Thesis (M.D.)--University of Pennsylvania, 1804. / Caption title: On the causes of sudden death, and the means of preventing it. Microform version available in the Readex Early American Imprints series.

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.

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.

Daphne is a widely dispersed genus with large variation in morphology, native habitats, and use. Unfortunately, broader acceptance of Daphne in the ornamental trade has been limited due to Daphne Sudden Death Syndrome (DSDS), a disease that kills the plant without warning. The results of this research identified Thielaviopsis basicola (Berk. etBr.) Ferr. as the causal agent for this disease. Pure cultures of the pathogen were developed and used in a germ plasm screen. To evaluate Daphne germ plasm in vitro, species-specific protocols were developed that alleviated two common problems in Daphne micropropagation, browning and hyperhydricity. Optimizing the concentrations of both PGRs and charcoal was able to control these problems. Selected species were evaluated for resistance against Thielavipsis basicola in both, in vivo and in vitro, conditions. The results of both methods displayed a strong correlation and indicated significant differences among the taxa. However, there were differences in disease progression rates. Typically, the in vitro challenge produced a comparable level of disease as the in vivo challenge but in two to three weeks less time. Across both screening methods, the most resistant species evaluated were D. tangutica and D. retusa, while D. cneroum was the most susceptible. Based on ITS sequences, phylogenetic relationships among selected Daphne species were established and associated with their resistance against T basicola. The phylogeny indicated that Daphne is possibly a monophyletic group. However, placement of D.genkwa remained problematic. The analysis of ITS sequences data resulted in a parsimony consensus tree with two well-supported major clades and one Glade with less support. In general, the evolutionary tree for resistance, inferred from the phylogenetic data and the results of the screening project, indicate that resistance is a derived character and that plants recently evolved this ability.

Atualmente o diagnóstico da morte súbita dos citros (MSC) é realizado através de inspeção visual e coleta do material do porta-enxerto o que confere ao método elevado grau de subjetividade e imprecisão, além de demandar muito tempo para o levantamento de dados de infestação. Este trabalho pretende estudar as mudanças nas propriedades físicas e químicas acarretadas pela MSC em folhas e porta-enxertos de laranjeira doces (Citrus (L.) Osbeck), e desenvolver uma nova metodologia de diagnóstico da doença. Para tanto, folhas, porta-enxertos e seus extratos foram analisados através das seguintes técnicas espectroscópicas: absorção de luz uv-visível, absorção de infravermelho com transformada de Fourier, fluorescência e fluorescência induzida por laser. Além do estudo utilizando técnicas espectroscópicas foram realizados estudos utilizando técnicas de imagem de fluorescência de folhas saudáveis e doentes. Foram coletadas amostras de folhas saudáveis, doentes com a MSC e doentes com o declínio dos citros (DC). A comparação entre estas doenças é primordial visto que no campo os sintomas são muito parecidos, confundindo muito o sistema de avaliação de contaminação. Foram observadas mudanças significativas nos espectros de emissão de fluorescência para os três tipos de amostras e baseados nestas diferenças foi definido um índice capaz de diagnosticar a MSC e o DC. A técnica de imagens de fluorescência também trouxe informações importantes permitindo diferenciar plantas saudáveis e doentes de uma forma muito rápida. A junção da técnica de imagens com as espectroscópicas deu origem a uma nova metodologia de diagnóstico da MSC com potencial de ser muito mais rápida, precisa e não invasiva permitindo análises da folha in natura. / Currently, the diagnosis of citrus sudden death (CSD) is carried out by visual inspection and collection of the rootstock, which causes the method to be inaccurate and allows for much subjectivity, besides demanding much time to examine the infestation data. The present work intends to study changes in the physical and chemical properties resulting in CSD of leaves and rootstock material of sweet orange trees (Citrus (L.) Osbeck), as well as developing a new diagnosis methodology of the disease. Thus, leaves, rootstock and their extracts were analyzed by means of the following spectroscopic techniques: absorption of uv-visible light, absorption of infrared with Fourier transform, fluorescence and laser-induced fluorescence. Besides employing spectroscopic techniques, studies using fluorescence images of healthy and sick leaves were carried out. Samples of healthy leaves, sick leaves with CSD and sick leaves with citrus decline (CD) were collected. Comparison of these diseases is primordial since in the field the symptoms are similar, causing much confusion in the evaluation system of contamination. Significant changes were observed in the spectra of fluorescence emissions for the three types of samples and based on such differences an index capable of diagnosing CSD and CD was defined. The fluorescence image techniques also brought important information, thus allowing to quickly differentiate between healthy and sick leaves. Joining the technique of images with spectroscopy originated a new methodology of CSD, which is potentially much faster, precise and non-invasive, thus allowing in natura analysis of leaves.

