Death, and in special ways, sudden death has struck the church and various families at different times in our lives. The grief in the bereaved has challenged the church, in numerous ways including having to deal with people who are out of possibility with regard to the competencies of the church due stress disorders. This has asked serious theological questions about the pastoral care of the church who is expected to be the custodian of healing through faith. Sudden death as a stressor, has grown to be more common in recent years, and having checked a number of church registers and finding out that there are more funerals than baptisms the church has to conduct, one looks and evaluate the effectiveness of the counseling done through funerals that the church has had to handle---whether there is still meaning accorded to such services or not---whether there is any attempt to engage the bereaved during their mourning in the sound theological reflection on to the questions:<ul><il> “Where, o death, is your victory? “Where, o death, is your sting? (1 Cor. 15: 55).</ul></il> Paul puts it in his address to the Corinthians “the sting of death is sin, and the power of sin is the law. This understanding, and several others usually cited has needed theological reflection in helping the people in grief for their loved ones snatched from them by sudden death, especially when it is through no fault of their own. Quiet practically, many people have befallen prey to stresses of different kinds trying to cope with big losses through sudden death, and this has manifested itself differently. In the event of lack of knowledge of what to do to help such people, the church and pastoral care givers have either conducted many ordinary services (common to those done usually) or have coincidentally engaged one or more of the other fields namely: <ul><il> The medical sciences</il> <il><br> Psychological sciences and/or</il> <il><br> Psychiatrical sciences. </il></ul></il> The work enquires into the improvements that have happened in the course of time in the theological sciences in dealing with people stricken by sudden death through pastoral care, and attempts to allow theology to claim her responsibility in the midst of all mentioned sciences. The work attempts to empower the church and guide all pastoral care givers to skillfully deal with such circumstances as sudden death, invoking the methodology of shepherding to alley the sting of death that has found the church to be lacking, and questioned her credibility on the subject. Effort is put into comparing sudden death with the common ‘bad luck’ perception brought about by cultural traditions. It will attempt to craft the common ground from which the church and all the sciences mentioned can cooperate fruitfully for common goals and better assistance to the people we all serve today. / Thesis (PhD)--University of Pretoria, 2011. / Practical Theology / unrestricted

Abstrakt Hypertrophe Kardiomyopathie (HCM) ist eine genetisch bedingte Herzmuskelerkrankung mit einer Prävalenz von 0,2 bis 0,6% und einem SCD-Risiko von 0,5 bis 1% pro Jahr. HCM ist die häufigste Ursache für plötzlichen Herztod in jungem Alter. Seit Jahrzehnten wird bei HCM der optimale Vorhersagescore für SCD untersucht. Der erste validierte SCD-Sore bei HCM wurde im Jahr 2014 in die ESC-Leitlinien integriert. Ziel der Studie: Vergleich des berechneten SCD-Scores bei HCM aus dem Jahr 2014 vor und nach Alkohol- Septum-Ablation (PTSMA) mit dem erreichten Endpunkt (SCD). Methoden: 56 Patienten mit hypertropher obstruktiver Kardiomyopathie (HOCM) und Erst-PTSMA im Jahr 2009 wurden eingeschlossen: Alter 53,9 ± 11,5 Jahre, 7% positive Familienanamnese für SCD, 9% ungeklärte Synkope im letzten Jahr, 43% NSVT, maximale LV-Wanddicke 20,2 ± 4,3 mm, maximaler LVOT-Gradient 118 ± 42 mmHg, LA-Durchmesser 45,3 ± 6,4 mm. Ergebnisse: Vor dem ersten PTSMA hatten die HOCM-Patienten einen errechneten SCD-Wert von 4,2 ± 3,2%, nach PTSMA von 3,2 ± 2,2%. Wir beobachteten 2 (3,6%) SCD-Fälle in 5 Jahren. Die PTSMA führte zu einer signifikanten Reduktion des errechneten SCD-Scores von 1,0 ± 2,8%, p <0,05. Diese Reduktion war hauptsächlich durch die signifikante Reduktion des LVOT-Gradienten (durchschnittlich 54 ± 42 mmHg, p <0,05) zurückzuführen. Fazit: PTSMA ist eine etablierte Behandlung zur Verbesserung der Symptome bei HOCM-Patienten ohne Hinweis auf eine höhere Mortalität nach induziertem Infarkt. Der ESC-SCD-Score ist nur ein Hilfsalgorithmus für die individuelle Entscheidung bezüglich einer primärprophylaktischen AICD-Implantation. / Abstract Hypertrophic cardiomyopathy (HCM) is a genetic heart muscle disease with a prevalence of 0.2-0.6% and an SCD risk of 0.5-1% per year. HCM is the leading cause of sudden cardiac death at a young age. For decades, the optimal prediction score for SCD has been investigated in HCM. The first validated score for SCD at HCM has been integrated into the ESC guidelines since 2014. Objective of the study: Comparison of the calculated SCD score for HCM from 2014 before and after alcohol septal ablation (PTSMA) with the endpoint reached (SCD). Methods: 56 patients with hypertrophic obstructive cardiomyopathy (HOCM) and first PTSMA in 2009 were included: age 53.9 ± 11.5 years, 7% positive family history for SCD, 9% unexplained syncope last year, 43% NSVTs, maximum LV wall thickness 20.2 ± 4.3 mm, maximal LVOT gradient 118 ± 42 mmHg, LA diameter 45.3 ± 6.4 mm. Results: Before the first PTSMA, the HOCM patients had a calculated SCD score of 4.2 ± 3.2%, after PTSMA 3.2 ± 2.2%. We observed 2 (3.6%) SCD patients in 5 years. PTSMA resulted in a significant reduction in the calculated SCD score of 1.0 ± 2.8%, p <0.05. This reduction was mainly due to the significant reduction in the LVOT gradient to 54 ± 42 mmHg (p <0.05). Conclusion: PTSMA is an established treatment to improve symptoms in HOCM patients without evidence of higher mortality after induced infarction. The ESC-SCD score is only an aid algorithm for individual decision to implante an ICD for primary prevention of SCD.

