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This is the latest story from the NPR Cities Project.

In an abandoned building near Spain's Mediterranean coast, someone softly strums a guitar. Chord progressions echo through empty halls.

It's an impromptu music lesson, offered among unemployed neighbors in Alfafar, a suburb south of Valencia. The town was built in the 1960s for timber factory workers. It's high-density housing: tidy, identical two- and three-bedroom apartments, in huge blocks — some 7,000 housing units in total.

But the local timber industry has since collapsed. More than 40 percent of local residents are now unemployed. A quarter of homes are vacant. Apartments that sold for $150,000 decades ago, are going for just $20,000 now.

That guitar lesson is just one way residents are using their free time and empty space creatively. And it's here that two young Spanish architects saw potential.

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The Improvistos architects' plans involve revamping the apartments, with minimal structural changes. Neighbors would be able to trade rooms, and share kitchens, roof gardens and office space. Improvistos hide caption

itoggle caption Improvistos

The Improvistos architects' plans involve revamping the apartments, with minimal structural changes. Neighbors would be able to trade rooms, and share kitchens, roof gardens and office space.

Improvistos

While still in architecture school, Mara Garca Mendez and Gonzalo Navarrete drafted a plan to re-design a high-density area of Alfafar, called Barrio Orba, using the principle of co-housing — in which residents trade and share space and resources, depending on their needs.

"It's like up-cycling the neighborhood — connecting existing resources to make them work," Garca explains. "For example, all this work force that's unemployed, all these empty spaces that are without use, all these elderly people that need help, all these natural resources that are not being taken care of — making a project for all these things."

Through their architecture startup Improvistos, Garca and Navarrete submitted their Orba design to U.N. Habitat, a United Nations agency holding a competition for urban mass housing. And they won.

Redefining Public And Private Space

The architects, both in their 20s, were relatively unknown, working in a Spanish region — Valencia — that's famous for soaring space-age designs of museums and other public infrastructure — which have bankrupted the local government.

Valencia's native son is Santiago Calatrava, the famous Spanish architect who's now working on the new Ground Zero transit station in New York.

In contrast to Calatrava's work, the Improvistos architects sketched out a humble plan to revamp some 7,000 nearly identical apartments, with minimal structural changes, to adapt the current structures to residents' changing spatial needs. Neighbors can trade rooms, and share kitchens, roof gardens and office space.

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Architects Mara Garca Mendez and Gonzalo Navarrete sketch out plans to revitalize high-density urban housing in Alfafar, Spain. Courtesy of Improvistos hide caption

itoggle caption Courtesy of Improvistos

Architects Mara Garca Mendez and Gonzalo Navarrete sketch out plans to revitalize high-density urban housing in Alfafar, Spain.

Courtesy of Improvistos

"We're trying to redefine the limit between public and private," Navarrete says. "So the way you walk on your street, and where your house and your private space finishes or starts."

"A thing as simple as creating a new door — having a room with two doors — can give enormous flexibility," Garca chimes in. "So that this same room can be used by one or another, depending on the need."

Their plan also has a time bank element, trading space for services.

"For example, you have an 80-year-old person who needs some help once or twice a week, [living alongside] a family with three children that doesn't get enough income," Garca explains. "So maybe [someone from] the low-income family can help the elderly person once a week, and get, in exchange, one room. It's like an exchange system — so every house can gain or give out some space. And that can change with time."

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About 15 people live at the Threshold Center at Cole Street Farm, a shared living space in the Dorset countryside. Ari Shapiro/NPR hide caption

itoggle caption Ari Shapiro/NPR

About 15 people live at the Threshold Center at Cole Street Farm, a shared living space in the Dorset countryside.

Ari Shapiro/NPR

The Improvisto architects in Alfafar plan to sit down with residents and sketch out how their buildings can adapt to different families' needs. They can add doors, retractable walls and shared space.

Garca and Navarrete, the Spanish architects, came up with the idea on a study trip to rural India — watching how a poor family would enlarge their thatched hut for new children, and share cooking areas with neighbors. The architects think that system can work in the Western world as well.

Collective Living In Rural England

One place it's already working is on England's southwest coast, amid picturesque rolling fields. A decade ago, Jane Stott helped create the Threshold Center at Cole Street Farm, a community that consists of a central 300-year-old farmhouse surrounded by small, low houses and about 15 residents.

The goal here is quite different from in Spain: This isn't about revitalizing an existing neighborhood. It's about creating something new. People have come to the Threshold Center for a variety of reasons, ranging from a desire to live in an environmentally sustainable way to the meditative aspects of living with others.

There are some echoes of life on a commune at the Threshold Center, where there's an optional group meditation each morning and the residents raise chickens.

But everyone also has a day job: among the residents are a nurse, a gardener and a social worker, for instance.

More broadly speaking, each co-housing community is different: Some are very religious; some are very environmentally friendly; some have lots of children; some have lots of seniors.

And the movement is growing: Stott says that when she founded the Threshold Center 10 years ago, she could count on one hand the number of British co-housing arrangements. Now there are more than 35.

Real Solutions For Real People

But the idea is a newer one in Spain, and residents in Alfafar have many questions. Over a traditional Valencia paella, residents of the Orba neighborhood discuss the plan. Some ask, how would the value of a home change, with the addition or subtraction of a room?

But in general they say they're intrigued by the plan — and flattered that the two architects chose their neighborhood for it. Most of Orba's residents have been living side-by-side for decades. They're not strangers.

Take Nacho Campillo and Patricia "Patri" Sanchez, a couple in their early 30s. They've lived in Orba for eight years, and took over Sanchez's grandmother's apartment there when she died. The flat hasn't been renovated since the 1960s.

But the young couple wants to stay in the neighborhood. Sanchez spent her childhood there and loves it — but they need more space. They have a small two-bedroom on the fourth floor with no elevator — and Sanchez is three months pregnant.

"Going up and down four flights of stairs is tiring now, and I'm not sure I'll be physically able to do it when I'm nine months pregnant!" Sanchez exclaims. "And what about the baby's stroller?" she says, exchanging a look with her partner, Campillo, and laughing.

But co-housing may help. The couple may "borrow" a ground-floor bedroom from a neighbor for the last few months of Sanchez's pregnancy — or for stroller storage afterward. The couple currently uses their second bedroom as a home office. But the addition of a shared co-working hub in the apartment complex would free up space for the baby's nursery.

Fusion Of Architecture And Social Policy

People in working-class Alfafar aren't used to getting attention from award-winning architects. The local mayor, Juan Ramon Adsuara, says he's surprised and bewildered by all the interest — but proud his town has been chosen by the architects and awarded the U.N. prize.

"It's not just an architecture project. It's a fusion of architecture and rehabilitation. It's social policy," Adsuara says. "Architecture is not just for big star projects like museums. It's for the slums around them, too."

The big question, though, is how to pay for all this. The U.N. award comes with fame, but no funding. The mayor says the town hall is struggling to pay for basic services — let alone a progressive architecture revamp.

"I need to make payroll for municipal employees — the cleaning staff, the garbage collectors," Adsuara says. "But our economy is improving. We need to think about what model we want for our town's future. And that's where this project comes in."

The Improvistos architects have no price tag for their design. It's adaptable — based on what residents want. They all hope to begin workshops to sketch that out, this spring. The mayor is applying for funding from the European Union, to help launch this project — and also add bike lanes throughout the city. Garca and Navarrete are also thinking about launching a Kickstarter crowd-funding campaign. Residents have volunteered to even do some of the renovation work themselves.

Among all of them, they're determined to change this neighborhood, for the better.

