Sudden Infant Death (SIDS) has been associated with medium-chain acyl-CoA dehydrogenase (MCAD) deficiency, an inborn error of fatty acid oxidation. Blood and tissue samples from a large cohort of SIDS victims were analyzed for the presence of dodecanoic acid (C₁₂) by gas chromatography. A subgroup of these cases had a significantly higher blood concentration than age-matched controls, suggesting MCAD deficiency. An animal study using Sprague-Dawley rats was done to mimic the effects of MCAD deficiency. Significantly increased blood concentrations of dodecanoic acid were observed. Decreased values in heart and liver were puzzling findings. The data indicate that dodecanoic acid is a blood marker for MCAD deficiency.

Abstract Physical activity with regular physical exercise (PE) has long been advocated because it lowers morbidity and mortality. However, there have been concerns about a transiently increased risk of adverse cardiac events such as sudden cardiac death (SCD) during PE. Our aim was to identify risk factors related to SCD during PE and clarify the effect of PE on cardiovascular well-being in the general population. In study I we found out that male gender as well as coronary artery disease (CAD), cardiac hypertrophy and myocardial scarring as autopsy-findings were clearly more common among exercise-related SCD. Typical northern activities in skiing and snow shoveling were among the three most common types of PE alongside cycling. In study II we analyzed the previously recorded electrocardiograms (ECG) of victims of SCD. Fragmented QRS complex (fQRS) in anterior leads was a common finding among subjects who died during exercise, especially among subjects with a prior diagnosis of CAD. In study III, we collected retrospectively out-of-hospital sudden cardiac arrest (SCA) data in Northern Ostrobothnia between the years 2007 and 2012. The subjects who suffered SCA in relation to PE were younger and previously healthier, and they had more often a shockable rhythm as the initial rhythm. There was a markedly better prognosis for hospital discharge when SCA occurred during PE. In study IV, we noticed a decrease in cardiac mortality in subjects who were physically active or became active during follow-up in a population of 1,746 stable CAD patients. A similar effect could be seen affecting SCD mortality. No increase in cardiac mortality could be seen among those with the highest levels of habitual PE. In conclusion, ischemic heart disease and male gender, especially when fQRS is present in anterior leads, are characteristics related to exercise-related SCD. On the other hand, when SCA takes place during PE, the prognosis is markedly better compared to SCA occurring at rest. An active lifestyle is also linked to decreased cardiac mortality. / Tiivistelmä Säännöllinen aktiivinen elämäntapa on yhteydessä pienempään fyysisten ja psyykkisten sairauksien riskiin. Tutkimuksissa on kuitenkin havaittu raskaampaan liikuntaan liittyvä väliaikaisesti lisääntynyt akuutin sydäntapahtuman, kuten äkkikuoleman, riski. Väitöskirjatutkimuksessa tutkitaan rasitukseen liittyvän sydänperäisen äkkikuoleman erityispiirteitä ja fyysisen aktiivisuuden merkitystä hyvinvoinnille. Ensimmäisessä osajulkaisussa havaittiin, että rasitukseen liittyvissä kuolemissa oli ruumiinavauslöydöksenä merkittävästi enemmän sepelvaltimotautia, sydänlihaksen arpeutumista ja sydänlihaksen liikakasvua verrattuna äkkikuolemiin levossa. Miessukupuoli oli selkeästi yliedustettuna rasituspopulaatiossa, sillä peräti 94 % oli miehiä. Yleisimmät rasitusmuodot olivat hiihto, pyöräily ja lumenluonti. Toisessa osatutkimuksessa tutkittiin edeltävien EKG-muutosten yhteyttä rasitusperäisiin äkkikuolemiin. Havaitsimme, että QRS-kompleksin pirstoutuminen etuseinäkytkennöissä oli selkeästi yleisempi löydös rasitusryhmässä. Tämä löydös oli erityisen merkittävä sepelvaltimotautipotilailla. Kolmas julkaisu sisältää tiedot sairaalan ulkopuolisista sydänpysähdyksistä Pohjois-Pohjanmaalla vuosina 2007–2012. Tässä aineistossa havaitsimme, että rasitukseen liittyvän sydänpysähdyksen alkurytmi oli useammin defibrilloitava, potilaat olivat nuorempia ja terveempiä, ja maallikkoelvytys aloitettiin useammin. Rasituksessa elottomaksi menneillä oli suhteellisen hyvä selviämisennuste. Neljännessä tutkimuksessa havaitsimme selkeästi paremman ennusteen niillä stabiilia sepelvaltimotautia sairastaneilla, jotka olivat liikunnallisesti aktiivisia. Sydänperäinen kuolleisuus oli pienempi myös niillä potilailla, jotka onnistuivat lisäämään liikunnallista aktiivisuuttaan. Samankaltainen tulos todettiin sydänperäisten äkkikuolemien osalta. Sepelvaltimotauti ja miessukupuoli ovat hyvin yleisiä löydöksiä, kun sydänperäinen äkkikuolema tapahtuu rasituksessa. Myös QRS-kompleksin pirstoutuminen etuseinäkytkennöissä liittyi rasitusperäisiin kuolemiin. Toisaalta potilaan ennuste selvitä on selkeästi parempi sydänpysähdyksen tapahtuessa rasituksessa. Osoitimme myös, että liikunnallinen aktiivisuus ja sen pienikin lisäys parantavat sepelvaltimotautipotilaiden ennustetta.

