Abstract Specific prevention of sudden cardiac death (SCD) caused by an acute coronary event in the general population has remained a challenge for clinicians since the recognizable risk factors for this fatal outcome of an underlying coronary artery disease (CAD) may be partly the same as those of a non-fatal coronary event. This case-control study was designed to compare genetic and several other factors between consecutive series of survivors (n = 644) and victims of SCD (n = 425) from an acute coronary event. Only subjects with an acute coronary event verified at medico-legal autopsy were included in the SCD group. As controls, 809 subjects without any history of CAD, acute myocardial infarction or aborted cardiac arrest were examined. Subjects to the sub-studies were drawn from these study populations. The increased risk for SCD in the general population was associated with family history of SCD, male gender, smoking, cardiac hypertrophy and the severity of CAD. In the present study, 100% mortality was observed when all these risk factors were present at the time of an acute coronary event. In the subjects with a family history of SCD, the increased risk of SCD was correlated with the severity of CAD without any clustering of coronary risk factors, suggesting that genetic factors affecting the accelerated progression of CAD may have an important role in familial SCD. However, polymorphisms of genes affecting thrombosis, which are believed to have effects on plaque progression and the consequences of plaque complications, were not associated with an increased risk for SCD. The present results show that the risk of SCD at the time of an acute coronary event can be assessed by generally available methods. If a subject is a male smoker and has a family history of SCD, the risk of SCD is substantially increased. In our study sample the currently known polymorphisms affecting thrombosis did not have a major impact in risk stratification of genetic susceptibility for SCD. Simple association studies have clear shortcomings when they attempt to reveal genetic associations with complex outcomes and thus new research strategies are needed to elucidate the genetic background of SCD.

Eleven short fictions are introduced with a discussion of genre. Genre is looked at as being a matter of degree ranging from absolute prose on one end of the spectrum to a very specific form of poem with conventions of its own such as the Shakespearean Sonnet on the other end of the spectrum. The analysis is made in an appeal for the short-short story (or sudden fiction) as being a genre of its own. It is argued that regardless of what category a fiction may fall into (and some of the distinctions seem arbitrary), that what is most important is success at conveying a meaningful experience.

Rates of survival of victims of sudden cardiac arrest (SCA) using cardio pulmonary resuscitation (CPR) have shown little improvement over the past three decades. Since registered nurses (RNs) comprise the largest group of healthcare providers in U.S. hospitals, it is essential that they are competent in performing the four primary measures (compression, ventilation, medication administration, and defibrillation) of CPR in order to improve survival rates of SCA patients. The purpose of this experimental study was to test a color-coded SMOCK system on:1) time to implement emergency patient care measures 2) technical skills performance 3) number of medical errors, and 4) team performance during simulated CPR exercises. The study sample was 260 RNs (M 40 years, SD=11.6) with work experience as an RN (M 7.25 years, SD=9.42).Nurses were allocated to a control or intervention arm consisting of 20 groups of 5-8 RNs per arm for a total of 130 RNs in each arm. Nurses in each study arm were given clinical scenarios requiring emergency CPR. Nurses in the intervention group wore different color labeled aprons (smocks) indicating their role assignment (medications, ventilation, compression, defibrillation, etc) on the code team during CPR. Findings indicated that the intervention using color-labeled smocks for pre-assigned roles had a significant effect on the time nurses started compressions (t=3.03, p=0.005), ventilations (t=2.86, p=0.004) and defibrillations (t=2.00, p=.05) when compared to the controls using the standard of care. In performing technical skills, nurses in the intervention groups performed compressions and ventilations significantly better than those in the control groups. The control groups made significantly (t=-2.61, p=0.013) more total errors (7.55 SD 1.54) than the intervention group (5.60, SD 1.90). There were no significant differences in team performance measures between the groups. Study findings indicate use of colored labeled smocks during CPR emergencies resulted in: shorter times to start emergency CPR; reduced errors; more technical skills completed successfully; and no differences in team performance.

