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“Flow” Transcranial Direct Current Stimulation (tDCS) for Depression Treatment in a Primary Healthcare General Practice—An Open-Label Cohort Study Measuring Montgomery-Åsberg Depression rating Scale (MADrS-S) Outcomes

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Open Journal of Psychiatry 2024年第4期14卷 386-399页

作者： Chris Griffiths harmony Jiang David Smart Azhar Zafar Northamptonshire Healthcare NHS Foundation Trust Northampton UK University of Northampton Northampton UK General Practice Alliance Ltd. Northampton UK

Background: Flow FL-100 is a transcranial direct current stimulation (tDCS) device self-administered by a patient at home in combination with a software application delivered wellbeing behaviour therapy training. tDCS has evidence of effectiveness in treating symptoms of depression. Purpose/Aim: This post marketing study evaluated the effect of Flow on depression for primary care general practice patients with depression symptoms. Methods: Open-label patient cohort design with no control group. Inclusion criteria were aged 18 years or over and reporting depression symptoms. Participants self-administered five 30 minute tDCS sessions per week for the first three weeks, and then 3 sessions per week following this. Three, six and ten week assessment with participant self-report measure: Montgomery- Åsberg Depression rating Scale (MADrS-S). results: MADrS-S remission rates were between 29% - 30% at three weeks, 33% - 34% at six-weeks and 50% at 10-weeks treatment. There was a significant improvement in MADrS-S with large effect sizes at all time points. Conclusions: Flow tDCS can be delivered through a primary healthcare general practice service and patients will choose to use. Flow tDCS provides an effective depression treatment in addition and as an alternative to antidepressants and psychotherapy. tDCS has evidence as an effective depression treatment, and the widespread availability of tDCS in primary care general practice should be considered.

关键词： Depression Transcranial Direct Current Stimulation Wellbeing General Practice

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Experience and Impact of the “Well-Track” Physical Activity and Sleep Tracker Based Healthy Lifestyle Intervention for Patients in an Early Intervention in Psychosis (EIP) Service

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Open Journal of Psychiatry 2023年第2期13卷 73-93页

作者： Chris Griffiths Kate Walker harmony Jiang Northamptonshire Healthcare NHS Foundation Trust Kettering Northamptonshire UK

Background: Physical activity and sleep are interconnected with mental health, physical health, wellbeing, quality of life, cognition, and functioning. Compared to the general population, people who experience psychosis are more likely to have low levels of physical activity, high levels of sedentary behaviour, and sleep problems. Intervention: The Well-Track intervention addresses these issues through: provision of a wearable activity and sleep tracker (Fitbit);physical activity and sleep hygiene advice;a brief motivational interview;a goal-setting workbook;and three engagement, feedback and discussion sessions with early intervention in psychosis (EIP) staff. Participants: Thirty participants using an EIP service took part in an eight-week intervention. Thirteen participants (6 males;7 females) with an age range of 18 to 61 years old (M = 28 years) took part in an interview. Methods: A qualitative approach was used to conduct in-depth semi-structured interviews. Thematic and content analyses were employed to analyse the data. results: Participants set goals, made lifestyle changes to their daily routine and integrated a Fitbit and its functions into their lives that resulted in more physical activity and enabled more effective sleep. This resulted in improved self-management, positive feelings and thoughts, motivation, confidence, social engagement, mood, health, and wellbeing. Participants made progress towards goals they had set. Conclusion: Well-Track has been successfully integrated into an EIP service and it could be delivered through all EIP and other healthcare services where there is a need to promote healthy lifestyle behaviours.

关键词： Fitbit Tracker Psychosis Exercise Sleep Wearables Activity

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Social Prescribing through Primary Care: A Systematic review of the Evidence

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Open Journal of Preventive Medicine 2022年第2期12卷 31-58页

作者： Chris Griffiths Farah Hina harmony Jiang Northamptonshire Healthcare NHS Foundation Trust Northampton UK

