INTRODUÇÃO. O aumento da densidade de arritmia ventricular e a redução da variabilidade da freqüência cardíaca estão associados com risco de morte súbita e mortalidade total em insuficiência cardíaca. A inibição colinesterásica com brometo de piridostigmina (PIR) aumenta a variabilidade da freqüência de pessoas normais, porém seu efeito em pacientes com insuficiência cardíaca é desconhecido. OBJETIVOS. Testar a hipótese de que a administração a curto prazo de piridostigmina reduz a densidade de arritmia ventricular e aumenta a variabilidade da freqüência cardíaca em pacientes com insuficiência cardíaca. MÉTODOS. Pacientes com insuficiência cardíaca e em ritmo sinusal participaram de um estudo duplo-cego, cruzado, randomizado para placebo e piridostigmina (30mg VO de 8 em 8 horas por 2 dias). Monitorização eletrocardiográfica ambulatorial de 24 horas foi realizada para análise de arritmia e para avaliação dos índices do domínio do tempo da variabilidade da freqüência cardíaca. Pacientes foram separados em 2 grupos, de acordo com a densidade de arritmia ventricular. O grupo Arritmia (n = 11) incluiu pacientes com mais de 10 extrassístoles ventriculares por hora (ESV/h), e o grupo Variabilidade da Freqüêcia Cardíaca (n = 12) incluiu pacientes com um número de ESVs em 24 horas que não excedia 1 % do número total de intervalos RR. RESULTADOS. No grupo Arritmia, PIR resultou em uma redução de 65% no número de extrassístoles ventriculares (Placebo 266 + 56 ESV/h vs. PIR 173 + 49 ESV/h; p = 0,03). No grupo da Variabilidade da Freqüência Cardíaca, a administração de PIR resultou em um aumento do intervalo RR médio (Placebo 733 + 22 ms vs PIR 790 + 33 ms; p = 0,01), e nos índices do domínio do tempo da variabilidade da freqüência cardíaca PNN50 (Placebo 3 + 1,1 % vs PIR 6 + 1,6 %; p = 0,03) e RMSSD (Placebo 21 + 2 vs PIR 27 + 3; p = 0,008). CONCLUSÃO. Em pacientes com insuficiência cardíaca, PIR reduziu a densidade de arritmia ventricular e aumentou a VFC, provavelmente por seu efeito colinomimético. Estudos a longo prazo com PIR em insuficiência cardíaca devem ser realizados. / OBJECTIVE To test the hypothesis that short-term administration of pyridostigmine bromide (PYR) reduces ventricular arrhythmia density and increases heart rate variability in patients with congestive heart failure. BACKGROUND Increased ventricular arrhythmia density and reduced heart rate variability are associated with risk of sudden death and overall mortality in patients with heart failure. Cholinesterase inhibition with pyridostigmine bromide increases heart rate variability in normal subjects, but its effect in patients with heart failure is unknown. METHODS Patients with heart failure and in sinus rhythm participated in a double-blind, cross-over protocol, randomized for placebo and pyridostigmine (30 mg PO TID for 2 days). Twenty-four hour electrocardiographic recordings were performed for arrhythmia analysis and for the measurement of time domain indices of heart rate variability. Patients were separated in 2 groups, according to their ventricular arrhythmia density. The Arrhythmia Group (n = 11) included patients with more than 10 ventricular premature beats per hour (VPBs/h), and the Heart Rate Variability Group (n = 12) included patients with a number of VPBs in 24 hours not exceeding 1 % of the total number of RR intervals. RESULTS For the Arrhythmia Group, PYR resulted in 65 % reduction of ventricular ectopic activity (Placebo 266 ± 56 VPBs/h vs. PYR 173 ± 49 VPBs/h; P = 0.03). For the Heart Rate Variability Group, PYR administration resulted in an increment of mean RR interval (Placebo 733 ± 22 msec vs PYR 790 ± 33 msec; P = 0.01), and in the time domain indices of heart rate variability RMSSD (Placebo 21± 2 vs PYR 27 ± 3; P = 0.01) and PNN50 (Placebo 3 ± 1 % vs PYR .6 ± 2 %; P = 0.03). CONCLUSION In patients with heart failure, PYR reduced ventricular arrhythmia density and increased HRV, most likely due to its cholinomimetic effect. Long-term trials with PYR in heart failure should be conducted.

