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Introduction
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Publications
Publications (117)
Two of the most well-studied types of reasoning are analogical reasoning (AR) and deductive reasoning (DR). Yet, our understanding of the relationship between reasoning abilities and their neuroanatomical basis remains surprisingly limited. We aimed to conduct fine-grained anatomical mapping of performance on tests of AR, DR and fluid intelligence...
BACKGROUND
Cannabinoids are being explored as potential treatments for gastroparesis due to their anti-emetic, gastric motility modulation, appetite stimulation, and analgesic properties coupled with their increasing use due to legalization in many states. While these theoretical benefits are promising, clinical evidence remains limited. This study...
Background
Atrial fibrillation causes one-fifth of ischaemic strokes, with a high risk of early recurrence. Although long-term anticoagulation is highly effective for stroke prevention in atrial fibrillation, initiation after stroke can be delayed by concerns over intracranial haemorrhage risk. Direct oral anticoagulants offer a significantly lower...
Ischaemic stroke, a leading cause of death and disability, critically relies on neuroimaging for characterising the anatomical pattern of injury. Diffusion-weighted imaging (DWI) provides the highest expressivity in ischemic stroke but poses substantial challenges for automated lesion segmentation: susceptibility artefacts, morphological heterogene...
Background
A high prevalence of disorders of gut‐brain interaction (DGBI) exist in patients with hypermobile Ehlers‐Danlos Syndrome (hEDS) and hypermobility spectrum disorders (HSD). However, it is unknown if clusters of hEDS/HSD patients exist which overlap with different DGBIs and whether this overlap influences presence of comorbidities and qual...
BACKGROUND
Residual tumour burden after surgery in GBM patients is a prognostic imaging biomarker, often involving the area of T2 signal elevation surrounding the tumour core, histopathologically representing infiltrative oedema with tumour cells. We present the first stage of a model to improve the prediction GBM recurrence by specifically investi...
AIMS
Residual tumour burden after surgery in GBM patients is a prognostic imaging biomarker, often involving the area of T2 signal elevation surrounding the tumour core, histopathologically representing infiltrative oedema with tumour cells. We present the first stage of a model to improve the prediction GBM recurrence by specifically investigating th...
AIMS
The VASARI (Visually AcceSAble Rembrandt Images) MRI feature set is a quantitative system designed to standardize glioma imaging descriptions. Though effective, deriving VASARI is time-consuming and therefore seldom used in clinical practice. This is however a problem that performant machine-learning software could plausibly automate.
METHOD...
AIMS
To develop non-linear machine learning models using the XGBoost algorithm to predict a continuous (overall survival (OS) and a binary survival outcome (OS > 5 years) using clinical, molecular and genetic, and radiomic data.
METHOD
Patients with LGGs treated at a single institution (2005-2020) with histology and MRIs at the time of malignant t...
Intracranial pressure (ICP) is a physiological parameter that conventionally requires invasive monitoring for accurate measurement. Utilising multivariate predictive models, we sought to evaluate the utility of non-invasive, widely accessible MRI biomarkers in predicting ICP and their reversibility following cerebrospinal fluid (CSF) diversion. The...
The VASARI MRI feature set is a quantitative system designed to standardise glioma imaging descriptions. Though effective, deriving VASARI is time-consuming and seldom used clinically. We sought to resolve this problem with software automation and machine learning. Using glioma data from 1172 patients, we developed VASARI-auto, an automated labelli...
The architecture of the brain is too complex to be intuitively surveyable without the use of compressed representations that project its variation into a compact, navigable space. The task is especially challenging with high‐dimensional data, such as gene expression, where the joint complexity of anatomical and transcriptional patterns demands maxi...
Introduction
Functional bowel disorders (FBDs) are multi-dimensional diseases varying in demographics, symptomology, lifestyle, mental health, and susceptibility to treatment. The patient lived experience is an integration of these factors, best understood with appropriately multivariate models.