Sudden unexplained infant death (SUID) is a sudden death of an infant under 1 year of age that cannot be explained after an investigation or an autopsy. SUID is the leading cause of infant deaths in the United States; SUID is considered a sentinel event to the birth hospital. Birth hospitals are held accountable for education, training, and role modeling of infant safe sleep practices (SSP) to reduce infant sleep-related deaths up to 1 year of age. This educational project was designed to answer the project-focused question of whether the implementation of an evidence-based, safe sleep training program for nurses would improve their knowledge of SSP. Bandura's social cognitive theory and the root cause analysis theory were used to guide the project that provided education on SSP and methods for teaching SSP for 48 nurses who work in a postpartum unit in a large hospital in the northeastern United States. A search of the literature provided the content from the National Institute of Child Health and Human Development for the education program and served the basis for the 15-item multiple-choice test, which was used for the pretest, posttest design project. The test was administered to the nurse participants who ranged in education from associate degree, baccalaureate degree, to master's degrees. The project goal was to increase nurses' knowledge by training and role modeling infant safe sleep environments and to reduce SUIDs. Results of the pretest and posttest evaluation revealed significant improvement in test scores from a pretest M = 72.9 to a posttest M = 90.0 (p <.05). The implications of this project for social change are that each nurse's knowledge and abilities to teach parents and families about SUID prevention strategies improve, sudden infant deaths may decrease in this hospital setting.

Master of Science / Department of Agronomy / William T. Schapaugh Jr / Fusarium virguliforme, the soilborne fungus which causes sudden death syndrome (SDS) of soybean, and Heterodera glycines Ichinohe, soybean cyst nematode (SCN), are two economically important pathogens in the Midwest. The pathogens are often found together in soybean (Glycine max (L.) Merr.) fields. This study was conducted to determine the effect of soybean genotype, F. virguliforme populations, and H. glycines populations have upon yield and to examine the interaction between the two pathogens. In 2008 and 2009, four genotypes with different levels of resistance to SDS and H. glycines were planted at seven environments. F. virguliforme and H. glycines soil populations were quantified at planting, midseason, and harvest. At the end of the growing season, area under the disease progress curves of SDS, F. virguliforme root populations, and H. glycines reproductive indices were determined and plots harvested for seed yield. Soil populations of F. virguliforme and H. glycines at planting, midseason, and harvest varied across environments. Within environments, generally, they were not significantly different. Seed yield varied within and across environments. As disease pressure increased, the performance of resistant genotypes increased compared to susceptible genotypes. Genotypes resistant to SDS yielded higher than susceptible genotypes. There were negative correlations between yield and disease rating and F. virguliforme root populations. F. virguliforme soil populations and H. glycines populations at planting were positively correlated. It is important to manage both SDS and H. glycines in fields with a history of the two diseases. This can be achieved through genetic resistance. Information in this study will improve decisions regarding genotype selection to minimize losses to SDS and H. glycines.

No description available.