INTRODUÇÃO. O aumento da densidade de arritmia ventricular e a redução da variabilidade da freqüência cardíaca estão associados com risco de morte súbita e mortalidade total em insuficiência cardíaca. A inibição colinesterásica com brometo de piridostigmina (PIR) aumenta a variabilidade da freqüência de pessoas normais, porém seu efeito em pacientes com insuficiência cardíaca é desconhecido. OBJETIVOS. Testar a hipótese de que a administração a curto prazo de piridostigmina reduz a densidade de arritmia ventricular e aumenta a variabilidade da freqüência cardíaca em pacientes com insuficiência cardíaca. MÉTODOS. Pacientes com insuficiência cardíaca e em ritmo sinusal participaram de um estudo duplo-cego, cruzado, randomizado para placebo e piridostigmina (30mg VO de 8 em 8 horas por 2 dias). Monitorização eletrocardiográfica ambulatorial de 24 horas foi realizada para análise de arritmia e para avaliação dos índices do domínio do tempo da variabilidade da freqüência cardíaca. Pacientes foram separados em 2 grupos, de acordo com a densidade de arritmia ventricular. O grupo Arritmia (n = 11) incluiu pacientes com mais de 10 extrassístoles ventriculares por hora (ESV/h), e o grupo Variabilidade da Freqüêcia Cardíaca (n = 12) incluiu pacientes com um número de ESVs em 24 horas que não excedia 1 % do número total de intervalos RR. RESULTADOS. No grupo Arritmia, PIR resultou em uma redução de 65% no número de extrassístoles ventriculares (Placebo 266 + 56 ESV/h vs. PIR 173 + 49 ESV/h; p = 0,03). No grupo da Variabilidade da Freqüência Cardíaca, a administração de PIR resultou em um aumento do intervalo RR médio (Placebo 733 + 22 ms vs PIR 790 + 33 ms; p = 0,01), e nos índices do domínio do tempo da variabilidade da freqüência cardíaca PNN50 (Placebo 3 + 1,1 % vs PIR 6 + 1,6 %; p = 0,03) e RMSSD (Placebo 21 + 2 vs PIR 27 + 3; p = 0,008). CONCLUSÃO. Em pacientes com insuficiência cardíaca, PIR reduziu a densidade de arritmia ventricular e aumentou a VFC, provavelmente por seu efeito colinomimético. Estudos a longo prazo com PIR em insuficiência cardíaca devem ser realizados. / OBJECTIVE To test the hypothesis that short-term administration of pyridostigmine bromide (PYR) reduces ventricular arrhythmia density and increases heart rate variability in patients with congestive heart failure. BACKGROUND Increased ventricular arrhythmia density and reduced heart rate variability are associated with risk of sudden death and overall mortality in patients with heart failure. Cholinesterase inhibition with pyridostigmine bromide increases heart rate variability in normal subjects, but its effect in patients with heart failure is unknown. METHODS Patients with heart failure and in sinus rhythm participated in a double-blind, cross-over protocol, randomized for placebo and pyridostigmine (30 mg PO TID for 2 days). Twenty-four hour electrocardiographic recordings were performed for arrhythmia analysis and for the measurement of time domain indices of heart rate variability. Patients were separated in 2 groups, according to their ventricular arrhythmia density. The Arrhythmia Group (n = 11) included patients with more than 10 ventricular premature beats per hour (VPBs/h), and the Heart Rate Variability Group (n = 12) included patients with a number of VPBs in 24 hours not exceeding 1 % of the total number of RR intervals. RESULTS For the Arrhythmia Group, PYR resulted in 65 % reduction of ventricular ectopic activity (Placebo 266 ± 56 VPBs/h vs. PYR 173 ± 49 VPBs/h; P = 0.03). For the Heart Rate Variability Group, PYR administration resulted in an increment of mean RR interval (Placebo 733 ± 22 msec vs PYR 790 ± 33 msec; P = 0.01), and in the time domain indices of heart rate variability RMSSD (Placebo 21± 2 vs PYR 27 ± 3; P = 0.01) and PNN50 (Placebo 3 ± 1 % vs PYR .6 ± 2 %; P = 0.03). CONCLUSION In patients with heart failure, PYR reduced ventricular arrhythmia density and increased HRV, most likely due to its cholinomimetic effect. Long-term trials with PYR in heart failure should be conducted.