Soybean (Glycine max [L.] Merr.) cultivars differ in their resistance to sudden death syndrome (SDS). The syndrome is caused by root colonization by Fusarium virguliforme (ex. F. solani f. sp. glycines). Breeding for improve SDS response has proven challenging, possible due to interactions among the 18 known loci for resistance. Four loci for resistance to SDS (cqRfs to cqRfs3) were found clustered within 20 cM of the rhg1 locus underlying resistance to soybean cyst nematode (SCN) on chromosome 18. Another locus on chromosome 20 (cqRfs5) was reported to interact with this cluster. The aims of this study were to compare the inheritance of resistance to SDS in a near isogenic line (NIL) population that was fixed for resistance to SCN but still segregated at 2 of the 4 loci (cqRfs1 and cqRfs) for resistance to SDS on chromosome 18; to examine the interaction with the locus on chromosome 20; and to identify candidate regions underlying quantitative trait loci (QTL). Used were a near isogenic line population derived from residual heterozygosity in an F5:7 recombinant inbred line EF60 1-40; SDS response data from 2 locations and years; four microsatellite markers and six thousand SNP markers. Polymorphic regions were found from 2,788 to 8,938 Kbp on chromosome 18 and 33,100 to 34,943 Kbp on chromosome 20. Both regions were significantly (0.005 < P > 0.0001) associated with resistance to SDS. A fine map was constructed that Mendelized the three loci. Substitution maps suggested the two loci on chromosome 18 were actually 3 loci (cqRfs, cqRfs1 and cqRfs19). Candidate genes for cqRfs19 were identified in a small region of the genome sequence of soybean. An epistatic interaction was inferred where the allele of loci on chromosome 18 determined the value of the locus on chromosome 20. It was concluded that SDS loci are both complex and interacting which may explain the slow progress in breeding for resistance to SDS.