La mort subite est un problème majeur de santé publique. Plus de 75% des morts subites sont d'origine coronaire et la mort subite est le principal mode de décès des infarctus du myocarde (IDM). Une analyse des similitudes et associations entre les deux est nécessaire. Les IDM survenant en heures non ouvrables ont une mortalité accrue. Par une analyse des données du registre francilien du Centre d'Expertise Mort Subite, nous avons constaté une surmortalité en dehors des heures ouvrables suite à une prise en charge initiale moins optimale, la prise en charge médicalisée n’étant pas influencée par l'horaire. Il devient clair que les efforts devraient se focaliser sur la prise en charge très précoce de la mort subite pour améliorer son pronostic.La deuxième partie a visé à identifier, parmi les IDM, ceux à risque de mort subite préhospitalière, afin d’anticiper sa survenue. A partir du registre e-MUST des IDM en Ile-de-France, nous avons identifié 5 facteurs associés à un risque accru de mort subite pré-hospitalière (âge jeune, absence de diabète et d'obésité, dyspnée, délai court entre le début de douleur et l'appel des secours). Nous avons ainsi créé et validé en interne et externe, un score de risque de mort subite. / It becomes clear that efforts should focus on early SCA management. The second part therefore aimed on identifying, among STEMI patients, those at risk of pre-hospital SCA, to plan early SCA management before it occurs. In the e-MUST registry for STEMI in the Greater Paris Area, we identified 5 simple predictors of pre-hospital SCA (young age, absence of obesity, absence of diabetes mellitus, shortness of breath, and short delay between pain onset and call to emergency medical services) that we used to build an SCA prediction score that we validated internally and externally. The first minutes after SCA are the main determinants of its prognosis and should ideally be planned before its occurrence. Anticipation of SCA in STEMI, the main cause of SCA, is feasible, allowing to tailor STEMI management accordingly. Even though the generalizability of this strategy to other causes of SCA remains to be demonstrated, a promising path for decreasing SCA burden can be foreseen.

The diploma thesis deal with what ways drivers react to an unexpected stimulus. In the theoretical part, the analysis of the current state, reaction time, methods of reaction of the driver, stimuli from the environment and finally is being analyzed, the vehicle and its assistance systems. The analytical part of the diploma thesis was performed by driving tests, where it was found that the way the driver reacts from the distance to which they are obstructed and the speed of the vehicle. For that reason, a TTC dependency analysis was performed. It was found that drivers at low TTC values chose an obstacle in which they brake the need to move their foot from the accelerator pedal to the brake pedal and they have to brake sharply. At medium TTC values, drivers brake most often. In the case of a combination of conductors, they chose braking with avoiding at lower TTC values and avoiding with braking at medium TTC values. There was also a dependence of the method of reaction on driving experience. Inexperienced drivers rather choose braking, experienced drivers use combinations.

Title: Being forced to work from home – A focus on how having to work from home following the covid-19 pandemic has affected the employee’s performance and social work life Authors: Ivan Cavar and Malin Jansert Supervisor: Aliaksei Kazlou Background: Because of the recent Covid-19 pandemic many employers had to make the decision to recommend or even force employees to work from home. For some it was an easy transition, for others a real challenge not only by the means of whether one can actually perform their work at home, but also concerning what happens to us when we remove all the necessary social interactions we experience everyday with colleagues and other people connected to the workplace. Aim: The purpose of our research is to understand how the forced shift in working remotely has affected the employees’ attitude towards the professional and social aspects of the workplace. It aims to determine crucial personal and external factors influencing the attitude of said employees, and why (and if) their opinion about their workplace has changed.This paper aims to contribute to the field of external shock in organizations and sudden organizational change. Having waited with the theoretical framework until we had good overview of what the results looked like, we have found the research by Lee and Mitchell (1994) about employee turnover to be relevant to our findings. Although most research about employee turnover concerns itself with turnover per se, we still find the theories discussed relevant as the prerequisite to turnover is attitude changes among employees which is exactly what we want to look at and contribute to. The main contribution of this paper will be to look at how the changes in working routines have affected the specific employee, and how this in turn has affected the employee’s opinion about their workplace. We hope to give a glimpse of how these specific workplaces have been affected and find reasons as to why this might have happened to better understand what factors influence the opinion about the workplace.Completion: To gather information about the perceived changes by employees, a qualitative study has been conducted through 13 interviews among two companies with jobs being based in government administration and academia. The different types of work give us good insight in how the same process has affected professions differently.Conclusion: The professors were affected by the change to a larger extent than the administration employees. Different employees were affected in different ways, but what affected everybody was a loss of social interactions as well as a new outlook on how to perform work.