Methods
In a large patient cohort (n=1175), we devel...
Objective: Functional bowel disorders (FBDs) are multi-dimensional diseases varying in demographics, symptomology, lifestyle, mental health, and susceptibility to treatment. The patient lived experience is an integration of these factors, best understood with appropriately multivariate models.
Methods: In a large patient cohort (n=1175), we develop...
Treatments are prescribed to individuals in pursuit of contemporaneously unobserved outcomes, based on evidence derived from populations with historically observed treatments and outcomes. Since neither treatments nor outcomes are typically replicable in the same individual, alternatives remain counterfactual in both settings. Prescriptive fidelity...
Introduction
Disorders of Gut-Brain Interaction (DGBI) are common in patients with hypermobile Ehlers Danlos Syndrome/Hypermobility Spectrum Disorder (hEDS/HSD). Food is a known trigger for DGBI symptoms which often leads to dietary alterations and increasingly, nutrition support. We aimed to explore dietary behaviours and influencing factors in hE...
AIMS
Gliomas typically exhibit a spectrum of genetic mutations, reflecting multiple, potentially complex interactions across distinct molecular pathways. Predicting disease evolution and prescribing individually optimal treatment plausibly requires statistical models complex enough to capture the intricate genetic structure underpinning oncogenesis...
AIMS
Tumour heterogeneity is increasingly recognized as a major obstacle to therapeutic innovation in neuro- oncology. Gliomas typically exhibit a spectrum of genetic mutations, reflecting multiple, potentially complex molecular interactions, and vary widely in their imaging appearances across size, morphology, texture, anatomical distribution, and...
AIMS
The quantitative evaluation of gliomas using the VASARI MRI feature sets aims to facilitate consistent radiological reporting of gliomas but rarely done in clinical practice due to user variability in addition to technical and time constraints. We questioned whether deep-learning driven systems for automated VASARI feature derivation might res...
AIMS
Low grade gliomas (LGG) represent 14.6% of gliomas and may remain stable years after initial diagnosis. MRI features suggesting malignant transformation (MT) include enlargement of non-enhancing areas and increasing enhancement but have low specificity. We report the first stages of a deep learning model to predict survival using radiomic feat...
Tumour heterogeneity is increasingly recognized as a major obstacle to therapeutic success across neuro-oncology. Gliomas are characterized by distinct combinations of genetic and epigenetic alterations, resulting in complex interactions across multiple molecular pathways. Predicting disease evolution and prescribing individually optimal treatment...
The quantification of cognitive powers rests on identifying a behavioural task that depends on them. Such dependence cannot be assured, for the powers a task invokes cannot be experimentally controlled or constrained a priori, resulting in unknown vulnerability to failure of specificity and generalisability. Evaluating a compact version of Raven's...
Foundational models such as ChatGPT critically depend on vast data scales the internet uniquely enables. This implies exposure to material varying widely in logical sense, factual fidelity, moral value, and even legal status. Whereas data scaling is a technical challenge, soluble with greater computational resource, complex semantic filtering canno...
Objective
Mechanisms of abdominal pain in children are not fully understood due to patient heterogeneity. We aimed to identify abdominal pain phenotypes in children to facilitate the investigation of phenotypic-genotypic associations and to determine risk factors for abdominal pain.
Design
This study included 13,789 children from a large birth coh...
Progress in neuro-oncology is increasingly recognized to be obstructed by the marked heterogeneity—genetic, pathological, and clinical—of brain tumours. If the treatment susceptibilities and outcomes of individual patients differ widely, determined by the interactions of many multimodal characteristics, then large-scale, fully-inclusive, richly phe...
Background
Intracranial pressure (ICP) is a physiological parameter that conventionally requires invasive monitoring for accurate measurement. Utilising multivariate predictive models, we sought to evaluate the utility of non-invasive, accessible MRI biomarkers in predicting ICP and their reversibility following cerebrospinal fluid (CSF) diversion....