In Medical Park Hospital in Winston-Salem, N.C., Angela Koons is still a little loopy and uncomfortable after wrist surgery. Nurse Suzanne Cammer gently jokes with her. When Koons says she's itchy under her cast, Cammer warns, "Do not stick anything down there to scratch it!" Koons smiles and says, "I know."

Koons tells me Cammer's kind attention and enthusiasm for nursing has helped make the hospital stay more comfortable.

"They've been really nice, very efficient, gave me plenty of blankets because it's really cold in this place," Koons says. Koons and her stepfather, Raymond Zwack agree they'd give Medical Park a perfect 10 on the satisfaction scale.

My poll of the family is informal, but Medicare's been taking actual surveys of patient satisfaction, and hospitals are paying strict attention. The Affordable Care Act ties a portion of the payments Medicare makes to hospitals to how patients rate the facilities.

Medical Park, for example, recently received a $22,000 bonus from Medicare in part because of its sterling results on patient satisfaction surveys.

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Medical Park Hospital's patients tend to be pretty happy customers, leading to thousands of dollars in rewards from Medicare. Novant Health hide caption

itoggle caption Novant Health

Medical Park Hospital's patients tend to be pretty happy customers, leading to thousands of dollars in rewards from Medicare.

Novant Health

Novant Health is Medical Park's parent company, and none of its dozen or so other hospitals even come close to rating that high on patient satisfaction. Figuring out why Medical Park does so well is complicated.

First, says Scott Berger, a staff surgeon, this isn't your typical hospital.

"It kind of feels, almost like a mom-and-pop shop," he says.

Medical Park is really small, only two floors. Doctors just do surgeries, like fixing shoulders and removing prostates, and most of their patients have insurance.

Another key is that no one at Medical Park was rushed to the hospital in an ambulance, or waited a long time in the emergency room. In fact, the hospital doesn't even have an emergency room.

The hospital doesn't tend to do emergency surgeries, says Chief Operating Officer Chad Setliff. These procedures are all elective, scheduled in advance. "So they're choosing to come here," he says. "They're choosing their physician."

These are the built-in advantages that small, specialty hospitals have in terms of patient satisfaction, says Chas Roades, chief research officer with Advisory Board Company, a global health care consulting firm.

"A lot of these metrics that the hospitals are measured on, the game is sort of rigged against [large hospitals]," Roades says.

Shots - Health News

Medicare Starts To Reward Quality, Not Quantity, Of Care

This is the third year hospitals can get bonuses or pay cuts from Medicare (partly determined by those scores) that can add up to hundreds of thousands of dollars.

More typical hospitals that handle many more patients – often massive, noisy, hectic places – are more likely to get penalized, Roades says.

"In particular, the big teaching hospitals, urban trauma centers — those kind of facilities don't tend to do as well in patient satisfaction," he says. Not only are they busy and crowded, but they have many more caregivers interacting with each patient.

Still, Roades says, although patient surveys aren't perfect, they are fair.

"In any other part of the economy," he points out, "if you and I were getting bad service somewhere – if we weren't happy with our auto mechanic or we weren't happy with where we went to get our haircut – we'd go somewhere else." In health care, though, patients rarely have that choice. So Roades thinks the evaluation of any hospital's quality should include a measurement of what patients think.

Shots - Health News

Hospitals' Medicare Quality Bonuses Get Wiped Out By Penalties

Medical Park executives say there are ways big hospitals can seem smaller — and raise their scores. Sometimes it starts with communication – long before the patient shows up for treatment.

On my recent visit, Gennie Tedde, a nurse at Medical Park, is giving Jeremy Silkstone an idea of what to expect after his scheduled surgery – which is still a week or two away. The hospital sees these conversations as a chance to connect with patients, allay fears, and prepare them for what can be a painful process.

"It's very important that you have realistic expectations about pain after surgery," Tedde explains to Silkstone. "It's realistic to expect some versus none."

Medical Park now handles this part of surgery prep for some of the bigger hospitals in its network. Silkstone, for example, will have surgery at the huge hospital right across the street — Forsyth Medical Center.