Bakgrund: Att förlora en anhörig är något som är väldigt traumatiskt och omtumlande. Reaktioner på krisen brukar visa sig enligt olika faser, dessa är chockfasen, reaktionsfasen, bearbetning- och reperationsfasen samt nyorienteringsfasen. Det är viktigt att kommunikationen är ärlig och ska alltid vara hjälpande för patienten eller anhöriga. Syfte: Syftet med den här studien är att sammanställa befintliga vetenskapliga artiklar för att belysa situationen för anhöriga och personal vid plötsligt dödsfall. Metod: En litteraturstudie gjordes som baserades på 13st vetenskapliga artiklar. Litteratursökningen gjordes med hjälp av databaserna CINAHL och PubMed. Resultat: Resultatet av studien visade på att anhöriga behövde olika stöd i olika stadier och att informationen gavs på ett så rakt och ärligt sätt. Personalen upplevde att utbildning var viktigt för hantering av omhändertagande och att de sökte stöd och kunskap hos mer erfarna kollegor. Slutsats: Informationen om dödsorsaken till de anhöriga var mycket viktig och att personalen var öppna och ärliga. Anhöriga uppskattade att personalen fanns tillgängliga. Att som sjuksköterska ha tillräcklig utbildning gör att självförtroende ökar och hanteringen av svåra situationer underlättas samt kunskapen hjälper att kunna stödja anhöriga bättre. / Background: Losing a loved one is something that is very traumatic and bewildering. Reactions to the crisis usually appear under different phases, these are the shock phase, reaction phase, processing- and repair phase and reorientation phase. It is important that communication is honest and that it always will be helping for the patient or the relatives. Purpose: The purpose of this study is to compile existing research articles to highlight the situation of family members and staff of sudden death. Method: A literature review conceders on 13 scientific articles. The literature search conceders the databases CINAHL and PubMed. Results: The results of the study showed that relatives needed different support at different stages and that the information is given in such a straight and honest way as possible. Staff felt that education was important for the management of care and that they sought the support and expertise of more experienced colleagues. Conclusion: The information about the cause of death to the families was very important and that the staff were open and honest. Relatives appreciated that the staff were available. Nurses that have sufficient training increases self-confidence enables the handling of difficult situations and knowledge will help to support families better.

Plötslig och oväntad död är något sjuksköterskan kan komma att uppleva i sitt yrkesverksamma liv. Plötslig och oväntad död innebär att en person avlider oväntat och att döden inträffar upp till 24 timmar efter symtomdebut, oberoende på om tidigare symtom på bakomliggande sjukdom är känd. Syftet med studien var att belysa sjuksköterskans upplevelser av patienters plötsliga och oväntade död. Det gjordes genom en litteraturstudie som innebär att på ett systematisk sätt identifiera och undersöka vetenskapliga artiklar. Många sjuksköterskor upplever känslor såsom sorg, skuld och otillräcklighet vid patienters plötsliga och oväntade död. Det är först när rätt tid och plats ges som sjuksköterskan får lov att ge utlopp för sina känslor. Dessutom har anhörigas reaktioner en stark inverkan på sjuksköterskans upplevelse av den egna kapaciteten. Copingstrategier är av vikt, både för att kunna möta anhöriga men även för att kunna hantera de egna känslorna. Mer forskning bör genomföras eftersom att plötslig och oväntad död är en händelse som upplevs vara svårhanterlig för sjuksköterskan. Också utbildning i hanteringen av plötsliga och oväntade dödsfall är av betydelse då det är något som sjuksköterskan kan komma att ställas inför och på grund av att kunskapen inom ämnet är bristfällig. / Sudden and unexpected death is something that the nurse may experience in his or her professional life. Sudden and unexpected death means that a person dies unexpectedly and that the death occurs within 24 hours after the first symptoms, regardless whether an underlying disease is known. The purpose of this study was to elucidate the nurses’ experience of patients sudden and unexpected death. This was done by a literature research which means that in a systematic way identify and examine scientific articles. Many nurses are experiencing feelings such as grief, guilt and inadequacy when a patient sudden and unexpected dies. It is only when the right time and place is given that the nurse is allowed to vent his or her own feelings. In addition, the reactions from relatives have a strong impact on the nurse’s experience of his or her own capacity. Coping strategies are of importance, both in beeing able to meet relatives but also to be able to manage his or her own emotions. More research should be conducted since sudden and unexpected death is an event that is perceived as difficult to handle for the nurse. Education in handling sudden and unexpected deaths is of importance since it is something that the nurse probably will encounter and because the knowledge within the subject is inadequate.