The distributed nature of the neural substrate, and the difficulty of establishing necessity from correlative data, combine to render the mapping of brain function a far harder task than it seems. Methods capable of combining connective anatomical information with focal disruption of function are needed to disambiguate local from global neural depe...
Tumour heterogeneity is increasingly recognized as a major obstacle to therapeutic success across neuro-oncology. Gliomas are characterised by distinct combinations of genetic and epigenetic alterations, resulting in complex interactions across multiple molecular pathways. Predicting disease evolution and prescribing individually optimal treatment...
Fluid intelligence is arguably the defining feature of human cognition. Yet the nature of its relationship with the brain remains a contentious topic. Influential proposals drawing primarily on functional imaging data have implicated ‘multiple demand’ frontoparietal and more widely distributed cortical networks, but extant lesion-deficit studies wi...
Brain tumour segmentation remains a challenging task, complicated by the marked heterogeneity of imaging appearances and their distribution across multiple modalities: FLAIR, T1-weighted, T2-weighted, and contrast-enhanced T1-weighted sequences (T1CE). This has compelled a research focus on uniformly multimodal models trained on complete acquisitio...
Tumor heterogeneity is increasingly recognized as a major obstacle to therapeutic innovation across neuro-oncology. Gliomas typically exhibit a spectrum of possible genetic mutations, reflecting multiple, potentially complex interactions across distinct molecular pathways. Predicting disease evolution and prescribing individually optimal treatment...
Tumor heterogeneity is increasingly recognized as a major obstacle to therapeutic innovation in neuro-oncology. Gliomas typically exhibit a spectrum of genetic mutations, reflecting multiple, potentially complex molecular interactions, and vary widely in their imaging appearances across size, morphology, texture, anatomical distribution, and many o...
The distributed nature of the neural substrate, and the difficulty of establishing necessity from correlative data, combine to render the mapping of brain function a far harder task than it seems. Methods capable of combining connective anatomical information with focal disruption of function are needed to disambiguate local from global neural depe...
Equity is widely held to be fundamental to the ethics of healthcare. In the context of clinical decision-making, it rests on the comparative fidelity of the intelligence – evidence-based or intuitive – guiding the management of each individual patient. Though brought to recent attention by the individuating power of contemporary machine learning, s...
Background
Dysfunction in the autonomic nervous system is common throughout many functional gastrointestinal diseases (FGIDs) that have been historically difficult to treat. In recent years, transcutaneous vagal nerve stimulation (tVNS) has shown promise for improving FGID symptoms. However, the brain effects of tVNS remain unclear, which we invest...
AIMS
Brain tumour segmentation remains a challenging task, complicated by the marked heterogeneity of imaging appearances and their distribution across multiple modalities: FLAIR, T1-weighted, T2-weighted, and contrast-enhanced T1-weighted sequences (T1CE). But the use of all four imaging sequences is not always possible. The causes for this are le...
AIMS
Brain tumours are heterogenous entities comprising multiple broad tissue sub-types when imaged with MRI. Delineating the enhancing tumour component is vital for neuro-oncological therapeutic planning, to-date only demonstrable with contrast-enhanced imaging. But not all patients can undergo this necessary contrast-enhanced acquisition, whether...
Hematological malignancies place individuals at risk of CNS involvement from their hematological disease and opportunistic intracranial infection secondary to disease-/treatment-associated immunosuppression. Differentiating CNS infection from hematological disease infiltration in these patients is valuable but often challenging. We sought to determ...
Fluid intelligence is arguably the defining feature of human cognition. Yet the nature of its relationship with the brain remains a contentious topic. Influential proposals drawing primarily on functional imaging data have implicated “multiple demand” frontoparietal and more widely distributed cortical networks, but extant lesion-deficit studies wi...
Equity is widely held to be fundamental to the ethics of healthcare. In the context of clinical decision-making, it rests on the comparative fidelity of the intelligence -- evidence-based or intuitive -- guiding the management of each individual patient. Though brought to recent attention by the individuating power of contemporary machine learning,...
