrust enforcers by remaining faithful to the narrative that, the more the available choices, the better the quality, miss a crucial point: that the quality of medical treatment also depends on non-economic values such as the notions of safety and trust, essential features of the therapeutic enterprise. This essay proposes that the antitrust enforcers should extend the notion of healthcare quality when they apply antitrust law in the healthcare sector so that this notion encompasses the multiple facets of healthcare quality and the ethical values the doctor - patient relationship crucially depends on. Adopting an alternative, less myopic, approach would allow the antitrust enforcers to create an analytical framework under which the multiple dimensions of healthcare quality could be balanced against harm to competition. More importantly, it would ensure that antitrust enforcers and medical associations do not continuously struggle to impose their own views on what the prevailing facets of healthcare quality should be. In Donabedian’s language, an alternative approach would ensure that all functions of the health system commit to the quality goals that the system as a whole pursues

Keynote speech: Directions in Space Syntax. Space Syntax modelling of pedestrian flows for sustainable urban development

Modelling pedestrian flows has been one of the main directions of Space Syntax since its introduction,but what we see in the last years is that it has also become a central interdisciplinary objective withinthe Sustainable Development research agenda. The agenda calls for promotion of sustainable mobility(i.e. walking, cycling, public transport) and a clear shift from car-oriented development. There is anacknowledged need in the broader fields of urban development to model pedestrian flows: to explainand assess the functioning of existing built environments, to predict future situations and assistscenario analysis when planning new areas and infrastructural changes and support decision-making.The keynote argues that Space Syntax can claim expertise for this emerging interdisciplinary field ofstudy, having built a relevant and comprehensive theoretical and methodological framework andhaving provided sufficient and solid empirical evidence that it is an appropriate methodology to modelpedestrian flows. What is more, it is perfectly aligned with the main tenets of SustainableDevelopment. The keynote continues to lay out the opportunities created for Space Syntax research bythe Sustainable Development research agenda, but also the needs for further development. Usingrecent and current projects from the Spatial Morphology Group (SMoG) at Chalmers University ofTechnology, three research priorities are identified and exemplified further

A SYSTEMATIC REVIEW OF MULTIFUNCTIONAL STREETS_Final research report

A state-of-the-art, quantitative systematic review of scientific literature on the theme of multifunctional streets was conducted, including scientific papers of the last 10 years, filtered from Web of Science and Scopus. The review is part of a 3-year research project (2019-2021) named: “Smart streets” (Smarta gator) led by Alexander St\ue5hle (KTH Royal Institute of Technology) and financed by Vinnova (Swedish governmental agency for Innovation systems). The research project aims to develop a Street Multifunctionality Index (Gatufunktionsindex) to assess how existing and designed streets combine five different street functions - Social, Ecologic, Economic, Technical and Traffic - and also produce design guidelines for the design and planning of future multifunctional streets, either in new infrastructure or via retrofits. Within this project, the aim of the systematic review is twofold: first, to assess the degree in which the multifunctionality of streets is addressed in recent literature and provide an overview of the field by identifying where the general literature on the subject is trending, which are the recurrent issues studied, what themes are missing or being understudied; second, since an end product of the research project is to provide guidelines for urban design and planning practice, the review aims to identify the physical factors which have been empirically proven to support the different street functions, and especially those which support multiple functions. The second aim is pursued through focused thematic reviews, which complement the general overview of the field

A systematic review of the scientific literature on the theme of multifunctional streets

Cities consist of 20-30% streets, a gigantic infrastructure that must be maintained and\ua0developed. As such, they have the potential to contribute to tackling contemporary challenges as\ua0the increasing urbanization and climate change which place higher demands on urban\ua0environments, from quality of life, health and safety to environmental sustainability.\ua0Multifunctional streets are introduced as an answer to these challenges, as they can fulfil this\ua0multitude of functions. This paper presents a state-of-the-art, quantitative systematic review of\ua0scientific literature on the theme of multifunctional streets. Scientific papers were filtered from\ua0Web of Science and Scopus. Only scientific papers of the last 10 years were included. We will\ua0first present a survey of the field and then focus on the empirical papers that help us identify the\ua0physical factors which have been proven to support and improve the different functions of streets,\ua0from the social and ecologic to the economic and technical. The empirical studies represent 24%\ua0of the scientific papers selected, where the social function is the one most frequently studied,\ua0followed by the ecologic and the economic function. Within the social function the empirical\ua0papers in relation to health (39%) and safety (21%) dominate, followed by the ones studying\ua0liveability (9%). We will focus on empirical studies on the themes of Liveability and Safety, two\ua0important variables of the Social function, interrelating yet often conflicting