The Cardiovascular diseases may evocated the high percentual risk of sudden cardiac death in whole world. In several western countries is the number of death higher then number of cancer death. In this time is used a lot of methods for prediction of sudden cardiac death with focus on ECG T-wave alternance. The aim of the theses was to do stronger relation and cooperation with Internal Cardiac Clinic of Faculty Hospital Brno Bohunice on the risk analysis of sudden cardiac death. Secondly, we met the methods used for detection and quantification of simulated TWA. Last but not least was necessary to find TWA detection methods improvement and process the data on real signals obtained from Faculty Hospital Brno Bohunice. First part of the Thesis is focused on summary of pathologic artifacts in ECG signal, which are important for sudden cardiac risk stratification. There are described further known detection and quantification methods for TWA analysis. An interesting part for clinical practice is analysis of TWA trend in time and looking for the best method, which is able to catch and track the short TWA trend changes. Second part describes the new methods improvements, which were tested with interesting outputs. Further, there was developed method for TWA presence statement probability evaluation.

Bakgrund:Ett plötsligt dödsfall beror ofta på sjukdom, olycka, mord eller självmord. År 2017 uppskattar man att cirka 10 360 människor miste livet tidigare än förväntat. När en människa plötsligt avlider kommer det oftast som en chock för de närstående. Det har visat sig att sorgeprocessen för de närstående kan påverkas vid plötsliga dödsfall då de inte varit förberedda på dödsfallet. Även bemötandet de får direkt efter dödsfallet har stor betydelse. Sjuksköterskor har ofta bristfällig utbildning i hur det närstående ska omhändertas vid plötsliga dödsfall och studier har visat att de närstående haft både bra och dåliga upplevelser kring bemötandet. Syfte:Syftet med denna litteraturöversikt var att undersöka sjuksköterskors upplevelse av mötet med närstående vid plötsligt dödsfall. Metod:En litteraturöversikt baserad på elva vetenskapliga artiklar, nio kvalitativa och två kvantitativa artiklar. Resultat:I resultatet framkom att sjuksköterskorna upplevde att de hade ett ansvar för patientens närstående trots att det många gånger upplevdes vara en svår situation och där etiska problem kan uppstå. Majoriteten av sjuksköterskorna upplevde även att de hade bristande kunskap och utbildning i hur närstående ska omhändertas. Även miljön och bristen på resurser gjorde det ofta svårt att kommunicera med de närstående. Diskussion:Sjuksköterskan upplever plötsligt dödsfall som en krävande situation i sin yrkesroll och ställs inför många olika etiska aspekter och känslor.  Att dessutom möta närstående i sorg vid plötslig död är ännu en yttre påfrestning i sjuksköterskans roll. För att sjuksköterskan ska känna sig säker i sin roll är kunskap om bemötande i sorgeprocessen en viktig del i professionen. I resultatdiskussionen tillämpades Joyce Travelbee´s omvårdnadsteori. / Background:A sudden death is often due to illness, accident, murder or suicide. In 2017, it is estimated that approximately 10 360 people lost their lives earlier than expected. When a person suddenly dies, it usually comes as a shock to the relatives. It has been found that the grieving process for those close to the family can be affected by sudden deaths when they have not been prepared for the death. The kind of clinical encounter they receive immediately after the death is also of great importance. Nurses often have inadequate training in how the relatives should be dealt with in the event of sudden death and studies have shown that the relatives have had both good and bad experiences regarding the clinical encounter. Aim:The purpose of this literature review was to investigate nurses' experience of meeting with relatives in the event of a sudden death. Method:A literature review based on eleven scientific articles, nine qualitative and two quantitative articles. Results:The results revealed that the nurses felt that they had a responsibility for the patient's relatives, despite the fact that many times it was perceived to be a difficult situation and where ethical problems could arise. The majority of the nurses also felt that they lacked knowledge and training in how to deal with relatives. The environment and the lack of resources also often made it difficult to communicate with the relatives. Discussion:The nurse experiences sudden death as a demanding situation in her professional role and is faced with many different ethical aspects and feelings.In addition, meeting relatives in mourning in the event of sudden death is yet another external strain in the nurse's role. In order for the nurse to feel secure in her role, knowledge about attending the grief process is an important part of the profession. In the results discussion, Joyce Travelbee's nursing theory was applied.