Background: The complex heterogeneity of brain tumours is increasingly recognized to demand data of magnitudes and richness only fully-inclusive, large-scale collections drawn from routine clinical care could plausibly offer. This is a task contemporary machine learning could facilitate, especially in neuroimaging, but its ability to deal with inco...
Introduction
Patients with Hypermobile Ehlers Danlos Syndrome(hEDS) pose complex nutritional challenges which can result in commencing Artificial Nutrition(AN). The factors that influence this and the prevalence of associated complications remains unknown.
Methods
hEDS patients from the charity organisation Ehlers-Danlos Support UK and tertiary Ne...
Introduction
Disorders of Gut-Brain Interaction (DGBI) may be associated with dietary alterations in Hypermobile Ehlers Danlos Syndrome (hEDS), yet the dietary behaviours and factors that influence them remain unknown.
Methods
Cross sectional study from August ‘21 to January ‘22. hEDS patients from the charity organisation Ehlers-Danlos Support UK...
The value of biomedical research—a $1.7 trillion annual investment—is ultimately determined by its downstream, real-world impact, whose predictability from simple citation metrics remains unquantified. Here we sought to determine the comparative predictability of future real-world translation—as indexed by inclusion in patents, guidelines, or polic...
The value of biomedical research--a $1.7 trillion annual investment--is ultimately determined by its downstream, real-world impact. Current objective predictors of impact rest on proxy, reductive metrics of dissemination, such as paper citation rates, whose relation to real-world translation remains unquantified. Here we sought to determine the com...
The autonomic nervous system governs the body's multifaceted internal adaptation to diverse changes in the external environment, a role more complex than is accessible to the methods — and data scales — hitherto used to illuminate its operation. Here we apply generative graphical modelling to large-scale multimodal neuroimaging data encompassing no...
Patients with haematological malignancy are at increased risk of developing central nervous system (CNS) infections, which are associated with significant morbidity and mortality. Neuroimaging plays a pivotal role in the diagnostic pathway of these patients; however, layers of complexity are added to image interpretation by the heterogeneity in ima...
Introduction
Chronic constipation is classified into two main syndromes, irritable bowel syndrome with constipation (IBS-C) and functional constipation (FC), on the assumption that they differ along multiple clinical characteristics and are plausibly of distinct pathophysiology. We tested this assumption by applying machine learning to a large pros...
![Figure 1. Network architecture [7] employed for the models used in this...](publication/346259976/figure/fig1/AS:1021206111211520@1620485918813/Network-architecture-7-employed-for-the-models-used-in-this-investigation_Q320.jpg)
Image segmentation is a computer vision task aiming to establish a probabilistic mapping between individual pixels (2D) or voxels (3D) in an input image and a set of predefined semantic categories with reference to domain-specific knowledge. When applied to medical images, e.g. Magnetic Resonance Imaging (MRI), it allows delineation between healthy...
Introduction:
Chronic constipation is classified into 2 main syndromes, irritable bowel syndrome with constipation (IBS-C) and functional constipation (FC), on the assumption that they differ along multiple clinical characteristics and are plausibly of distinct pathophysiology. Our aim was to test this assumption by applying machine learning to a...
Background
The vagus nerve exerts an anti‐nociceptive effect in the viscera.
Aims
To investigate whether transcutaneous vagal nerve stimulation (t‐VNS) prevents the development and/or reverses established visceral hypersensitivity in a validated model of acid‐induced oesophageal pain.
Methods
Before and after a 30‐minute infusion of 0.15M hydroch...
Image segmentation is a computer vision task aiming to establish a probabilistic mapping between individual pixels (2D) or voxels (3D) in an input image and a set of predefined semantic categories with reference to domain-specific knowledge. When applied to medical images, e.g. Magnetic Resonance Imaging (MRI), it allows delineation between healthy...