Thesis (MScMedSc)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Sudden Unexpected Death in Infancy (SUDI) refers to any such sudden demise in a child. If the child dies while asleep within the first year of life, and if no conclusive cause of death can be ascertained by means of complete autopsy and investigation into the circumstances surrounding death, including visit of the death scene, such a case is classified as one of Sudden Infant Death Syndrome (SIDS). By South African law, a full medico-legal autopsy is mandated in cases where the cause of death is not evident – including cases of possible SIDS. There can be little doubt that viral infection can be a cause of death in cases of supposed SUDI. At the Tygerberg medico-legal (forensic) laboratory, the evaluation of lung tissue for the presence of fatal viral lung infections forms part of the institutional protocol for the examination of SUDI cases. Lung samples of these SUDI cases are routinely tested for the presence of Cytomegalovirus (CMV), adenovirus and respiratory syncytial virus (RSV) by means of shell vial cultures. In a retrospective pilot study of 366 SUDI case files from Tygerberg Hospital, Western Cape, from 2004 – 2006, it was evident that in only 13.9% of possible SIDS cases, positive results for one or more of the aforementioned viruses were obtained. We hypothesise that the current method of virus detection, together with other factors such as the interval between death and post mortem examination, transport time of the specimens to the laboratory etc. might not be optimal to give a realistic picture of death in infancy caused by viral pulmonary infection. As other test modalities exist for the diagnosis of pulmonary viral infections, these methods were compared in terms of positive yield and association with viral pneumonitis, keeping the cost and time needed for each assay in mind. A total of 82 samples were collected over an 8 month period and routine shell vial cultures were done, followed by real-time Polymerase Chain Reaction (PCR) and immunohistochemical (IHC) staining of the lung sections with consensus pathology opinion. As expected, the real-time PCR method was much more better suited for identifying positive samples than shell vials (35% vs. 3.7% respectively). IHC staining also aided the pathologist in diagnosing viral infections microscopically. We expect the findings to be instrumental in streamlining not only our institutional SIDS investigation protocol, but also the development of a standardised national SIDS investigation protocol. / AFRIKAANSE OPSOMMING: “Sudden Unexpected Death in Infancy” (SUDI) verwys na enige skielike sterfte van ‘n kind. Indien die kind sterf tydens sy/haar slaap periode en geen oortuigende oorsaak van dood bepaal kan word deur middel van ’n volledige nadoodse ondersoek en ondersoek na die omstandighede tydens die dood, insluitend ’n besoek aan die doodstoneel nie, word so ’n geval as Wiegiedood (SIDS) geklassifiseer. SuidAfrikaanse wetgewing vereis ’n volledige medies-geregtelike nadoodse ondersoek in gevalle waar die oorsaak van dood onbekend is – insluitend gevalle van moontlike Wiegiedood. Daar is min twyfel dat virusinfeksie ‘n oorsaak van, of bydraende faktor tot dood kan wees in gevalle van moontlike SUDI. By die Tygerberg forensiese laboratorium vorm die evaluasie van long weefsel vir die teenwoordigheid van dodelike virusinfeksies deel van die institusionele protokol vir die ondersoek van SUDI gevalle. Long monsters van hierdie SUDI gevalle ondergaan roetine toetse vir die teenwoordigheid van sitomegaalvirus, respiratoriese sinsitialevirus en adenovirus deur middel van selkulture (“shell vial cultures”). In ‘n retrospektiewe steekproef van 366 SUDI gevalle by Tygerberg Hospitaal, Wes-Kaap van 2004 – 2006, is bevind dat in slegs 13.9% van moontlike SUDI gevalle die teenwoordigheid van een of meer van bogenoemde virusse bevestig kon word. Ons hipotese is dat hierdie metode van virus deteksie, tesame met ander faktore soos die tydsinterval tussen dood en nadoodse ondersoek, tyd om monsters na die laboratorium te vervoer ens. moontlik nie optimaal is om ‘n realistiese beeld van dood in babas as gevolg van pulmonale virusinfeksie te gee nie. Aangesien ander toets modaliteite bestaan vir die diagnose van pulmonale virusinfeksies, is hierdie metodes vergelyk in terme van positiewe opbrengs en assosiasie met virale pneumonitis, teen ’n agtergrond van die koste en tyd benodig per toets. ’n Totaal van 82 monsters is oor ‘n 8 maande periode versamel en roetine selkulture is gedoen, gevolg deur “real-time” Polimerase Ketting Reaksie (PKR), asook immunohistochemiese (IHC) kleuring van long snitte met patologiese verslae. Soos vermoed, is gevind dat die real-time PKR metode baie meer akkuraat is om positiewe monsters te identifiseer as roetine selkulture (35% vs 3.7% onderskeidelik). IHC kleuring het ook mikroskopiese diagnose van virale infeksies deur die patoloog vergemaklik. Ons verwag dat hierdie bevindinge grootliks kan bydra in die vaartbelyning van ons institusionele SIDS ondersoek protokol, asook in die ontwikkeling van ’n gestandaardiseerde nasionale SIDS ondersoek protokol.