A doenÃa de Chagas à um dos principais problemas mÃdico-sociais do Brasil. A morte sÃbita à um dos fenÃmenos clÃnicos caracterÃsticos da doenÃa de Chagas desde suas descriÃÃes iniciais. Mais de 50% da mortalidade nos pacientes com doenÃa de Chagas sÃo atribuÃveis à morte sÃbita cardÃaca. O cardiodesfibrilador implantÃvel (CDI) tornou-se a principal estratÃgia terapÃutica para prevenÃÃo de morte sÃbita. Contudo, a eficÃcia e a seguranÃa de se tratar o paciente chagÃsico com o CDI foi avaliada em poucos estudos observacionais. O objetivo do presente trabalho foi avaliar as caracterÃsticas clÃnicas, epidemiolÃgicas e a evoluÃÃo de pacientes com cardiopatia chagÃsica crÃnica e desfibrilador cardÃaco implantÃvel no Estado do CearÃ. Delineamento, populaÃÃo e mÃtodos: estudo retrospectivo, descritivo e analÃtico. A populaÃÃo consistiu de pacientes chagÃsicos com CDI por profilaxia primÃria ou secundÃria de morte sÃbita, atendidos em Ãnico hospital universitÃrio de referÃncia. Para anÃlise comparativa, foram incluÃdos pacientes com cardiopatia isquÃmica e CDI por profilaxia primÃria ou secundÃria de morte sÃbita. Os desfechos analisados foram: terapia apropriada (choque apropriado e terapia antitaquicardia), choque apropriada, mortalidade geral e sobrevida livre de eventos (choque apropriado, terapia apropriada ou Ãbito). Resultados: foram avaliados 146 pacientes, sendo 63 (42,5%) chagÃsicos com a mediana do tempo de seguimento de 27 meses (Q1=9,0 e Q3=47) e 83 (57,5%) isquÃmicos com a mediana do tempo de seguimento de 35 meses (Q1=22 e Q3=59). A taxa de mortalidade anual, a incidÃncia de morte sÃbita, a incidÃncia de tempestade arrÃtmica e a incidÃncia de choque inapropriados foram semelhantes nos dois grupos. Os pacientes isquÃmicos eram em mÃdia 10 anos mais velhos que os chagÃsicos (p<0,001). Observou-se terapia apropriada deflagrada pelo CDI em 27 (42,9%) pacientes chagÃsicos e 14 (16,9%) isquÃmicos (p=0,001). Choque apropriado foi observado em 23 (36,5%) pacientes chagÃsicos e 14 (16,9%) isquÃmicos. A cardiopatia chagÃsica aumentou em 2,07 vezes (IC 95%: 1,02-4,17) o risco de o paciente receber terapia apropriada. A classe funcional (I a IV), a fraÃÃo de ejeÃÃo (normal ou disfunÃÃo leve à severa) e o tipo de prevenÃÃo nÃo foram preditores de choque ou terapia apropriada nos pacientes com cardiopatia chagÃsica. NÃo houve diferenÃa significativa no tempo de sobrevida entre os pacientes chagÃsicos e os isquÃmicos. A sobrevida livre de eventos (choque, terapia apropriada e Ãbito) foi similar nos dois grupos (chagÃsicos e isquÃmicos). NÃo houve nenhuma morte sÃbita durante o seguimento dos pacientes chagÃsicos. A baixa escolaridade (HR=4,6 IC 95%;1,6-13,3) e a fraÃÃo de ejeÃÃo do ventrÃculo esquerdo menor que 30% (HR=6,3 IC 95%: 1,2-31,7) estiveram associadas de forma significante com o desfecho de Ãbito. ConclusÃes: a maior frequÃncia de pacientes chagÃsicos com registro de terapia apropriada e choque apropriado à consistente com a presenÃa de um substrato arritmogÃnico mais grave nessa patologia. Apesar dessa maior frequÃncia, nÃo houve nenhuma morte sÃbita no seguimento, o que sugere a efetividade do CDI nos pacientes chagÃsicos. A ausÃncia de diferenÃa na taxa de terapia apropriada ou choque apropriado entre os chagÃsicos com e sem disfunÃÃo ventricular sugere que a FEVE nÃo deveria ser usada como critÃrio preponderante e decisivo de indicaÃÃo do cardiodesfibrilador nesses pacientes. / Chagas disease is one of the major social-medical problems of Brazil. Sudden death is one of the clinical phenomena characteristic of the Chagas disease since their initial descriptions. More than 50% of mortality in patients with Chagas disease are attributable to sudden cardiac death. The Implantable Cardioverter-defibrillator (ICD) has become the main therapeutic strategy for prevention of sudden death. However, the efficacy and safety of treating Chagas patients with CDI was assessed in a few observational studies. The aim of this paper was to evaluate the clinical, epidemiological and outcome of patients with chronic Chagas heart disease and implantable cardioverter-defibrillator in the state of CearÃ. This was retrospective, descriptive and analytical study. The population consisted of chagasic patients with ICD for primary or secondary prevention of sudden death, enrolled at a sole university hospital. For comparative analysis, we included patients with ischemic cardiomyopathy and ICD for primary or secondary prevention of sudden death. The outcomes analyzed were: appropriate therapy (shock therapy and appropriate antitachycardia), appropriate shock, mortality and event-free survival (appropriate shock, appropriate therapy or death). Results: 146 patients were evaluated, 63 (42.5%) chagasic patients with median follow-up time of 27 months (Q1 = 9.0 and Q3 = 47) and 83 (57.5%) with a median of ischemic follow-up time of 35 months (Q1 = Q3 = 22 and 59). The annual mortality rate, the incidence of sudden death, the incidence of arrhythmic storm and the incidence of inappropriate shock were similar in both groups. The ischemic patients were on average 10 years older than the Chagas patients (p <0.001). Observed appropriate therapy triggered by CDI in 27 (42.9%) chagasic patients and 14 (16.9%) ischemic (p = 0.001). Appropriate shock was observed in 23 (36.5%) chagasic patients and 14 (16.9%) ischemic. Chagas heart disease increased by 2.07 times (95% CI: 1.02 to 4.17) the risk of the patient receiving appropriate therapy. The functional class (I to IV), ejection fraction (normal or mild dysfunction to severe) and type of prevention were not predictors of shock or appropriate therapy in patients with Chagas heart disease. There was no significant difference in survival time between patients with Chagas disease and the ischemic ones. The event-free survival (shock, appropriate therapy and death) was similar in both groups (Chagas disease and ischemic). There was no sudden death during follow-up of patients with Chagas disease. The low educational level (HR = 4.6 95% CI 1.6 to 13.3) and the ejection fraction of the left ventricle less than 30% (HR = 6.3 95% CI 1.2 to 31.7) were associated significantly with the outcome of death. Conclusions: The higher frequency of appropriate shock therapy in chronic Chagas disease is consistent with the presence of an arrhythmogenic substrate. Despite this higher frequency, there was no sudden death following, which suggests the effectiveness of ICD in patients with Chagas disease. The lack of difference in the rate of appropriate therapy or appropriate shock among chagasic patients with and without ventricular dysfunction suggests that LVEF should not be used as a preponderant and decisive criterion of the defibrillator indication in these patients.