Carol Smith, the director of Medical Park's nursing staff, says that after she and her colleagues took over these pre-surgical briefings, "Forsyth's outpatient surgical scores increased by 10 percent."

But some doctors and patients who have been to both hospitals agree that the smaller one is destined to have higher scores. It is just warmer and fuzzier, one patient says.

This story is part of NPR's reporting partnership WFAE and Kaiser Health News.

health care quality

Affordable Care Act

North Carolina

Hospitals

New Zealand-born photographer Amos Chapple was a long, long way from home. Out in the middle of Russia's vast Sakha Republic, an area that spans over 1 million square miles, he was heading towards the world's coldest city.

And he was alone.

In these far reaches of northeast Russia, Chapple says, "If people don't need to be outside, they won't be outside. So in the smaller towns, they all look abandoned. And if you see somebody, they're racing between doors with mitts clasped over faces hurrying to get inside again."

Out in the freezing cold, he finally crossed paths with the only other creature audacious enough to face this kind of weather.

"I saw some cows out in the streets," he says. "So I figured, OK, they're on their way somewhere, they're going to take me back to a person, who hopefully I can speak to, who will be doing something outdoors. So I decided to follow these cows."

They led him off the road through a forest.

"Finally, I come to this sort of secondary settlement — a couple of houses and there's this stable. And then sure enough this old man kind of stumbles outside into the cold," Chapple says. "He looks around, he does a double take when he sees me, like, 'Where did you come from?' There was this beautiful moment when I was able to say, 'Oh, I'm from New Zealand! Hello!' "

In that remote region six time zones from Moscow, Chapple was making his way into Yakutsk, Russia.

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A woman sells an arctic hare along with her usual fare of frozen fish in the central market of Yakutsk. Amos Chapple hide caption

itoggle caption Amos Chapple

A woman sells an arctic hare along with her usual fare of frozen fish in the central market of Yakutsk.

Amos Chapple

Life In The Heart Of Siberia

Maybe you've heard of Yakutsk from the board game Risk, which you might have played in the comfort of your warm home. Out here, the average winter temperature dips down to -30 degrees Fahrenheit.

"The first impression I had was being physically gripped by [the cold]," Chapple says. "It was literally like something had wrapped around my legs."

Chapple says he's never experienced a cold like that. He describes the streets of Yakutsk, a city of about 270,000, as dark and foggy.

"The mist from people's breath, from car exhaust and from factory emissions, it never goes away, it never dissipates," he says. "It just hangs there. So very, very misty, all through the day and night."

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While the majority of the city's population are indigenous Yakutian, many ethnic Russians and Ukrainians moved to Yakutsk in Soviet times, lured by high wages for working in the harsh climate. Amos Chapple hide caption

itoggle caption Amos Chapple

While the majority of the city's population are indigenous Yakutian, many ethnic Russians and Ukrainians moved to Yakutsk in Soviet times, lured by high wages for working in the harsh climate.

Amos Chapple

He says Yakutsk was one of his most difficult assignments. Being outside for hours on end took a toll on his body and his camera would seize up in the cold.

"It took me a while to figure out why I was getting all of these kind of hazy, very un-contrasty images. And that was because when I would breathe, when I would exhale, the mist from my breath would just kind of waft around in front of the lens and ruin the shot," Chapple says. "So you would have to hold your breath before you took a picture."

Indoor Entertainment, Outdoor Adventure

Yakutsk is the largest city in the world built on permafrost. Most buildings are constructed on stilts that go deep underground. And while the weather may be hostile, this giant region in Russia is rich with natural resources — especially gold and diamonds.

The people braving the cold here have lived in this region for generations, like freelance journalist, Bolot Bochkarev. He was born and raised in Yakutsk.

