The strain on health care systems due to the COVID-19 pandemic has led to increased psychological distress among health care workers (HCWs). As this global crisis continues with little signs of ...abatement, we examine burnout and associated factors among HCWs.
Cross-sectional survey study.
Doctors, nurses, allied health professionals, administrative, and support staff in 4 public hospitals and 1 primary care service in Singapore 3 months after COVID-19 was declared a global pandemic.
Study questionnaire captured demographic and workplace environment information and comprised 3 validated instruments, namely the Oldenburg Burnout Inventory (OLBI), Safety Attitudes Questionnaire (SAQ), and Hospital Anxiety and Depression Scale (HADS). Multivariate mixed model regression analyses were used to evaluate independent associations of mean OLBI-Disengagement and -Exhaustion scores. Further subgroup analysis was performed among redeployed HCWs.
Among 11,286 invited HCWs, 3075 valid responses were received, giving an overall response rate of 27.2%. Mean OLBI scores were 2.38 and 2.50 for Disengagement and Exhaustion, respectively. Burnout thresholds in Disengagement and Exhaustion were met by 79.7% and 75.3% of respondents, respectively. On multivariate regression analysis, Chinese or Malay ethnicity, HADS anxiety or depression scores ≥8, shifts lasting ≥8 hours, and being redeployed were significantly associated with higher OLBI mean scores, whereas high SAQ scores were significantly associated with lower scores. Among redeployed HCWs, those redeployed to high-risk areas in a different facility (offsite) had lower burnout scores than those redeployed within their own work facility (onsite). A higher proportion of HCWs redeployed offsite assessed their training to be good or better compared with those redeployed onsite.
Every level of the health care workforce is susceptible to high levels of burnout during this pandemic. Modifiable workplace factors include adequate training, avoiding prolonged shifts ≥8 hours, and promoting safe working environments. Mitigating strategies should target every level of the health care workforce, including frontline and nonfrontline staff. Addressing and ameliorating burnout among HCWs should be a key priority for the sustainment of efforts to care for patients in the face of a prolonged pandemic.
Taking the traditional fort-type settlements in Shaanxi as the research object, quantitative research methods such as K-means clustering algorithm, correlation analysis, density analysis, and nearest ...neighbor index are used to study their spatial distribution, formation causes, and cluster characteristics. The objective of the study is to break through the geographical limitations of fort-type settlements research and to explore the scientific methods of classifying and analyzing traditional fort-type settlements. The conclusions are: (1) The results of cluster analysis show that the fort-type settlements in Shaanxi can be divided into three categories; (2) The overall distribution of fort-type settlements in Shaanxi shows multi-point aggregation, and contains both point and linear aggregation distribution; (3) There are four typical cluster systems among the traditional fort-type settlements in Shaanxi; (4) The factors that have the greatest influence on the distribution of settlements are construction force, wall masonry, age, fortification purpose, and topographic environment. The article innovatively proposes the "cluster system" perspective and introduces mathematical algorithms and quantitative research methods to study the cluster system of the fort-type Settlements. This approach is feasible and can be applied to other settlement-related studies. At the same time, the perspective of cluster system could be used in heritage conservation, which can contribute to the restoration of architectural relics and systemic conservation on a larger scale.
In ancient China, an unobstructed, convenient and efficient transmission system nationwide was established for long-distance transmission of information. The transmission system works to different ...degrees in different regions, which is an important index to measure the interregional information level. Yet, some minor differences, may not be easily sensed by people subjectively. Identifying and quantifying the influences of information transmission efficiency is the best way to solve this problem. Based on the historical information map visualized by ArcGIS software, this study established a hierarchy evaluation model suitable for the analysis of ancient information transmission efficiency from three aspects of Wei-Suo system, beacon system and post system. The information transmission systems in five different regions of Wenzhou in the Ming Dynasty were quantitatively explored respectively. The results break through the qualitative conclusions of the general studies, and find out that the overall information transmission efficiency of Wenzhou in Ming Dynasty was strong in coastal, northern and southern regions, but weak in inland and central regions, which was closely related to the geographical environment and military defense demands in coastal areas of the Ming Dynasty. The model is proven to greatly contribute to judging the spatial configuration of ancient information transmission system in different regions, and provides a new idea for the study on ancient information transmission system.