Atualmente o diagnóstico da morte súbita dos citros (MSC) é realizado através de inspeção visual e coleta do material do porta-enxerto o que confere ao método elevado grau de subjetividade e imprecisão, além de demandar muito tempo para o levantamento de dados de infestação. Este trabalho pretende estudar as mudanças nas propriedades físicas e químicas acarretadas pela MSC em folhas e porta-enxertos de laranjeira doces (Citrus (L.) Osbeck), e desenvolver uma nova metodologia de diagnóstico da doença. Para tanto, folhas, porta-enxertos e seus extratos foram analisados através das seguintes técnicas espectroscópicas: absorção de luz uv-visível, absorção de infravermelho com transformada de Fourier, fluorescência e fluorescência induzida por laser. Além do estudo utilizando técnicas espectroscópicas foram realizados estudos utilizando técnicas de imagem de fluorescência de folhas saudáveis e doentes. Foram coletadas amostras de folhas saudáveis, doentes com a MSC e doentes com o declínio dos citros (DC). A comparação entre estas doenças é primordial visto que no campo os sintomas são muito parecidos, confundindo muito o sistema de avaliação de contaminação. Foram observadas mudanças significativas nos espectros de emissão de fluorescência para os três tipos de amostras e baseados nestas diferenças foi definido um índice capaz de diagnosticar a MSC e o DC. A técnica de imagens de fluorescência também trouxe informações importantes permitindo diferenciar plantas saudáveis e doentes de uma forma muito rápida. A junção da técnica de imagens com as espectroscópicas deu origem a uma nova metodologia de diagnóstico da MSC com potencial de ser muito mais rápida, precisa e não invasiva permitindo análises da folha in natura. / Currently, the diagnosis of citrus sudden death (CSD) is carried out by visual inspection and collection of the rootstock, which causes the method to be inaccurate and allows for much subjectivity, besides demanding much time to examine the infestation data. The present work intends to study changes in the physical and chemical properties resulting in CSD of leaves and rootstock material of sweet orange trees (Citrus (L.) Osbeck), as well as developing a new diagnosis methodology of the disease. Thus, leaves, rootstock and their extracts were analyzed by means of the following spectroscopic techniques: absorption of uv-visible light, absorption of infrared with Fourier transform, fluorescence and laser-induced fluorescence. Besides employing spectroscopic techniques, studies using fluorescence images of healthy and sick leaves were carried out. Samples of healthy leaves, sick leaves with CSD and sick leaves with citrus decline (CD) were collected. Comparison of these diseases is primordial since in the field the symptoms are similar, causing much confusion in the evaluation system of contamination. Significant changes were observed in the spectra of fluorescence emissions for the three types of samples and based on such differences an index capable of diagnosing CSD and CD was defined. The fluorescence image techniques also brought important information, thus allowing to quickly differentiate between healthy and sick leaves. Joining the technique of images with spectroscopy originated a new methodology of CSD, which is potentially much faster, precise and non-invasive, thus allowing in natura analysis of leaves.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23465号 / 医博第4772号 / 新制||医||1053(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 近藤 尚己, 教授 山本 洋介, 教授 松村 由美 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM