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Background: Post-sepsis cardiomyopathy is associated with an increased risk of adverse cardiovascular outcomes. It remains poorly understood, which limits therapeutic development. This study characterised post-sepsis cardiomyopathy using cardiovascular magnetic resonance (CMR) imaging. Methods: Patients admitted with acute sepsis and suspected cardiac injury or heart failure who subsequently (47 days [IQR: 22–122]) underwent CMR at a UK tertiary cardiac centre were included. Age- and gender-matched controls (n = 16) were also included. Subjects underwent CMR at 1.5 Tesla with cines, native T1- and T2-mapping, and late gadolinium enhancement (LGE) imaging. Results: Of the 22 post-sepsis patients (age 50 ± 13 years; 64% males), 13 patients (59%) had left ventricular (LV) dilatation. Patients had significantly elevated left ventricular (LV) end-diastolic and end-systolic volume indices compared to controls (p = 0.011 and p = 0.013, respectively). Eleven patients (50%) had LV systolic dysfunction (ejection fraction < 50%), most of whom (8/11) had non-ischaemic patterns of LGE (n = 7 mid-wall; n = 1 mid-wall/patchy). In the eleven patients with preserved LV systolic function (ejection fraction ≥ 50%), three patients (27%) had significant LGE (n = 1 mid-wall; n = 1 subepicardial/mid-wall; n = 1 patchy). Compared to controls, patients had elevated septal native myocardial T1 values (p < 0.001) but similar septal native myocardial T2 values (p = 0.090), suggesting the presence of myocardial fibrosis without significant oedema. Conclusions: Post-sepsis cardiomyopathy is characterised by LV dilatation, systolic dysfunction, and myocardial fibrosis in a non-ischaemic distribution. Significant myocardial oedema is not prominent several weeks post-recovery. Further work is needed to test these findings on a multi-centre basis and to develop novel therapies for post-sepsis cardiomyopathy.

The EDDA plastic scintillator detector system at the Cooler Synchrotron (COSY) has been used to demonstrate that it is possible using a thick target at the edge of the circulating beam to meet the requirements for a polarimeter to be used in the search for an electric dipole moment on the proton or deuteron. Emphasizing elastic and low Q-value reactions leads to large analyzing powers and, along with thick targets, to efficiencies near 1%. Using only information obtained comparing count rates for oppositely vector-polarized beam states and a calibration of the sensitivity of the polarimeter to rate and geometric changes, the contribution of systematic errors can be suppressed below the level of one part per million.

Doc number: E119

IntroductionLung cancer is a leading cause of cancer deaths worldwide and surgery remains the main treatment for early stage disease. Prior to the introduction of video-assisted thoracoscopic surgery (VATS), lung resection for cancer was undertaken through an open thoracotomy. To date, the evidence base supporting the different surgical approaches is based on non-randomised studies, small randomised trials and is focused mainly on short-term in-hospital outcomes.Methods and analysisThe VIdeo assisted thoracoscopic lobectomy versus conventional Open LobEcTomy for lung cancer study is a UK multicentre parallel group randomised controlled trial (RCT) with blinding of outcome assessors and participants (to hospital discharge) comparing the effectiveness, cost-effectiveness and acceptability of VATS lobectomy versus open lobectomy for treatment of lung cancer. We will test the hypothesis that VATS lobectomy is superior to open lobectomy with respect to self-reported physical function 5 weeks after randomisation (approximately 1 month after surgery). Secondary outcomes include assessment of efficacy (hospital stay, pain, proportion and time to uptake of chemotherapy), measures of safety (adverse health events), oncological outcomes (proportion of patients upstaged to pathologic N2 (pN2) disease and disease-free survival), overall survival and health related quality of life to 1 year. The QuinteT Recruitment Intervention is integrated into the trial to optimise recruitment.Ethics and disseminationThis trial has been approved by the UK (Dulwich) National Research Ethics Service Committee London. Findings will be written-up as methodology papers for conference presentation, and publication in peer-reviewed journals. Many aspects of the feasibility work will inform surgical RCTs in general and these will be reported at methodology meetings. We will also link with lung cancer clinical studies groups. The patient and public involvement group that works with the Respiratory Biomedical Research Unit at the Brompton Hospital will help identify how we can best publicise the findings.Trial registration number ISRCTN13472721

This dissertation presents my composition Chamber Concerto for nine players and electronics. An accompanying commentary examines notions of hybridity in the work, focusing particularly on the hybridization of overtone-based and equal-tempered conceptions of harmony.

Background Knowledge of cardiac arrest (CA) causes other than coronary artery disease is derived predominantly from post-mortem studies, identifying hypertrophic cardiomyopathy (HCM) as the commonest diagnosis. Management of CA survivors mandates definite attempts towards diagnosis, particularly as the cause may be inherited with implications for family screening. Our approach to non-ischaemic CA includes cardiac magnetic resonance (CMR) and electrophysiological (EP) assessment. Methods We identified 102 consecutive CA survivors (VT/VF CA or VT requiring cardioversion) without obstructive CAD who presented to our institution to evaluate this strategy (2008–13). Results Mean age was 51 years (range 19–80), 66% were male; median CA to CMR interval was 10 days (IQR 12). CMR findings contributed to a structural diagnosis in 54 (53%). In the remaining 48, EP studies in 34 contributed to a diagnosis in 7 (7%). Accordingly, we identified a diagnosis in 61 patients (60%). In the 54 with structural disease, dilated cardiomyopathy (DCM) was diagnosed in 21 (39%), myocarditis 16 (30%–4 with sarcoid), missed myocardial infarction 8 (15%), HCM 5 (9%), arrhythmogenic right ventricular cardiomyopathy in 2 (4%), amyloid in 1 (2%) and severe valve disease in 1 (2%). EP causes were identified in 7: accessory pathways (3), long QT (3) and Brugada Syndrome (1). Only 4 patients had previous cardiac diagnoses (all DCM). In the 41 with no clear diagnosis, CMR findings of uncertain significance were detected in 15 patients; tissue abnormalities in 7, mild left ventricular (LV) hypertrophy in 3 and mild LV systolic impairment in 5. DCM later developed in 2. Follow up data was available for 84 patients; 64 (76%) had an ICD implanted, 2 died before implantation and 2 declined. CA risk was considered treated or transient in the remainder. During mean follow-up of 31-months, appropriate ICD therapy was received by 12/36 (33%) structural diagnosis patients, 1/4 (25%) EP patients and 6/24 (25%) patients with no cardiac diagnosis. Conclusions MRI and EP studies are key components of the investigation of non-ischaemic CA survivors, leading to diagnosis in 60% of patients. Our study describes heterogeneous diagnoses, with DCM and myocarditis the commonest identified. Notably, 40% of CA survivors have no cardiac diagnosis, have high rates of ICD therapy and may have pre-phenotypic cardiomyopathy.

Today in the federal government, department and agency human capital (HC) offices are expected to be an integral part of the organization’s strategic planning and provide assistance to operational managers on how to address their HC challenges. But to do that, HC offices must first gain credibility by delivering basic HC services in an efficient and effective way. The HC office will have difficulty convincing agency leadership that it deserves “a seat at the table” if hiring processes are slow, basic personnel functions are error-prone, and paychecks are not accurate.