Sammanfattning Bakgrund: Vid plötsligt dödsfall har närstående kort eller ingen tid till förberedelse. Detta kan påverka sorgeprocessen och risken för försämrad psykisk hälsa är hög. Sjuksköterskor bistår med stöd men bristande erfarenhet, otillräcklig bemanning och stressig arbetsmiljö kan försvåra stödinsatser. Syfte: Syftet var att beskriva närståendes erfarenheter av stöd från sjuksköterskor vid plötsligt dödsfall och att granska artiklarnas undersökningsgrupper. Metod: En beskrivande litteraturstudie med 13 vetenskapliga artiklar hämtade via databaserna PubMed, Cinahl samt genom manuella sökningar. Huvudresultat: Det stöd närstående efterfrågade från sjuksköterskor varierade. Informativa brister förknippades hos närstående med en ovilja hos sjuksköterskor att beröra svåra samtalsämnen. Sjukhusmiljön upplevdes främmande för många närstående, som kunde känna utanförskap. Genom gott bemötande, vägledning och inkludering av närstående i omvårdnaden skapades gemenskap. När närstående kände sig delaktiga och behövda skapades positiva känslor. När sjuksköterskor gav närstående chans att utnyttja den tid som fanns tillsammans med den döende och bistod med praktiskt stöd möjliggjordes kontinuerlig samvaro. Efter dödsfall kunde närstående känna sig övergivna. Ett avsked utan tidspress och inbjudan till uppföljning var betydelsefullt för närstående för att kunna gå vidare i livet. Slutsats: Erfarenhet av bristande information från sjuksköterskor var vanligt förekommande hos närstående, vilka även noterade om sjuksköterskor agerar undvikande i svåra situationer. Eftersom behovet av stöd varierar mellan närstående bör sjuksköterskor utgå från personcentrerade stödinsatser. Om sjuksköterskor får insikt i närståendes erfarenheter av stöd vid plötsligt dödsfall finns större möjligheter att kunna förbättra stödet för närstående i en sårbar situation. / Background: In a sudden death situation family members have little time for preparation. This can affect their process of grief and increase the risk of a negative psychological outcome. Nurses have the possibility of supporting the family, but lack of experience, shortage of staff, and a stressful environment can obstruct the support. Aim: The aim of this study was to describe family members’ experiences of support from nurses when a person dies a sudden death, and to investigate the sample groups of selected result studies. Method: A descriptive literature review, where 13 scientific articles were included. Articles were collected from the databases PubMed and Cinahl and through manual research. Main result: The type of support family members requested from nurses differed. Lack of information was associated with the nurses’ unwillingness to lift difficult topics. The hospital environment was an unfamiliar place for many family members, who could feel lost in the context. By including and guiding the family members, a feeling of becoming a team was generated. When the family members felt involved and needed, positive emotions evolved. When nurses gave practical support and created opportunities for family members to be close to the dying person, they could make use of precious time without interruption. After death occurred family members could feel abandoned. To be able to proceed in life, it was important that family members had enough time to say goodbye and were offered a follow-up meeting. Conclusion: Family members frequently experienced a lack of information from nurses and noticed if the nurse tried to avoid difficult situations. Acknowledging individual differences, makes it possible to apply person-centered support. If nurses gain knowledge of family members’ experiences of support on sudden death occasions, the nurses will have better chances of providing the support requested.

INTRODUÇÃO. O aumento da densidade de arritmia ventricular e a redução da variabilidade da freqüência cardíaca estão associados com risco de morte súbita e mortalidade total em insuficiência cardíaca. A inibição colinesterásica com brometo de piridostigmina (PIR) aumenta a variabilidade da freqüência de pessoas normais, porém seu efeito em pacientes com insuficiência cardíaca é desconhecido. OBJETIVOS. Testar a hipótese de que a administração a curto prazo de piridostigmina reduz a densidade de arritmia ventricular e aumenta a variabilidade da freqüência cardíaca em pacientes com insuficiência cardíaca. MÉTODOS. Pacientes com insuficiência cardíaca e em ritmo sinusal participaram de um estudo duplo-cego, cruzado, randomizado para placebo e piridostigmina (30mg VO de 8 em 8 horas por 2 dias). Monitorização eletrocardiográfica ambulatorial de 24 horas foi realizada para análise de arritmia e para avaliação dos índices do domínio do tempo da variabilidade da freqüência cardíaca. Pacientes foram separados em 2 grupos, de acordo com a densidade de arritmia ventricular. O grupo Arritmia (n = 11) incluiu pacientes com mais de 10 extrassístoles ventriculares por hora (ESV/h), e o grupo Variabilidade da Freqüêcia Cardíaca (n = 12) incluiu pacientes com um número de ESVs em 24 horas que não excedia 1 % do número total de intervalos RR. RESULTADOS. No grupo Arritmia, PIR resultou em uma redução de 65% no número de extrassístoles ventriculares (Placebo 266 + 56 ESV/h vs. PIR 173 + 49 ESV/h; p = 0,03). No grupo da Variabilidade da Freqüência Cardíaca, a administração de PIR resultou em um aumento do intervalo RR médio (Placebo 733 + 22 ms vs PIR 790 + 33 ms; p = 0,01), e nos índices do domínio do tempo da variabilidade da freqüência cardíaca PNN50 (Placebo 3 + 1,1 % vs PIR 6 + 1,6 %; p = 0,03) e RMSSD (Placebo 21 + 2 vs PIR 27 + 3; p = 0,008). CONCLUSÃO. Em pacientes com insuficiência cardíaca, PIR reduziu a densidade de arritmia ventricular e aumentou a VFC, provavelmente por seu efeito colinomimético. Estudos a longo prazo com PIR em insuficiência cardíaca devem ser realizados. / OBJECTIVE To test the hypothesis that short-term administration of pyridostigmine bromide (PYR) reduces ventricular arrhythmia density and increases heart rate variability in patients with congestive heart failure. BACKGROUND Increased ventricular arrhythmia density and reduced heart rate variability are associated with risk of sudden death and overall mortality in patients with heart failure. Cholinesterase inhibition with pyridostigmine bromide increases heart rate variability in normal subjects, but its effect in patients with heart failure is unknown. METHODS Patients with heart failure and in sinus rhythm participated in a double-blind, cross-over protocol, randomized for placebo and pyridostigmine (30 mg PO TID for 2 days). Twenty-four hour electrocardiographic recordings were performed for arrhythmia analysis and for the measurement of time domain indices of heart rate variability. Patients were separated in 2 groups, according to their ventricular arrhythmia density. The Arrhythmia Group (n = 11) included patients with more than 10 ventricular premature beats per hour (VPBs/h), and the Heart Rate Variability Group (n = 12) included patients with a number of VPBs in 24 hours not exceeding 1 % of the total number of RR intervals. RESULTS For the Arrhythmia Group, PYR resulted in 65 % reduction of ventricular ectopic activity (Placebo 266 ± 56 VPBs/h vs. PYR 173 ± 49 VPBs/h; P = 0.03). For the Heart Rate Variability Group, PYR administration resulted in an increment of mean RR interval (Placebo 733 ± 22 msec vs PYR 790 ± 33 msec; P = 0.01), and in the time domain indices of heart rate variability RMSSD (Placebo 21± 2 vs PYR 27 ± 3; P = 0.01) and PNN50 (Placebo 3 ± 1 % vs PYR .6 ± 2 %; P = 0.03). CONCLUSION In patients with heart failure, PYR reduced ventricular arrhythmia density and increased HRV, most likely due to its cholinomimetic effect. Long-term trials with PYR in heart failure should be conducted.