Simplified geodata models for integrated urban and public transport planning

The current division between urban and transport planning is a significant obstacle to achieving sustainable urban development. To transform cities towards sustainability, both fields must adopt shared or at least compatible models of the urban systems, namely transport, street and public space networks for all users and urban activities. Although several models and tools have emerged in recent years to facilitate this integration, there are still usability gaps that hinder their wider adoption. One of the gaps is a lack of flexibility to operate at different stages of integrated planning. To address this gap, the study aims to develop a set of aligned and flexible multimodal urban network models and tools to support different stages of planning. This paper focuses on the public transport geodata models, which were built by aggregating a General Transit Feed Specification (GTFS) dataset at various spatial and temporal levels. The aggregation levels range from a baseline data model that is useful for detailed planning stages, up to a topological data model that is suitable for macro scale and strategic planning. By using this unified set of models, the dialogue between the two fields at different integrated planning phases can be facilitated, and decision-making can be enhanced

Urban Calculator

Major steps have in recent decades been taken when it comes to understanding how cities work. Essential is the change from understanding cities as locations to understanding them as flows (Batty 2013). In principle this means that we need to understand locations (or places) as defined by flows (or different forms of traffic), rather than locations only served by flows. This implies that we need to understand the built form and spatial structure of cities as a system, that by shaping flows creates a series of places with very specific relations to all other places in the city, which also give them very specific performative potentials. It also implies the rather fascinating notion that what happens in one place is dependent on its relation to all other places (Hillier 1996). Hence, to understand the individual place, we need a model of the city as a whole.Extensive research in this direction has taken place in recent years, that has also spilled over to urban design practice, not least in Sweden, where the idea that to understand the part you need to understand the whole is starting to be established. With the Urban Calculator that we present here, we take a important leap towards integrating this knowledge in the daily practice of urban designers and other professionals active in urban development. The objective of this project is to provide a user-friendly software that allows for effective knowledge transfer. The software will support the evaluation of different urban scenario’s as well as mirror these against a references database. The project is expected to impact decision making in urban development projects, especially during the initial phases

PHILANTHROPIC FOUNTAIN OF KORNAROU SQUARE: USING SFM TO CALCULATE THE FOUNTAIN’S GEOMETRIC CHARACTERISTICS IN ORDER TO DETERMINE ITS INELASTIC DYNAMIC RESPONSE

[EN] This paper proposes the use of Structure from Motion (SfM) techniques to survey inaccessible monument structures and presents its application on capturing Kornarou Square's philanthropic fountain in Heraklion, Crete. A series of aerial and terrestrial photos of the fountain were combined in order to build the 3D geometry of the monument using Agistoft's Photoscan. This 3D model was used to study the dynamic behavior of the fountain. Its response was determined through multiple inelastic dynamic analyses. The analysis results were summarized in the average dynamic curveLiratzakis, A.; Parthenios, P.; Stavroulaki, M. (2016). PHILANTHROPIC FOUNTAIN OF KORNAROU SQUARE: USING SFM TO CALCULATE THE FOUNTAIN’S GEOMETRIC CHARACTERISTICS IN ORDER TO DETERMINE ITS INELASTIC DYNAMIC RESPONSE. En 8th International congress on archaeology, computer graphics, cultural heritage and innovation. Editorial Universitat Politècnica de València. 472-476. https://doi.org/10.4995/arqueologica8.2015.4167OCS47247