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There are thirty-six appearances of the Greek word ἐξαίφνης in Plato’s dialogues. Usually translated as “all of a sudden” or “suddenly,” ἐξαίφνης emerges in several significant passages. For example, ἐξαίφνης appears three times in the “allegory of the cave” from Republic vii, and heralds the vision of the Beautiful in Symposium. Commonly translated in the Parmenides as “the instant,” ἐξαίφνης also surfaces in a crucial section of the dialogue’s training exercise. This dissertation demonstrates the connection obtaining between the thirty-six scattered appearances of ἐξαίφνης in order to reveal the role it plays in linking Plato’s theory of ideas with education. In short, it discloses how Plato’s step-by-step, methodical approach to philosophical education climaxes with a dynamic conversion experience signified by the appearance of ἐξαίφνης. / McAnulty College and Graduate School of Liberal Arts; / Philosophy / PhD; / Dissertation;

Background: In Sweden about 19000 people fall victims of sudden death every year. This covers around 20% of all deaths. Relatives are those who are closest to the patient, regardless of the type of relationship. When a patient suddenly dies this affects the relatives and they can suffer from high risk of complicated grief reactions or crises. Being the nearest professional contact in these situations, the nurse has an important role in supporting and guiding the relatives. Aim: The aim of this literature review was to nominate the relatives' needs of support from the nurse when a loved person suddenly dies. Method: The literature review was based on seven articles with a quality approach. Results:The analysis resulted in four themes; "to be seen and confirmed", "information", "take farewell" and "follow-up ". To be able to give support both mentally and physically, it is important for the nurse to give proper attention to the relatives. The nurse supports according to individual circumstances, giving clear and concise information. With privacy, peace and quiet the nurse may create the conditions for a dignified farewell. Afterwards, when the shock phase subsides, many questions need to be answered and a follow-up meeting is important. Conclusion: As nurses we will meet with relatives of patients who have suddenly died. Our results are, however, useful in all types of care, not only in cases of sudden death. The nurse´s attention to the relatives is an important factor in health care. Knowledge about the benefits of taking care of relatives in a situation of sudden death is, currently insufficient. Knowledge of the reactions of relatives who are confronted with sudden death needs to be further explored and existing research needs to be conducted / implemented in health care.

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