Apresentamos nesta tese a primeira geração direta de emaranhamento tripartite entre feixes intensos de luz. Medimos o emaranhamento entre os feixes sinal, complementar e bombeio refletido, produzidos por um Oscilador Paramétrico Ótico (OPO) operando acima do limiar de oscilação. A principal característica do nosso sistema é a diferença entre os comprimentos de onda dos campos (l0 = 532.251 nm, l1 = 1062.102 nm, e l2 = 1066.915 nm). Esta é a primeira medida de emaranhamento entre mais de dois subsistemas produzidos por uma única fonte no âmbito de variáveis contínuas. Para investigar a existência emaranhamento, utilizamos o critério de positividade sob transposição parcial (PPT). Este critério, aplicado a sistemas compostos por estados gaussianos, dispostos em bipartições do tipo 1×(N 1), torna-se necessário e suficiente na demonstração do emaranhamento. Realizamos também a caracterização do emaranhamento produzido quando submetemos os campos a perdas, identificando regiões de parâmetros onde os estados apresentam emaranhamento frágil ou robusto. A fim de garantir que estamos lidando com estados gaussianos, investigamos a estatística das flutuações dos campos, mostrando excelente acordo entre os valores dos momentos de ordem mais alta da fotocorrente medida e os valores esperados para uma distribuição gaussiana. O estudo que apresentamos é um passo importante para a elaboração de uma rede de informação quântica que possibilitará a comunicação entre diferentes sistemas físicos. / We present in this thesis the first direct generation of tripartite entanglement among bright beams of light. We measured the entanglement among signal, idler and reflected pump beams, produced by an Optical Parametric Oscillator (OPO) operating above the threshold. The main feature of our system is the difference between the wavelengths of the fields (l0 = 532.251 nm, l1 = 1062.102 nm, e l2 = 1066.915 nm). This is the first measurement of entanglement among more than two subsystems produced by a single source, in a continuous variable system. In order to investigate the existence of entanglement, we applied the criterion of positivity under partial transposition (PPT). This criterion, applied to systems composed of Gaussian states, arranged in 1×(N1) bipartition, becomes necessary and sufficient to demonstrate entanglement. We also characterized the entanglement when the fields are submitted to losses, identifying regions of parameters where the states have fragile or robust entanglement. To ensure that we are dealing with Gaussian states, we investigate the statistics of the fields, showing excelent agreement among values of higher order moments of the photocurrent measured and expected values for a Gaussian distribution. The present study is an important step in the development of a quantum information network formed by different physical systems.

Introdução: A morte súbita é a principal causa de morte na doença de Chagas, correspondendo de 55 a 65% dos casos. Observa-se que parte destas, ocorre em pacientes com função ventricular esquerda (FEVE) preservada, levando a acreditar que fatores desestabilizadores do substrato arritmogênico exercem um importante papel nestes eventos. Evidências já demonstraram a depressão parassimpática como fator contribuinte na gênese de arritmias diversas em presença de cardiopatia isquêmica. Assim, insiste-se na necessidade de se identificar precocemente quais os pacientes, no contexto da cardiopatia chagásica crônica, apresentam risco aumentado para o desenvolvimento de eventos arrítmicos complexos. Acredita-se que a avaliação autonômica identifique subgrupos distintos de risco. O presente estudo teve como objetivo determinar a sensibilidade do barorreflexo (SBR) em pacientes com doença de Chagas, nas formas indeterminada (GI) e arritmogênica com taquicardia ventricular não sustentada (GII) e com taquicardia ventricular sustentada (GIII) e, secundariamente, avaliar a associação entre a severidade da arritmia ventricular com o grau de comprometimento da SBR. Métodos: 42 pacientes foram submetidos à monitorização cardiovascular não invasiva pelo sistema Task Force ® onde foi determinada a SBR, utilizando o método da fenilefrina e analisada a variabilidade da frequência cardíaca (VFC) no domínio do tempo por meio da eletrocardiografia dinâmica de 24horas e a FEVE, por meio da ecocardiografia. Resultados: Observou-se diferença estatística significativa entre os grupos em relação à SBR em resposta à fenilefrina. O GIII apresentou o menor valor de SBR (6,09 ms/mmHg) quando comparado aos GII (11,84ms/mmHg) e GI (15,23ms/mmHg). Após comparação múltipla entre os grupos, verificou-se diferença significativa entre GI e GIII (p= 0,01). Quando se correlacionou SBR e densidade de extra-sístoles ventriculares (EV), observou-se que todos os pacientes portadores de baixa densidade de EV (< 10/hora) apresentavam SBR preservada (6,1ms/mmHg).Em contrapartida, entre aqueles com alta densidade de EV (>10/hora) somente 59% tinham SBR preservada (p=0,003). Nos pacientes com