The application of automated algorithms to imaging requires knowledge of its content, a curatorial task, for which we ordinarily rely on the Digital Imaging and Communications in Medicine (DICOM) header as the only source of image meta-data. However, identifying brain MRI scans that have full or near-full coverage among a large number (e.g. >5000)...
Introduction
Clinical practice and trial endpoints studying chronic constipation typically define therapeutic success by increasing stool frequency, using this as a marker for improvement in symptom burden and patient quality of life (QOL). However, given constipation engenders numerous other distressing symptoms, such as abdominal pain, bloating,...
Introduction
The Patient Assessment of Constipation Symptoms (PAC-sym) is a widely validated questionnaire that numerically quantifies symptom burden in patients with constipation. PAC-sym evaluates various domains, including pain, bloating, tenesmus, rectal bleeding, straining and the quality of the bowel movement by volume or hardness of stool pa...
Irritable bowel syndrome (IBS)is a functional gastrointestinal disorder characterized by chronic abdominal pain associated with a change in frequency and form of stool. IBS is common, with a population prevalence of around 10%, and causes a reduction in quality of life. Its pathophysiology remains incompletely understood, although abnormal communic...
Key points
Nausea is an adverse experience characterised by alterations in autonomic and cerebral function.
Susceptibility to nausea is difficult to predict, but machine learning has yet to be applied to this field of study.
The severity of nausea that individuals experience is related to the underlying morphology (shape) of the subcortex, namely o...
Background
Linaclotide is efficacious in the management of irritable bowel syndrome with constipation (IBS‐C), yet relatively little is known regarding its effect on human gastrointestinal physiology. The primary aim of the study was to examine the effect of linaclotide on change in pH across the ileocecal junction (ICJ), a proposed measure of ceca...
Interoception is defined as a “sensitivity to stimuli arising inside of the body,” in contrast to exteroception which can be defined as a “sensitivity to stimuli arising outside of the body.” There are a myriad of “gut feelings” which, taken together, form the construct of gastrointestinal (GI) interoception. The GI tract is the second most innerva...
Technological advances in artificial intelligence (AI) represent an enticing opportunity to benefit gastroenterological practice. Moreover, AI, through machine or deep learning, permits the ability to develop predictive models from large datasets. Possibilities of predictive model development in machine learning are numerous dependent on the clinic...
Background
Irritable bowel syndrome (IBS) is common and is characterised by recurrent abdominal pain, which is a major contributor to healthcare seeking. The neurobiological basis of this pain is incompletely understood. Conditioned pain modulation is a neuromodulatory mechanism through which the brain inhibits the nociceptive afferent barrage thro...
Abstract The mechanisms that underpin the anti-nociceptive effect of the parasympathetic nervous system (PNS) on visceral pain remain incompletely understood. We sought to describe the effect of resting parasympathetic tone on functional brain networks during the anticipation and experience of oesophageal pain. 21 healthy participants had their res...
Objective: Nausea is an unpleasant experience characterised by a range of gastric, cardiac, psychological and sopite symptoms. Nausea susceptibility is highly variable between individuals, which we hypothesised could be attributed to differences in brain struc- ture. We therefore aimed to investigate this by studying subcortical brain morphology in...
Objective: Nausea is a common symptom in gastrointestinal disorders. Whilst the neural response for emesis is defined, the brain process- ing of nausea remains poorly characterised. Moreover, it is unknown whether nausea can be predicted accurately from its neuro-signature.We thus aimed to address this knowledge gap using functional mag- netic reso...
Objective: Opioids are potent analgesics used for the treatment of pain. Side effects are common and amongst the most debilitating are those associated with opioid-induced constipation (OIC). Naloxegol is an oral, once daily, peripherally acting mu opioid receptor antago- nist, licensed for the treatment of OIC (1). We aimed to evaluate the utility...
Figure S1 Partial regression plot showing regional blood flow values extracted from the cluster found to be associated with component 1 derived from the principal component analysis.
