Cardiff University

We aim to inform the design of new diffusion MRI (dMRI) approaches for microvasculature quantification that enhance the biological specificity of imaging towards cancer. We adopted simulation-informed modelling of the vascular dMRI signal. We synthesised signals from 1500 synthetic vascular networks, for a variety of protocols (flow-compensated [FC], non-compensated [NC], hybrid), featuring different samplings and diffusion times. We estimated the number of independent, recoverable signal degrees of freedom in presence of noise (signal-to-noise ratio of 5), and ranked 12 microvascular metrics depending on the quality of their estimation. Lastly, we demonstrated the feasibility of estimating the top-ranking metrics on 3T dMRI of a healthy volunteer and of a metastatic colorectal cancer (CRC) patient. Both NC and FC synthetic vascular signals exhibited complex behaviour as, for example, non-zero kurtosis and diffusion time dependence. Two independent degrees of freedom appeared recoverable from directionally-averaged vascular signals (SNR of 5). Mean volumetric flow rate and an Apparent Network Branching (ANB) index maximised correlations between ground truth and estimated values in silico. In the patient, both and detected re-vascularisation after 3 months of targeted therapy against liver metastases, consistently with Intra-Voxel Incoherent Motion (IVIM) metrics. Simulation-based modelling of the vascular dMRI signal suggests and as the most promising metrics for tissue microvasculature characterisation. Their estimation in vivo appears feasible to capture general trends, and demonstrates contrasts that are biologically plausible, encouraging their usage in future studies.

The principles underpinning Equity, Diversity and Inclusivity (EDI) are seen by many as being essential in contemporary society while others consider it disparaging and claim it can negatively affect meritocracy. In the USA, EDI is referred to as DEI (Diversity, Equity and Inclusivity) and appears to be under attack by the present governmental agencies. Indeed, multinational companies and other governments are responding in various ways, including partial compliance and outright resistance. Wherever one stands politically on the matter, the International Federation of Anatomical Associations (IFAA) has promulgated a strong statement of intent concerning the importance of EDI and the IFAA Executive, through its Federative International Committee for Equality and Diversity in Anatomy (FICEDA), has also provided guidelines for EDI based on the results of a survey of the IFAA's member associations. The findings of that survey are presented in this article and show a clear recognition by virtually all member associations of the importance of EDI, while highlighting some areas lacking diversity and inclusivity.

With Complex Post Traumatic Stress Disorder (CPTSD) as a new diagnostic category, there is a diversity of interventions and influences on clinical practice, it is prudent that we gather information about current 'treatment as usual'. This study aims to address this need by describing the current clinical landscape of CPTSD treatments offered in NHS services in Scotland. An online survey was distributed via heads of service managers to clinicians working with adults. The survey posed questions about psychological therapy models, professional experience and, for the clinicians' latest 3 discharged cases, the length of therapy and perceived patient outcomes. Forty-nine clinicians, most of whom were clinical psychologists, took part and provided data about 139 clinical cases. Twenty-three different therapeutic models were cited by clinicians, with phase-based approaches described by 64% of clinicians. The modal number of sessions was 21-30. Most cases were described as completed, with 28% ending before therapy was completed, and a further 7% dropped out. Of those who completed therapy, 86% were judged to have improved after therapy, with 11% judged to have deteriorated. There is a wide variety of treatments available for complex PTSD, and innovative interventions and trials are required to support future clinical decision-making about the optimal treatment components and therapy length.