SBR deprimida (3,0-6,0 ms/mmHg) houve maior densidade de EV (p=0,01). Pacientes com SBR preservada apresentaram tanto função ventricular normal como moderadamente comprometida (66,7% com FEVE<40% e 79,5% com FEVE40%; p=0,62). O mesmo observou-se em pacientes com SBR moderadamente deprimida, (15,4% com FEVE<40% e 33,3% com FEVE40%; p=0,46). Não foi verificada correlação entre SBR e VFC. Ao se aplicar o modelo de regressão logística, observou-se que somente a SBR influenciou o aparecimento da taquicardia ventricular sustentada (p=0.028). Conclusão: A SBR está preservada na forma indeterminada da doença de Chagas e diminuída na forma arritmogênica. O comprometimento da SBR é progressivo e acompanha a evolução da doença, sendo mais intenso nos pacientes com arritmias ventriculares mais complexas. O grau de disfunção autonômica não se correlacionou com a função ventricular, mas, sim, com a densidade e a complexidade das arritmias / Introduction: Sudden death is the main cause of death in Chagas disease, corresponding to 55 to 65% of the cases. Some of these occur in patients with normal or almost normal left ventricular function (LVF), leading us to believe that factors that destabilize the arrhythmogenic substrate play an important role in these events. Evidences show parasympathetic depression to be a contributing factor in the genesis of diverse arrhythmias in the presence of ischemic heart disease. Thus, we insist on the need of an early identification of the patients, in the context of chronic Chagas heart disease, that are at increased risk of developing complex arrhythmic events. It is possible that autonomic assessment allows the identification of distinct risk subgroups. The objective of this study was to determine the baroreflex sensitivity (BRS) in patients with the indeterminate form of Chagas disease, (GI), and with the arrhythmogenic form of Chagas disease with nonsustained ventricular tachycardia (GII) and sustained ventricular tachycardia (GIII) and to assess the correlation between the severity of ventricular arrhythmia and the degree of BRS impairment. Methods: Forty-two patients were subjected to noninvasive cardiovascular monitoring using the Task Force® system. The phenylephrine method was used to determine BRS, 24- hour dynamic electrocardiography was used to analyze heart rate variability (HRV) over time and echocardiography was used to determine LVF. Results: A statistical difference was observed between the groups regarding their BRS to phenylephrine. GIII presented the lowest BRS value (6.09 ms/mmHg) when compared with GII (11.84ms/mmHg) and GI (15.23ms/mmHg). After multiple comparisons among the groups, a significant difference was found between GI and GIII (p=0.01). When BRS was correlated with ventricular extrasystole (VE) density, all patients who had low VE density (<10/hour) had preserved BRS (6.1ms/mmHg). On the other hand, only 59% of those with high EV density (>10/hour) had preserved BRS (p=0.003). In patients with moderately depressed BRS (3.0-6.0 ms/mmHg) there was a greater density of EV (p=0.01). Patients with preserved BRS had preserved or moderately compromised LVF (66.7% with LVF<40% and 79.5% with LVF40%; p=0.62) as had patients with moderately depressed BRS (15.4% with LVF<40% and 33.3% with LVF40%; p=0.46). There was no correlation between BRS and LVF. When the logistic regression model was applied, only BRS influenced the presence of sustained ventricular tachycardia (p=0.028). Conclusion: BRS is preserved in indeterminate Chagas disease and diminished in the arrhythmogenic form. The BRS impairment is progressive as the disease progresses, being more evident in patients with more complex ventricular arrhythmias. The degree of autonomic dysfunction did not correlate with ventricular function but with the density and complexity of the arrhythmias

Master of Science / Department of Biological & Agricultural Engineering / Ajay Sharda / Discovered in 1971, sudden death syndrome (SDS), caused by the fungus Fusarium virguliforme, has spread from the US to South American and European countries. It has potential to infect soybean crops worldwide, causing yield losses of 10% to 15% and even 70% in extreme cases. There is a need for rapid spatial assessment of SDS. Currently, the extent and severity of SDS are scored using visual symptoms as indicators. This method can take hours to collect and is subject to human bias and changing environmental conditions. Color infrared (CIR) and thermal infrared (TIR) imagery detect changes in light reflectance (visible and near-infrared bands) and emittance (canopy temperature), respectively. Stressed crops may show deviations in light reflectiveness, as well as elevated canopy temperatures. The use of CIR and TIR imagery and flexible aerial remote sensing platforms offer an alternative for SDS detection and diagnosis compared to hand scoring methods. Crop stress and diseases have been detected using manned and unmanned aerial systems previously. Yet, to date, SDS has not been remotely assessed