Introduction
Nausea is an unpleasant experience characterised by a range of gastric, cardiac, psychological and sopite symptoms. The brain processing of nausea is poorly understood. A number of factors have been proposed to influence an individual’s experience of nausea, including age, gender, autonomic nervous system (ANS) and neuroanatomy; includ...
Background
Functional gastrointestinal disorders (FGID) are common and characterised by chronic unexplained visceral pain. Conditioned pain modulation (CPM), a bulbar reflex permitting ‘’pain to inhibit pain’’ by descending inhibition, is a validated measure that interrogates the brain-gut axis. Previous studies variably implicate diminished CPM in...
Introduction
Visceral pain is influenced by an array of individual factors. We have previously coalesced many of these, reporting that two major endophenotypic ‘pain clusters’ exist: Pain Cluster 1 (PC1), in comparison to Pain Cluster 2 (PC2), had higher neuroticism and anxiety scores, higher baseline sympathetic tone and serum cortisol, but during...
Visceral information reaches the brain through a diverse array of neural, humoral, and immune pathways, conveying an abundance of ascending visceral information that helps to maintain homeostasis within the gastrointestinal (GI) tract. While the vast majority of these physiological processes are subconscious, those that do enter the consciousness i...
Background
Traditional psychometric measures aimed at characterizing the pain experience often show considerable overlap, due to interlinked affective and modulatory processes under central nervous system control. Neuroimaging studies have been employed to investigate this complexity of pain processing, in an attempt to provide a quantifiable, adju...
Introduction: Visceral pain is a complex percept influenced by numerous factors. Of these, differences in the autonomic nervous system (ANS)–in particular, para- sympathetic cardiac vagal tone (CVT)–has been suggested to have a physiological role in the regulation and modulation of painful sensory signalling, to the extent of vagal nerve stimulatio...
The autonomic nervous system (ANS) is a brain body interface which serves to maintain homeostasis by influencing a plethora of physiological processes, including metabolism, cardiorespiratory regulation and nociception. Accumulating evidence suggests that ANS function is disturbed in numerous prevalent clinical disorders, including irritable bowel...
The autonomic nervous system (ANS) is a brain body interface which serves to maintain homeostasis by influencing a plethora of physiological processes, including metabolism, cardiorespiratory regulation and nociception. Accumulating evidence suggests that ANS function is disturbed in numerous prevalent clinical disorders, including irritable bowel...
The autonomic nervous system (ANS) is a brain body interface which serves to maintain homeostasis by influencing a plethora of physiological processes, including metabolism, cardiorespiratory regulation and nociception. Accumulating evidence suggests that ANS function is disturbed in numerous prevalent clinical disorders, including irritable bowel...
The autonomic nervous system (ANS) is a brain body interface which serves to maintain homeostasis by influencing a plethora of physiological processes, including metabolism, cardiorespiratory regulation and nociception. Accumulating evidence suggests that ANS function is disturbed in numerous prevalent clinical disorders, including irritable bowel...
Introduction: Avascular necrosis is defined as the death of bone tissues secondary to lack of inadequate vascular supply. Its aetiology is numerous, and sometimes multifactorial, but in essence may be caused by any perturbation in bony vasculature 1. Such examples range from fracture, joint dislocation, slipped and epiphysis, to more complex diseas...
INTRODUCTION & AIM: Differences in parasympathetic cardiac vagal tone (CVT) has been suggested to have a physiologi- cal role in the regulation and modulation of painful sensory signal- ling, to the extent of vagal nerve stimulation (to raise subject CVT) being tested as a possible anti-nociceptive. To date, no studies have explored the brain funct...
Introduction: Visceral pain is a complex experience, and is influenced by an array of physiological, psychological and anatomical factors. Previous research from our group has coalesced many of these factors, demonstrating that two major endophenotypic ‘pain clusters’ (PC) exist with the following features: Pain Cluster 1 (PC1), in comparison to Pa...