Abstract
In ancient China, where was frequently troubled by invaders, the government set up many beacon towers for alerting and transmitting military information along the border and the coast. Many ...beacon sites still exist in some areas, which are generally located in dangerous places with high mountains and rough terrain, bringing great difficulties to archaeological discovery. Therefore, it is particularly important to develop a predictive model applicable to the distribution of mountain beacon sites. Taking 68 beacon sites found in Wenzhou as research samples, this study used the superimposed method of logistic regression and viewshed analysis, forming a high-precision, scientific and operational predictive model for the distribution of beacon sites, which was verified by the cross-validation method. The results showed that the beacon site predictive model simulated in this study could reduce the probability scope of site location by 90% compared with the common logistic regression predictive model, which greatly improved the accuracy and ability of site prediction. At the same time, it could also be used to understand the relationship between the known sites and their surroundings to assist in decision-making about conservation and management.
The spatial layout of the coastal forts defense system of the Ming Dynasty of China has been studied in a relatively comprehensive way. Nonetheless, ancient defense mechanisms have not been fully ...revealed. Previous studies have focused more on the macro and meso levels. Studies into its microscopic construction mechanism need to be enhanced. This research attempts to quantify and validate the rationality of the ancient microscopic defense mechanism, using the ancient defense mechanism of Pu Zhuang Suo-Fort in Zhejiang Province as an instance. This study concentrates on the distribution of firepower strength beyond the walls of coastal defense forts, as well as the effect of wall height on firepower defense capabilities. There is a specific firepower attenuation area near the walls due to the firing blind area in the coastal forts defense system. And the construction of the moat plays an additive role in its defensive capability. Meanwhile, the height of the fort wall will also affect the range of the firing blind zone under Yangmacheng. In theory, there is a reasonable height range of the wall and a proper position of the moat. This height range can meet both good economy and defensive capabilities. In turn, the position of the moats and the height of the walls can verify the rationality of the construction mechanism of the coastal forts' defense system.
As a famous coastal defense heritage in the world’s military history, the maritime defense heritage of China’s Ming Dynasty represents the highest achievement of China’s ancient coastal military ...defense. There is a relative lack of holistic research on this defense system from its establishment to stabilization. Additionally, there is a lack of comparative research on the combination of Wokou invasions and defense patterns from a spatio-temporal perspective. The study aims to offer insights into the temporal and spatial evolution of ancient military defense heritage and investigate the significance of Ming Dynasty coastal defense. This study focuses on Zhejiang, a key coastal defense during the Ming Dynasty. Using GIS tools, it analyzes the spatio-temporal evolution characteristics of Wokou invasions and defense mode in the process of Zhejiang coastal defense from its establishment to its perfection by using GIS analytical tools, and explores the driving factors of the dynamic adjustment of this coastal defense system. The results show that: (1) Hongwu 1 to 31 (1368–1398) witnessed the construction of a 12-area defense system, encompassing Wei and Suo citadels. This followed a multi-point defense strategy, with Wei citadels controlling the coastline and Suo citadels supporting them; (2) Hongwu to Wanli (1368–1588) saw the evolution of five defense modes, evolving from decentralized to centralized and then to a coexistence of both. This culminated in the establishment of 4–6 Defense Mode (4 Canjiang and 6 Bazong); (3) the evolution of the defense paradigm is largely driven by Wokou incursions and is an adaptation from small-scale, short-duration infestations to large-scale, long-duration infestations. The findings show that the Ming Dynasty’s coastal defense system in China was flexible and adaptive, evolving to meet changing defense needs.
The effective protection and utilization of historical and cultural heritage in urban and rural areas are increasingly gaining public attention. Constructing a continuous and complete heritage ...spatial network is an important means for achieving holistic protection and utilization of heritage, and it is also a crucial approach to enhancing the overall connectivity of regional culture. How to construct a cultural heritage corridor is of great significance to the comprehensive protection of cultural heritage in historic urban areas. This study takes the cultural heritage of Tianjin’s historical urban areas as an example, uses the Minimum Cumulative Resistance (MCR) and Gravity Model (GM) to construct a cultural heritage corridor, and evaluates its suitability. This research enriches the theory of heritage conservation, aims to enhance the connectivity and integrity of cultural heritage, and provides a new perspective for the integrated development of regional culture and tourism in the process of activation and utilization.