Bakgrund: I Sverige dör cirka 90 000 personer varje år. Majoriteten av dessa är förväntade dödsfall relaterat till ålder och sjukdomar. Plötslig död innefattar mord, suicid, olycksfall eller akut sjukdom. I mötet med anhöriga efter plötslig död har sjuksköterskan till uppgift att delge stöd och information. Det finns många studier gjorda på hur anhöriga upplever bemötandet i vården men desto mindre forskning om hur sjuksköterskan upplever mötet med anhöriga vid plötslig död. Syfte: Att beskriva sjuksköterskans upplevelse av att möta anhöriga vid plötslig död på sjukhus. Metod: Kvalitativ intervjustudie där 10 sjuksköterskor, från två olika avdelningar från ett sjukhus i södra delen av Sverige, har intervjuats.  Intervjuerna bearbetades och har analyserats genom en kvalitativ innehållsanalys. Resultat: Studien resulterade i tre huvudkategorier; Kräver professionalitet, Anhörigas reaktioner påverkar och Behöver vara personlig. Slutsats: Hur sjuksköterskan möter och bemöter anhöriga är ett viktigt moment i vården och för den familjecentrerade omvårdnaden. Sjuksköterskor som påträffar plötsliga dödsfall i sitt yrke upplever att det är komplext att möta anhöriga vid dessa situationer. / Background: Approximately 90 000 people die each year in hospitals throughout Sweden. The majority of these are expected deaths related to age and disease. The causes of sudden death include homicide, suicide, accidental or acute illness. When this occurs, nurses are responsible for sharing support and information with the relatives. There have been many studies conducted on the experience of family members and the treatment they receive in hospitals. However, there is less research present on the experiences of nurses when meeting families after sudden death. Aims: To describe nurses' experience of meeting relatives, when sudden death occurs in a hospital. Method: Qualitative interview study where a total of 10 nurses participated in the interviews, from two different departments of a hospital, in southern Sweden. The interviews were analyzed using a qualitative content analysis. Results: The study resulted in three main categories; Require professionalism, Relatives` reactions effects and Need to be personal. Conclusion: How the nurse meets and treats families is an important part of the care and the family-centered care. Nurses who encounters sudden death in the professional experience that it is complex to meet relatives after sudden death.

This study investigated the incidence of peripheral hearing loss in sickle cell anemia and the possibility of central auditory nervous system involvement. Nine Black subjects with sickle cell disease and nine with normal hemoglobin were administered an auditory test battery. There appeared to be no correlation between number of crisis episodes, duration of symptoms, severity of symptoms, and audiologic manifestations. Acoustic reflex testing suggested the possibility of "aired neural function in the sickle cell group. Whether impaired function was due to peripheral VIIIth nerve or to central brain stem involvement could not be determined. Results of the central auditory test battery suggested the possibility of impaired or reduced central auditory function in subjects with sickle cell anemia.