To evaluate whether cervical spinal neurons can influence cardiac indices and myocyte viability in the acutely ischemic heart, the hearts of anesthetized rabbits subjected to 30. min of LAD coronary arterial occlusion (CAO) were studied 3. h after reperfusion. Control animals were compared to those exposed to pre-emptive high cervical cord stimulation (SCS; the dorsal aspect of the C1-C2 spinal cord was stimulated electrically at 50. Hz; 0.2. ms; 90% of motor threshold, starting 15. min prior to and continuing throughout CAO). Four groups of animals were so tested: 1) neuroaxis intact; 2) prior cervical vagotomy; 3) prior transection of the dorsal spinal columns at C6; and 4) following pharmacological treatment [muscarinic (atropine) or adrenergic (atenolol, prazosin or yohimbine) receptor blockade]. Infarct size (IS) was measured by tetrazolium, expressed as percentage of risk zone. C1-C2 SCS reduced acute ischemia induced IS by 43%, without changing the incidence of sudden cardiac death (SCD). While SCS-induced reduction in IS was unaffected by vagotomy, it was no longer evident following transection of C6 dorsal columns or atropinization. Beta-adrenoceptor blockade eliminated ischemia induced SCD, while alpha-receptor blockade doubled its incidence. During SCS, myocardial ischemia induced SCD was eliminated following vagotomy while remaining unaffected by atropinization. These data indicate that, in contrast to thoracic spinal neurons, i) cranial cervical spinal neurons affect both adrenergic and cholinergic motor outflows to the heart such that ii) their activation modifies ventricular infarct size and lethal arrhythmogenesis.

Background: This is a case study of an 18-year-old female who suffered a bilateral idiopathic sensorineural hearing loss that was coincident with the removal of four impacted wisdom teeth. Throughout childhood the patient had normal hearing for pure tones bilaterally as measured at the pediatrician's office. One month prior to dental surgery (May) the patient volunteered to participate in an auditory experiment at which time her pure-tone audiogram was normal. Immediately following surgery (June), the patient had substantial swelling of the face and complained of some hearing loss with no other auditory/vestibular complaints. The following month (July) during the course of a routine physical examination a pure-tone audiogram revealed bilateral, air-conduction thresholds of 30-35 dB HL (500-4000 Hz) and 20 dB HL (8000 Hz). Because bone conduction was not tested, it is impossible to know whether the hearing loss was conductive, mixed, or sensorineural. The pediatrician thought that the hearing loss was conductive and would resolve as the edema subsided. A month later (August) the subject again volunteered for an auditory experiment at which time her hearing again was tested. Purpose: The purpose of this report is to detail the dental procedures involved in the extraction of the wisdom teeth, to report the results of a variety and series of post-op hearing tests, and to discuss the possible mechanisms that might be involved in the ''idiopathic'' bilateral sensorineural hearing loss. Research Design: Case report. Results: During the August visit to the laboratory, hearing for pure tones bilaterally was 0 to 5 dB HL at 250-1000 Hz with a 40-45 dB HL notch at 2000 Hz with a return to 10 dB HL at 8000 Hz. Air conduction and bone conduction thresholds were equivalent. Word recognition in quiet was ≥92 percent correct for both ears, whereas the signal-to-noise ratio (SNR) hearing loss measured with the Words-in-Noise test was high normal in the left ear with a mild SNR hearing loss in the right ear. Tympanometry and acoustic reflex thresholds were normal. Distortion product otoacoustic emissions were reduced in the 1000-3000 Hz region for both ears, which is consistent with cochlear hearing loss. The hearing loss has remained unchanged for the past 19 months. Conclusions: The possible etiologies, including insults to the cochleae by vibration trauma and through alterations in the blood supply to the cochleae, are considered.