Defensive capability is one of the essential attributes of traditional military settlements. In the Ming dynasty, coastal Wei fort was the one of the most functionally complex and wide-ranging ...fortifications in the military defense system of China. Because many factors affect their defensive capacities, including three dimensions: individual construction, synergistic links, and regional jurisdiction, it is not easy to compare different settlements’ defensive capacities or to judge the degrees of different factors’ influences. Through principal component analysis, this study determines the weights of each minor factor. It constructs a model for evaluating traditional Chinese military settlements’ defensive capabilities, to quantify the defensive capability. The results show that the synergistic relationship between the settlements, especially settlement accessibility, has the most significant impact on defensive capability, much higher than a single castle's defensive construction. The defensive capability index of the Wei forts in Guangdong is the highest, consistent with the highest rate of victory in the wars fought on the coast during the Ming dynasty. The defensive capacity is directly proportional to the rate of victory, which validates this evaluation model’s soundness. This study not only comprehensively evaluates the coastal Wei forts’ defensive capacity in the Ming Dynasty, but also provides new methods for the quantitative or comparative analysis of military settlements at other temporal and spatial scales.
R-spondins (RSPOs) are secreted signaling molecules that potentiate the Wnt/β-catenin pathway by cooperating with Wnt ligands. RSPO1 is crucial in tissue development and tissue homeostasis. However, ...the molecular mechanism by which RSPOs activate Wnt/β-catenin signaling remains elusive. In this study, we found that RSPOs could mediate the degradation of Axin through the ubiquitin-proteasome pathway. The results of Co-IP showed that the recombinant RSPO1 protein promoted the interaction between Axin1 and CK1ε. Either knockout of the CK1ε gene or treatment with the CK1δ/CK1ε inhibitor SR3029 caused an increase in Axin1 protein levels and attenuated RSPO1-induced degradation of the Axin1 protein. Moreover, we observed an increase in the number of associations of LRP6 with CK1ε and Axin1 following RSPO1 stimulation. Overexpression of LRP6 further potentiated Axin1 degradation mediated by RSPO1 or CK1ε. In addition, recombinant RSPO1 and Wnt3A proteins synergistically downregulated the protein expression of Axin1 and enhanced the transcriptional activity of the SuperTOPFlash reporter. Taken together, these results uncover the novel mechanism by which RSPOs activate Wnt/β-catenin signaling through LRP6/CK1ε-mediated degradation of Axin.
This research explores the spatial distribution patterns of water engineering facilities along the Grand Canal during the Ming and Qing dynasties. It employs the entropy method to assess the social ...development status of prefectures during these periods and uses the Tobit model to examine the primary indicators influencing the distribution of water engineering facilities. The results show that the spatial distribution pattern of water engineering facilities was characterized by aggregation during the Ming and Qing dynasties. In contrast, the Qing dynasty’s distribution was more dispersed, with a shift in the construction focus of water engineering facilities towards the south. The spatial distribution pattern of water engineering facilities in the Ming Dynasty centered around the hotspot areas of Shuntian Prefecture, Yanzhou Prefecture, and Yangzhou Prefecture. During continuous improvements, these facilities exhibited a multi-point-regional aggregation phenomenon.The influence of commercial development indicator on the spatial distribution of water engineering facilities is positively correlated in both the Ming and Qing dynasties. However, the impacts of the indicator on different types of water engineering facilities vary between the two dynasties. During the Ming Dynasty, the indicators of transportation accessibility and cultural prosperity facilitated the construction of regional water engineering facilities, whereas in the Qing Dynasty, they significantly influenced several types of water engineering facilities. During the Ming and Qing Dynasties, neither the agricultural development indicator nor the population size indicator significantly affected the distribution of water engineering facilities. However, there was a negative correlation between the population size indicator and the distribution of water distribution facilities in the Ming Dynasty. This study enhances the importance of environmental protection in historical societies and provides a valuable reference for other international studies of linear cultural and material heritage.
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