Background: In primary care, social prescribing (SP) is where a patient is referred to a “link worker”, who considers their needs and then “prescribes” or connects them to appropriate community-based resources and services. recent policy and guidance in the UK has significantly expanded the provision of SP to improve patient health and wellbeing. Methods: This study conducted a systematic review of evidence for SP effectiveness and to report needs addressed, interventions provided, and behaviour change techniques employed. Inclusion criterion was patient referral from primary care to a SP link worker. Online databases were searched for studies published from February 2016 to July 2021. Searches were restricted to English language only. risk of bias assessment and a narrative analysis were undertaken. results: Eight studies were included. All studies reported some positive outcomes. There were weaknesses and limitations in study design and in reporting of results: a lack of comparative controls, short duration and single point follow-up, a lack of standardised assessments, missing data, and a failure to consider potential confounding factors. All studies had features which indicated a high risk of bias. Conclusion: Evidence for the value and positive impact of SP is accumulating, but evaluation design remains relatively weak. There is a need to improve evaluation through robust methodological design and the adoption of universal outcome measures and evaluation/analytical framework. SP should seek to assess patient wellbeing, self-management, and quality of lifeoutcomes systematically, and adopt behaviour change techniques to enable healthier lifestyles in the short and long term.

关键词： Social Prescription Greenspaces Systematic review Wellbeing Self-Management Quality of Life Behaviour Change

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Understanding the Underlying Mechanisms of Action for Successful Implementation of Social Prescribing

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Open Journal of Preventive Medicine 2023年第2期13卷 41-56页

作者： Kate Walker Chris Griffiths harmony Jiang Northamptonshire Healthcare NHS Foundation Trust Berrywood Hospital Northampton England

There is growing evidence for the use of social prescribing as a means of facilitating healthy lifestyle behavior changes by linking patients to sources of support in the community. However, there are gaps in understanding about what works to facilitate and enable this behavior change i.e. , the mechanisms of actions underpinning social prescribing delivery. This study used a qualitative approach involving interviews with 18 Social Prescription Link Workers (SPLWs). reflective thematic analysis was used to analyze the data. Through this, an overall theme of “Theoretical underpinning: Solution-focused and strengths-based” was identified. This was made up of sub-themes relating to mechanisms underpinning: the SPLWs’ role (comprising asking questions, motivational interviewing and the therapeutic alliance);the patients’ role, (empowerment and active engagement);and the approach adopted (solution building, goal and action orientated). To formalize this, a framework could be developed for SPLWs that encapsulates the solution-focused strengths-based approach for application within social prescribing. This framework can then be embedded into practice facilitating more successful healthy lifestyle behavior change for social prescribing patients.

关键词： Social Prescribing Behaviour Change Solution-Focused Goal and Action Orientation

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renal impairment and heart failure with preserved ejection fraction early post-myocardial infarction

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World Journal of Cardiology 2010年第1期2卷 13-18页

作者： Vinod Jorapur Gervasio A Lamas Zygmunt P Sadowski harmony r reynolds Antonio C Carvalho Christopher E Buller James M rankin Jean renkin Philippe Gabriel Steg Harvey D White Carlos Vozzi Eduardo Balcells Michael ragosta C Edwin Martin Vankeepuram S Srinivas William W Wharton III Staci Abramsky Ana C Mon Shari S Kronsberg Judith S Hochman Columbia University Division of Cardiology Mount Sinai Medical Center II Ischemic Heart Disease Department National Institute of Cardiology Leon Charney Division of Cardiology New York University School of Medicine Cardiology Division-Hospital Sao Paulo Federal University of Sao Paulo Division of Cardiology University of British Columbia Department of Cardiovascular Medicine Royal Perth Hospital Department of Cardiology UCL St Luc University Hospital INSErM U-698 Department of CardiologyHopital Bichat Cardiology Department Green Lane Cardiovascular ServiceAuckland City Hospital Interventional Cardiology Instituto de Intervenciones Cardiovasculares S.A. Cardiovascular Associates Wellmont Holston Valley Medical Center Cardiovascular Division University of Virginia Department of Medicine-Division of Cardiology York Hospital Division of Cardiology Montefiore Medical Center/Albert Einstein College of Medicine research Department Asheville Cardiology AssociatesP.A. Maryland Medical research Institute