CLASSIFICATION OF BUILDING STONES OF THE FRANGOKASTELLO CASTLE, SFAKIA, CRETE

Το Φραγκοκάστελλο είναι μεσαιωνικό κάστρο που χτίστηκε στο διάστημα 1371-74 από τους Βενετούς σε μια στενή παράκτια ζώνη στο νοτιοανατολικό τμήμα των Λευκών Όρεων, περίπου 12 χιλιόμετρα ανατολικά της Χώρας Σφακίων. Αυτό το τμήμα χαρακτηρίζεται από ένα έντονο μορφολογικό ανάγλυφο που η δημιουργία του καθορίστηκε από την κινητικότητα κανονικών ρηγμάτων με γενικές διευθύνσεις Α-Δ, ΒΒΑ- ΝΝΔ και ΒΒΔ-ΝΝΑ. Την περιοχή ενδιαφέροντος δομούν επιφανειακά ακολουθίες (κυρίως θαλάσσιες) του Τορτονίου, του Κάτω Πλειοκαίνου και του Κατώτερου Πλειστόκαινου. Από το Μέσο Πλειστόκαινο πολλαπλές συμφύσεις αλλουβιακών ριπιδίων κάλυψαν τόσο το αλπικό υπόβαθρο της ευρύτερης περιοχής που αποτελείται από τα μεταμορφωμένα πετρώματα της Ομάδας των Πλακωδών Ασβεστολίθων, της ενότητας Τρυπαλίου και της Φυλλιτικής Χαλαζιακής Σειράς καθώς και τους νεότερους σε ηλικία σχηματισμούς. Στρογγυλωμένα και γωνιώδη κλάσματα πετρωμάτων των αλπικών αλλά και μεταλπικών σχηματισμών που μεταφέρθηκαν και αποτέθηκαν εντός των διαφόρων τμημάτων των αλλουβιακών ριπιδίων αποτέλεσαν τους δομικούς λίθους για της κατασκευή του κάστρου. Το μικροκλίμα της περιοχής και η έντονη τεκτονική δραστηριότητα που σχετίζεται με σχετικά υψηλούς ρυθμούς ανύψωσης των ρηξιτεμαχών στην περιοχή, επηρέασαν καθοριστικά όχι μόνο την στατική του κάστρου αλλά και την αντοχή στην αποσάθρωση των δομικών του λίθων μετά την φυσική αποψίλωση μεγάλων τμημάτων του κονιάματος του εξωτερικού της τοιχοποιίας. Με βάση τα ανωτέρω στόχος της εργασίας αυτής αποτέλεσε αρχικά η συλλογή βιβλιογραφικών δεδομένων σχετικών με την στρωματογραφία και τεκτονική της περιοχής. Τα αποτελέσματα που προέκυψαν συνδυαζόμενα με τα αποτελέσματα από την καταμέρηση και στατιστική επεξεργασία των διαφόρων λιθολογικών τύπων των δομικών υλικών του κάστρου μπορούν να αποτελέσουν δεδομένα εισαγωγής μοντέλων στατικό τητας, στα πλαίσια των προτάσεων συντήρησης και αποκατάστασης του μνημείου.Frangokastello is a medieval castle which was built by the Venetians in 1371-74 in a narrow coastal zone at the southeastern part of the White Mountains, approximately 12 km east of Chora Sfakion. The region around Frangokastello characterized by a strong morphological relief, which was formed by activity of normal faults striking E-W, NNESSW and NNW-SSE. The region of interest has covered at the surface from sequences mainly marine sediments of Τortonian, Low Pliocene and Lower Pleistocene. From the Middle Pleistocene multiple alluvial fans have been cover the alpine basement of the region which consists from metamorphic rocks of the Plattenkalk Group, Trypali Unit and Phyllite Quartzite Series as well the youngest in age formations. Rounded and angular fragments of rock materials from alpine and post alpine formations transported and deposited within the various parts of alluvial fan which had deposited over the Frangokastello formation, constituted the building stones for the construction of the castle. The microclimate of the region and the intense tectonic activity associated with relatively high rates of uplift of the tectonic segments in the region, has critically affect not only the static of the castle but also the resistance from the weathering of building stones after physical dismantling large parts of the binding cement and surface from outer wall. On the basis of the above, the objective of this work is initially the collection of bibliographic data related to the stratigraphy and tectonics of the region. The results obtained, combined with the results from counting and statistical processing of various lithological types of building materials of the castle can be considered input data to form static models, in the framework of proposals for maintenance and restoration of the monument

Empirical support for a theory of spatial capital: Housing prices in Oslo and land values in Gothenburg

Land is, besides labour and capital, one of the classic production factors in economic theory. However, neoclassical economics dominating the 20thcentury, simplified production theory to only labour and capital, treating land either as just another form of capital or as the natural resources it harbours. This hides the central role of land – in the meaning of spatial extension and location – for contemporary economies, where land rent is an essential cost and location a productive factor for most economic activities, not least since these increasingly are located in cities. Critical here is the confusion often found concerning property values and the distinction between land and improvements, the latter most often constituted by buildings, where buildings quite naturally can be treated as capital, while land cannot. Importantly, while property value can be increased by its owner through improvements, such as new buildings, she is very limited in influencing the land value, since this is a collective variable dependent on the economic development of the city as a whole. It is here proposed that improvements on land in contemporary urbanised economies to a dominant degree concern systems of centrality and accessibility generating relative locations, that are further enhanced by buildings and land division, and that this constitutes what is proposed to be called a spatial capital, which to a large degree is created through the practices of urban planning and design.In this paper we investigate the dependency of spatial form on land value. First, we review how spatial form and the configurations of accessibility it generates on land, influences housing prices to find support for the intimate relationship between relative location and monetary market values. Second, we investigate the dominance of land values compared to improvement values in four Swedish cities of different size Third, we investigate how known parameters of spatial form correlates with land values in Gothenburg, Sweden. We see close associations between spatial form and land values, both in shape of market housing prices and as property taxation values. Land value holds a larger share of total property taxation value in larger cities, suggesting that relative location is valued higher where economic activity is greater. Furthermore, we find clear correlations between spatial form and land taxation values. Altogether, these findings indicate that spatial capital encompasses monetary value. In extension, these findings also indicate how knowledge based and skilful urban planning and design can create measurable value