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A woman enters Preobrazhensky Cathedral in Yakutsk. "You get this blast of freezing mist coming through the door," photographer Amos Chapple says. "It was just spectacular." Amos Chapple hide caption

itoggle caption Amos Chapple

A woman enters Preobrazhensky Cathedral in Yakutsk. "You get this blast of freezing mist coming through the door," photographer Amos Chapple says. "It was just spectacular."

Amos Chapple

"We've got many facilities like stadium, restaurants, many nightclubs, concert halls," Bochkarev says. "We've got enough entertainment. But everything is done indoors because it's cold outside."

Bochkarev says he plays tour guide to visitors who travel across the world.

"When tourists, international visitors come to Yakutsk, we go on the ice to catch fish," he says. "Also snowmobiling, dog sledding. You know, frozen 'eye brushes,' frozen noses. People like it."

Bochkarev says in the world's coldest city, there's always adventure.

cold

Russia

Last year, frozen fruit sales in this country surpassed a billion dollars, shattering all previous records. Sales have more than doubled since 2011.

So what's behind this explosion of frozen fruit?

Sarah Nassauer, who reports on the food business for the Wall Street Journal, points to a pair of studies from the world's biggest seller of fresh fruit.

"Dole [Packaged Foods] got into this business, started selling frozen fruit in 2005," she says. "So in 2006, they did a big sort of frozen fruit usage study, and then they did another one last year in 2014."

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One of Dole Packaged Food's frozen fruit options. Over the years, frozen fruit companies have adjusted packaging to make it flashier and more colorful, and also put their products in stand-up bags, says Wall Street Journal reporter, Sarah Nassauer. Dole.com hide caption

itoggle caption Dole.com

One of Dole Packaged Food's frozen fruit options. Over the years, frozen fruit companies have adjusted packaging to make it flashier and more colorful, and also put their products in stand-up bags, says Wall Street Journal reporter, Sarah Nassauer.

Dole.com

In the studies, Dole asked things like: What kind of frozen fruit do you buy? How much? And, most importantly, what do you use it for?

Back in 2006, Nassauer says, "People saw it more as a dessert topping. It was near whipped toppings in the frozen food aisle. And it was in these sort of hard-to-find lie-flat bags that were what frozen fruit was in for decades."

But Dole thought, here's this inherently healthy food — there has to be a bigger market out there.

"So they very intentionally said, 'Let's put it in these stand-up bags, put shiny graphics on it, suggest healthy recipes like smoothies on the back of the bag,' " Nassauer says. "And that was definitely their approach."

"At the same time," she adds, "I do think they probably got pretty lucky in terms of the health trends that has happened those years as well."

One health trend in particular is leading the charge: Smoothies. Busy, health-conscious Americans are sucking them down like mad.

"In 2014, they estimate that 60 percent of frozen fruit purchased went into smoothies," Nassauer says. "And that number was 21 percent in 2006."

NPR host Arun Rath went to Whole Foods, where you don't have to take the trouble of sliding glass. Unlike bags of veggies, frozen fruit containers are ready-to-grab in an open, reach-in freezer.

Tart cherries, sweet cherries, organic blueberries, cranberries, wild blueberries, mango chunks: the selections was extensive.

The Salt

What's More Nutritious, Orange Juice Or An Orange? It's Complicated

The Salt

Blending Vs. Juicing? How To Get The Most Nutrition From Your Fruit

He also noticed the fruits were more nicely presented than they used to be, some in stand-up bags: "Some of these bags, the organic ones, look nice and wholesome ... beautiful pictures all over them."

When he was a kid, he remembers, they were packaged in plainer, white bags.

Nassauer says that with the smoothie craze spreading, it's no surprise that blender sales also hit the billion-dollar mark for the first time last year.

And to make things even easier, Dole and other companies are now selling combo bags, ready to blend.

You can even get kale in the mix, if you're so inclined. Or you could stick to the classic frozen berries — even if they come in new-fangled packaging.

smoothies

fruit