AIM:To study if impaired renal function is associated with increased risk of peri-infarct heart failure (HF) in patients with preserved ejection fraction (EF).METHODS:Patients with occluded infarct-related arteries (IrAs) between 1 to 28 d after myocardial infarction (MI) were grouped into chronic kidney disease (CKD) stages based on estimated glomerular filtration rate (eGFr).rates of early post-MI HF were compared among eGFr *** regression was used to explore independent predictors of ***:reduced eGFr was present in 71.1% of 2160 patients,with significant renal impairment (eGFr ry 1.73 m2) in 14.8%.The prevalence of HF was higher with worsening renal function:15.5%,17.8% and 29.4% in patients with CKD stages 1,2 and 3 or 4,respectively (P rence in mean EF across eGFr groups:48.2 ± 10.0,47.9 ± 11.3 and 46.2 ± 12.1,respectively (P=0.02).The prevalence of HF was again higher with worsening renal function among patients with preserved EF:10.1%,13.6% and 23.6% (P relationship was not significant among patients with depressed EF:27.1%,26.2% and 37.9% (P= 0.071).Moreover,eGFr was an independent correlate of HF in patients with preserved EF (P=0.003) but not in patients with depressed EF (P=0.181).CONCLUSION:A significant proportion of post-MI patients with occluded IrAs have impaired renal *** renal function was associated with an increased rate of early post-MI HF,the association being strongest in patients with preserved *** findings have implications for management of peri-infarct HF.

关键词： Heart failure Myocardial infarction Kidney disease

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Gene expression profiling as a prognostic tool in multiple myeloma

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Cancer Drug resistance 2021年第4期4卷 1008-1018页

作者： harmony Black Siobhan Glavey Department of Haematology Beaumont HospitalDublin D09 V2N0Ireland Department of Pathology Royal College of Surgeons in IrelandDublin D02 YN77Ireland

Multiple myeloma(MM)is an aggressive plasma cell malignancy with high degrees of variability in outcome,some patients experience long remissions,whilst others survive less than two years from *** refractoriness and relapse remain challenges in MM management,and there is a need for improved prognostication and targeted therapies to improve overall survival(OS).The past decade has seen a surge in gene expression profiling(GEP)studies which have elucidated the molecular landscape of MM and led to the identification of novel gene signatures that predict OS and outperform current clinical *** this review,we discuss the limitations of current prognostic tools and the emerging role of GEP in diagnostics and in the development of personalised medicine approaches to combat drug resistance.

关键词： Multiple myeloma gene expression profiling prognostication risk stratification risk-adapted therapies SKY92 drug resistance

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Plant Carbonic Anhydrases： Structures, Locations, Evolution, and Physiological roles

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Molecular Plant 2017年第1期10卷 30-46页

作者： robert J. DiMario harmony Clayton Ananya Mukhedee Martha Ludwig James V. Moroney Department of Biological Sciences Louisiana State University Baton Rouge LA 70803 USA School of Chemistry and Biochemistry University of Western Australia Perth WA 6009 Australia

Carbonic anhydrases （CAs） are zinc metalloenzymes that catalyze the interconversion of CO2 and HCO3- and are ubiquitous in nature. Higher plants contain three evolutionarily distinct CA families, αCAs, 13CAs, and γCAs, where each family is represented by multiple isoforms in all species. Alternative splicing of CA transcripts appears common; consequently, the number of functional CA isoforms in a species may exceed the number of genes. CAs are expressed in numerous plant tissues and in different cellular locations. The most prevalent CAs are those in the chloroplast, cytosol, and mitochondria. This diversity in location is paralleled in the many physiological and biochemical roles that CAs play in plants. In this review, the number and types of CAs in C3, C4, and crassulacean acid metabolism （CAM） plants are considered, and the roles of the α and yCAs are briefly discussed. The remainder of the review focuses on plant βCAs and includes the identification of homologs between species using phylogenetic approaches, a consideration of the inter- and intracellular localization of the proteins, along with the evidence for alternative splice forms. Current understanding of βCA tissue-specific expression patterns and what controls them are reviewed, and the physiological roles for which βCAs have been implicated are presented.

关键词： carbonic anhydrase regulation alternative splicing physiological role

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Environmental variation shifts the relationship between trees and scatterhoarders along the continuum from mutualism to antagonism

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Integrative Zoology 2018年第3期13卷 319-330页

作者： Gina M.SAWAYA Adam S.GOLDBErG Michael A.STEELE harmony J.DALGLEISH Department of Biology College of William and MaryWilliamsburgVirginiaUSA Department of Biology Wilkes UniversityWilkes-BarrePennsylvaniaUSA