• All age groups reflected similarly on the qualities of supportive adults and on the key role of peers. • School spaces that were most challenging were noisy, crowded and lacking supervision. • Tackling multiple aspects of the school environment together may support mental wellbeing. • Not all of aspects of school environment are equally amenable to change or under school control. There have been reported increases in mental health challenges among young people in the UK, including since the Covid-19 pandemic. There is increasing interest in the role of school environment as both a potential contributing factor to these challenges and as a site for intervention. In Wales, this is embodied in 2021 government legislation which mandates schools to take a whole school approach to emotional and mental wellbeing. This research interviewed pupils in a range of school sites across Wales to discuss aspects of the social and physical environment in school that are perceived as more and less conducive to mental wellbeing. Twelve case study schools were recruited as part of a wider evaluation of the whole school approach in Wales and, within these, twenty-two group interviews took place with pupils of both primary and secondary age. This involved discussion of people and places in the school environment and a draw-write task. Findings highlighted differences between age groups on which adults in school were considered as key in supporting mental wellbeing, although all age groups reflected similarly on the qualities of supportive adults and on the role of peers. There were also overlaps in terms of spaces in school that were most challenging, with noise, crowding and lack of supervision key. Findings suggest that approaches aimed at tackling multiple aspects of both the social and physical school environment may be supportive of positive mental wellbeing, however not all of these aspects are equally amenable to change or under school control.

Medial knee osteoarthritis is increasingly diagnosed in younger adults who are often unsuitable for joint replacement. High tibial osteotomy corrects varus malalignment but is invasive. Gait retraining is a low-cost, non-surgical option to reduce medial tibiofemoral loading, but its effects in varus deformity are unclear. We quantified the immediate biomechanical effects of short-term gait modifications on internal tibiofemoral loading. Twenty-nine patients (30 knees) with medial knee osteoarthritis scheduled for high tibial osteotomy performed three modified gaits: toe out, wide base, and medial thrust. Motion capture and musculoskeletal modelling estimated internal tibiofemoral joint forces in this pre- high tibial osteotomy, varus-aligned cohort. Toe out increased medial loading in early stance but reduced it in late stance. Wide base increased medial and lateral forces early, then reduced medial loading later with compensatory lateral increases. Medial thrust was difficult: only 20/30 knees achieved the target reduction in maximum knee adduction angle, and successful trials still increased early-stance loading. Overall effects were modest, phase-specific, and inconsistent. Generic gait modifications produced small, phase-dependent changes in internal tibiofemoral loading, with early-stance increases, late-stance reductions, and occasional compensatory lateral loading. Longer-term, individualised retraining incorporating symptoms is needed to determine net clinical benefit.

Low back pain (LBP) is a leading cause of global disability. Most cases are non-specific (NSLBP) and lack identifiable causes. Early active management is endorsed by clinical guidelines; however, exercises are rarely customised despite substantial variability in impairments. Existing classification systems can support targeted rehabilitation but require extensive clinical training and lengthy assessment procedures, limiting timely personalised care. This study used AI methods to identify the two most common motor control impairments (MCIs)-flexion and extension patterns (FP/EP)-in NSLBP. The approach used spinal silhouettes extracted from movement videos to enable self-phenotyping and guide personalised exercise selection. Data were collected from a research fellowship involving ninety NSLBP participants classified by an expert physiotherapist (LS) into FP or EP MCIs. Participants performed standard forward- and backward-bend tasks recorded in the sagittal plane. Pose estimation and instance segmentation techniques were applied to extract motion features and spine silhouettes. From each participant, a curated set of 80 black-and-white back images captured at specific bending angles was produced. These features were used to train a feedforward neural network. Model performance was assessed using five-fold cross-validation with accuracy, sensitivity, specificity, F1 score and AUC. The model achieved a diagnostic accuracy of 91.91% (95% CI 84.8-99.1) for backward-bend videos, exceeding reported inter-examiner agreement rates for trained physiotherapists. Robustness was supported by a mean AUC of 0.9422. Accuracy was lower for forward-bend images (86.69%), combined tasks (86.29%), or PROMs alone (63.82%). Adding PROMs to forward- or backward-bend tasks provided only modest improvements (66.32% and 71.62%, respectively). The model reliably distinguished between FP and EP NSLBP subgroups, demonstrating the potential of AI to support timely personalised rehabilitation. The integration of PROMs with motion features reduced classification accuracy, suggesting that self-reported outcomes may provide limited benefit when tailoring exercises to specific physical impairments.