Spatial accessibility and equity of community healthcare: unraveling the impact of varying time and transport mode.

Background: Achieving a higher level of accessibility and equity to community healthcare services has become a major concern for health service delivery from the perspectives of health planners and policy makers in China. Methods: In this study, we introduced a comprehensive door-to-door (D2D) model, integrating it with the open OD API results for precise computation of accessibility to community hospitals over different transport modes. For the D2D public transit mode, we computed the temporal variation and standard deviation of accessibility at different times of the day. Additionally, accessibility values for D2D riding mode, D2D driving mode, and simple driving mode were also computed for comparison. Moreover, we introduced Lorenz curve and Gini index to assess the differences in equity of community healthcare across different times and transport modes. Results: The D2D public transit mode exhibits noticeable fluctuations in accessibility and equity based on the time of day. Accessibility and equity were notably influenced by traffic flow between 8 AM and 11 AM, while during the period from 12 PM to 10 PM, the open hours of community hospitals became a more significant determinant in Nanjing. The moments with the most equitable and inequitable overall spatial layouts were 10 AM and 10 PM, respectively. Among the four transport modes, the traditional simple driving mode exhibited the smallest equity index, with a Gini value of only 0.243. In contrast, the D2D riding mode, while widely preferred for accessing community healthcare services, had the highest Gini value, reaching 0.472. Conclusion: The proposed method combined the D2D model with the open OD API results is effective for accessibility computation of real transport modes. Spatial accessibility and equity of community healthcare experience significant fluctuations influenced by time variations. The transportation mode is also a significant factor affecting accessibility and equity level. These results are helpful to both planners and scholars that aim to build comprehensive spatial accessibility and equity models and optimize the location of public service facilities from the perspective of different temporal scales and a multi-mode transport system.

Spatial scale effects of integrated landscape indicators on river water quality in Chaohu Lake basin, China.

Climate change and rapid urbanization have changed the characteristics of basin landscapes. Non-point-source (NPS) pollution affects river water quality. Exploring the impact of landscapes on river water quality is crucial for the control of water pollution in a basin. Current researchers focus on the impact of landscape pattern change on NPS pollution in the basin, but few consider climate, terrain, soil, and other geographical factors. In this study, we selected a subtropical agricultural basin in China named Chaohu Lake basin as the study area, added precipitation, soil erosion resistance, and slope to the original landscape pattern indicators. We quantified the spatial scale effect and seasonal dependence of integrated landscape indicators on water quality and comprehensively analyzed the optimal spatial scale and key landscape indicators. According to the nonlinear relationship between the key landscape indicators and river nutrients, we also determined the Type-1 threshold values of key landscape indicators for water quality protection in the basin. The results showed that the rivers in Chaohu Lake basin were mainly polluted by nitrogen and phosphorus. The strength of interpretation of the integrated landscape indicators of river water quality increased with riparian zone width. We determined the subbasin scale to be the optimal spatial scale. The key landscape indicators affecting water quality in the wet season at the optimal scale were precipitation and aggregation index of construction land (AIbul), whereas those in the dry season were AIbul and COHESION. The interpretation of the key landscape indicators in the wet season was slightly higher than that in the dry season. The above conclusions provide a scientific reference for NPS pollution control and water quality protection in subtropical agricultural basins.

Spatial Distribution Characteristics of Healthcare Facilities in Nanjing: Network Point Pattern Analysis and Correlation Analysis.

The spatial distribution of urban service facilities is largely constrained by the road network. In this study, network point pattern analysis and correlation analysis were used to analyze the relationship between road network and healthcare facility distribution. The weighted network kernel density estimation method proposed in this study identifies significant differences between the outside and inside areas of the Ming city wall. The results of network K-function analysis show that private hospitals are more evenly distributed than public hospitals, and pharmacy stores tend to cluster around hospitals along the road network. After computing the correlation analysis between different categorized hospitals and street centrality, we find that the distribution of these hospitals correlates highly with the street centralities, and that the correlations are higher with private and small hospitals than with public and large hospitals. The comprehensive analysis results could help examine the reasonability of existing urban healthcare facility distribution and optimize the location of new healthcare facilities.

An Enhanced Variable Two-Step Floating Catchment Area Method for Measuring Spatial Accessibility to Residential Care Facilities in Nanjing.

Civil administration departments require reliable measures of accessibility so that residential care facility shortage areas can be accurately identified. Building on previous research, this paper proposes an enhanced variable two-step floating catchment area (EV2SFCA) method that determines facility catchment sizes by dynamically summing the population around the facility until the facility-to-population ratio (FPR) is less than the FPR threshold (FPRT). To minimize the errors from the supply and demand catchments being mismatched, this paper proposes that the facility and population catchment areas must both contain the other location in calculating accessibility. A case study evaluating spatial accessibility to residential care facilities in Nanjing demonstrates that the proposed method is effective in accurately determining catchment sizes and identifying details in the variation of spatial accessibility. The proposed method can be easily applied to assess other public healthcare facilities, and can provide guidance to government departments on issues of spatial planning and identification of shortage and excess areas.

Accumulation of B lymphocytes with a naive, resting phenotype in a subset of hepatitis C patients.

Chronic infection with hepatitis C virus (HCV) is associated with disturbances of B lymphocyte activation and function: autoantibody production, mixed cryoglobulinemia, and B cell lymphomas. It has been proposed that these abnormalities reflect chronic antigenic stimulation or aberrant signaling through the B cell coreceptor, the latter mediated by binding of the HCV E2 glycoprotein to CD81. To test this hypothesis, we measured expression of activation and differentiation markers on peripheral blood B cells from patients with chronic HCV infection. Thirty-six HCV patients with and without mixed cryoglobulinemia were compared with 18 healthy control volunteers and 17 sustained virologic responders who had cleared HCV infection. Ten of the 36 HCV patient samples showed increased B cell frequencies; B cell frequency was higher in patients with more severe hepatic fibrosis. However, these samples lacked evidence of Ag-driven activation or proliferation. The expanded cells were low in the activation markers CD25, CD69, CD71, CD80, and CD86. Proliferation of circulating B cells was unchanged in HCV patients. These cells did not express the differentiation marker CD27, suggesting that they were not enriched in memory B cells. Furthermore, the expanded B cells expressed both IgD and IgM, suggesting that they were antigenically naive. Together, these results indicate that B cell expansion in the peripheral blood of HCV patients is not associated with Ag-mediated activation and differentiation. Instead, factors other than antigenic stimulation may promote the accumulation of peripheral blood B cells with a naive phenotype in a subset of HCV patients.