using CIR or TIR imagery collected with aerial platforms. The following research utilizes high throughput CIR and TIR imagery collected using a small unmanned aerial system (sUAS) to detect and assess SDS. A comparative evaluation of ground-based and aerial CIR methods for assessing SDS was conducted to understand the effectiveness of novel aerial SDS detection methods. Furthermore, a TIR case study investigating the use of potential thermal canopy changes for SDS detection was conducted to investigate the possibility of using TIR as an SDS indicator. CIR reflectance measured from a ground-based spectrometer and sUAS was collected data over a two-year period. Ground-based spectrometer data were collected weekly, while a sUAS collected aerial imagery late in the growing season each year before plant maturity. Pigment index (PI) values were derived from ground-based and aerial data. Results showed a strong negative correlation between SDS score and PI values. Aerial and ground-based data both showed strong correlations to SDS score, however, aerial data displayed a stronger relationship possibly due to minimal changes in environmental conditions. High SDS scores correlated strongly to aerial derived PI (R2 = 0.8359). Rapidly assessed high SDS allows for accurate screening of SDS critical for soybean breeding. The second year of the study investigated each component of SDS score, severity, and incidence. PI proved to have the best correlation with severity (R2 = 0.6313 and ρ = -0.8016) rather than incidence or SDS score. PI also correlated to SDS scores with R2 = 0.6159 and ρ = -0.7916. A sUAS mounted TIR camera collected imagery four times during the growing season when SDS foliar symptoms were just starting to appear. At the start of the study period, the correlation between canopy temperature and SDS is low (ρ = -0.2907), but increases over the growing season as SDS prevalence increases ending with a strong correlation (ρ = -0.7158). Early identification of SDS leads to the implementation of mitigation practices and changes in irrigation scheduling before the disease reaches severe symptoms. Early mitigation of SDS reduces yield loses for farmers. The use of both CIR and TIR aerial imagery captured using sUAS can provide rapid spatial assessments of SDS, which is required by both producers and plant breeders. PI derived from CIR imagery showing strong correlations to SDS score reinforce the idea of replacing the time-consuming traditional ground-based systems with the more flexible, faster, sUAS methods. TIR imagery was shown to be reliable in assessing SDS in soybeans further establishing another possible aerial method for early detection of SDS.

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.

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.

Bakgrund: Möten med anhöriga ingår i sjuksköterskans dagliga arbete inom slutenvården och plötslig död är något som kan inträffa på alla vårdavdelningar. Syfte: Syftet med litteraturöversikten var att sammanställa sjusköterskors upplevelser av att möta anhöriga till patienter som drabbats av plötslig död inom slutenvården. Metod: Litteraturöversikten genomfördes med kvalitativ ansats och baserades på 10 vetenskapliga studier. Databassökningar gjordes i CINAHL och PubMed. Resultat: Analysen av de utvalda studiernas resultat visade sjuksköterskors upplevda otrygghet i mötet med anhöriga som drabbats av plötslig förlust, svårigheter att hantera de egna känslorna relaterat till döden samt sjuksköterskornas upplevda betydelse av att etablera goda relationer med anhöriga för att kunna tillgodose deras omvårdnadsbehov. Konklusion: Det råder osäkerhet bland sjuksköterskor gällande möten och kommunikation med anjöriga till patienter som drabbats av plötslig död och många sjuksköterskor önskar mer stöd gällande den egna känslohanteringen i relation till mötet med dessa anhöriga. / Background: Encounters with the people having close relationships with patients occurs daily for nurses working in a hospital setting and sudden death is something that can arrive in any department of care. Aim: The aim of this litterature review was to assemble nurses´ experiences of caring for the suddenly bereaved. Method: The litterature review was conducted with a qualitative approach using Friberg´s method book (2017) and is based on 10 scientific studies collected from the two databases CINAHL and PubMed. Result: The analysis of the chosen studies showed how the nurses felt uncertain in the encounters with the suddenly bereaved, the struggle of dealing with their own emotions related to death and the nurses´ perceptions of the importance of establishing good relationships with the next of kin to be able to provide good care for them. Conclusion: There is a general feeling of uncertainty among nurses regarding the encounters with, and the communication with next of kin suffering from sudden loss. Many nurses need further emotional support regarding their own feelings in relation to the encounters with the suddensly bereaved next of kin.