The conditional mutualism between scatterhoarders and trees varies on a continuum from mutualism to antagonism and can change across time and space,and among *** examined 4 tree species(red oak[Quercus rubra],white oak[Quercus alba],American chestnut[Castanea dentata]and hybrid chestnut[***×Castanea] mollissima)across 5 sites and 3 years to quantify the variability in this conditional *** used a published model to compare the rates of seed emergence with and without burial to the probability that seeds will be cached and left uneaten by scatterhoarders to quantify variation in the conditional mutualism that can be explained by environmental variation among sites,years,species,and seed provenance within *** species tested had increased emergence when ***,comparing benefits of burial to the probability of caching by scatterhoarders indicated a mutualism in red oak,while white oak was nearly always *** was variable around the boundary between mutualism and antagonism,indicating a high degree of context dependence in the relationship with *** found that different seed provenances did not vary in their potential for *** did not explain microsite differences in seed emergence in any of the species *** hybrid chestnut only,emergence on the surface declined with soil moisture in the *** quantifying the variation in the conditional mutualism that was not caused by changes in scatterhoarder behavior,we show that environmental conditions and seed traits are an important and underappreciated component of the variation in the relationship between trees and scatterhoarders.

关键词： Castanea dentata conditional mutualism Quercus alba Quercus rubra temperate forest

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“Well-Track”: Fitbit Based Physical Activity and Sleep Hygiene Intervention for Early Intervention in Psychosis (EIP) and At-risk Mental State (ArMS) Service Patients

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Open Journal of Psychiatry 2023年第4期13卷 246-261页

作者： Chris Griffiths Ksenija da Silva Sue Jugon harmony Jiang rowena rogers Thomas Althorpe Josephine Davis Andrea Morris Neil redding Kate Walker Marlene Kelbrick research and Innovation Northamptonshire Healthcare NHS Foundation Trust (NHFT) Northamptonshire UK Centre for Healthcare and Communities Coventry University Coventry UK

Background: Compared to the general population, people who are at a high risk of or experience severe mental illness (SMI) such as psychosis, are more likely to have low levels of physical activity, high levels of sedentary behaviour, and sleep problems. Intervention: The Well-Track intervention comprises a wearable activity and sleep tracker (Fitbit);one session with mental health service staff providing physical activity and sleep hygiene advice;a brief motivational interview;completing a goal setting workbook;and one or two further engagement, feedback and discussion sessions. Participants: Twenty-four participants using an early intervention in psychosis (EIP) or at-risk mental state (ArMS) service completed an eight-week, three session intervention (14 males and 10 females), with an age range of 18 - 61, and average age of 27.75 years. Methods: An open-label patient cohort design with no control group. Pre-intervention, 4-week and 8-week intervention assessments using participant self-report measures: Patient Health Questionnaire (PHQ-9) (depression), Warwick–Edinburgh Mental Wellbeing Scale (WEMWBS), and Sleep Conditioning Index (SCI);and clinician measurement of body weight. results: Mean scores showed a significant improvement in PHQ-9 from 9.29 (SD 5.89) to 5.58 (SD 3.68) at 4 weeks and to 5.83 (SD 4.40) at 8 weeks, with large effect sizes. For those who met a diagnosis of depression at baseline, at 4 week follow-up seven participants (26%) experienced remission and nine (33%) reliable improvement, and at 8 week follow-up four (21%) experienced remission and seven (37%) reliable improvement. WEMWBS scores significantly improved, from 44.04 (SD 9.44) to 48.54 (SD 8.71) at 4 weeks and to 48.67 (SD 8.76) at 8 weeks, with large effect sizes. Body weight did not change significantly, remaining unchanged at 4 weeks and reduced from a mean of 82.8 kg (baseline) to 80.15 kg at 8 weeks, a reduction of 2.65 kg. Conclusion: Well-Track was integrated into an EIP and Ar

关键词： Fitbit Tracker Psychosis Exercise Insomnia Wearables Activity

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以加利福尼亚水银行为对象的水资源分配法律问题研究

以加利福尼亚水银行为对象的水资源分配法律问题研究

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作者： GABrIEL harmony JENNINGS 中国海洋大学

学位级别：硕士

Look to the California system of water management and allocation to improve the allocation of China’s water resources. Incentivize water market based pricing schemes and permit system through a hybrid laissez-faire water bank and administrative mediation, tax, and license. This paper investigates the optimal cost-benefit coefficient of the California Water Bank with an eye to manage China’s water resources. Water available by volume has a price, while water pollution as measured by quality standards has a cost. Consumptive users pay for water by volume and quality, while water polluters pay for water treatment. In 2005, the PrC’s Ministry of Water resources （MWr） published an important opinion, charging water basin management teams to "Give full play to the market mechanism for allocation of water resources." In this thesis I have taken the government’s challenge to heart by investigating California’s market mechanisms from a legal standpoint. I hope it serves Chinese policy makers to reform water markets.

关键词：水资源分配水银行为法律规制加利福尼亚

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