En pacemaker eller implantable cardioverter defibrillator (ICD) kan för många innebära en upplevelse av att de får en ny chans till livet. Sedan den första pacemakern sattes in på 50-talet har utvecklingen gått framåt och många livshotande rytmrubbningar kan behandlas. Att behandlas med pacemaker eller ICD kan innebära både fysiska och psykiska omställningar i det vardagliga livet. Dessa fysiska och psykiska omställningar kan påverka patientens livsvärld, levda kropp, hälsa och välbefinnande samtidigt som det kan inge ett hopp inför framtiden. För att vårdpersonal och närstående ska kunna ge ett bra stöd till personerna med pacemaker eller ICD är det av stor vikt att belysa upplevelsen av hur det är att leva med detta hjälpmedel. Syftet är att undersöka upplevelser av att leva med pacemaker eller ICD. För att svara på syftet genomfördes en litteraturstudie där Fribergs (2006, ss. 115-124) modell användes för analys av data. Resultatet bygger på analyser av åtta kvalitativa och två kvantitativa studier, dessa redovisas i form av fyra huvudteman; Att uppleva livsförändringar, att vara i behov av stöd och utbildning, att hitta sin egen väg till acceptans och att uppleva oro. Att behandlas med en pacemaker eller ICD kan för många innebära att livet förändras. Det kan innebära att individen får en mer positiv inställning till livet men det kan också innebära en del begränsningar som i sin tur kan leda till att personen drar sig undan. Det finns ett stort behov av mer stöd och utbildning från vårdpersonal för att individerna ska uppleva en trygghet i sin vardag. Den nya livssituationen kan innebära att individen måste försöka finna en egen väg mot att acceptera sin livsvärld. Det kan även finnas en oro inför framtiden och hur deras sjukdom kommer att påverka deras barn. För att patienten ska uppleva en trygghet i sin vardag behöver vårdpersonalen en större insikt och förståelse i patientens liv och på så sätt kunna ge en bättre information och utbildning. / Program: Sjuksköterskeutbildning

Introdução: Pretende-se com a estimulação cardíaca artificial promover melhor qualidade de vida a portadores de complicações cardíacas graves, porém, a falta de conhecimento dos pacientes e o despreparo dos profissionais de saúde podem influenciar nos hábitos de vida e no surgimento de possíveis complicações. Objetivo: Avaliar a qualidade de vida relacionada à saúde (QVRS) de pacientes portadores de marca-passo (MCP) e explorar as associações entre QVRS e variáveis sociodemográficas, clínicas e sintomas de ansiedade e depressão. Método: Estudo observacional analítico, de corte transversal, realizado em hospital universitário do interior paulista. Uma amostra consecutiva e não probabilística foi constituída de pacientes de ambos os sexos, maiores de 18 anos, portadores de MCP há pelo menos um mês. Para a avaliação da QVRS, foi utilizado um instrumento genérico (SF-36) e um específico (AQUAREL). Para investigarmos a associação da QVRS com o sexo e o estado civil, utilizamos o teste t de Student. Para QVRS com a idade, o tempo de implante de MCP e os sintomas de ansiedade e de depressão, utilizamos o teste de Correlação de Pearson. O nível de significância foi de 0,05. Resultados: Participaram 88 pacientes, maioria do sexo masculino e com companheiro. Sua média de idade foi 64,3 (DP=13,0). Utilizando o SF-36, o domínio que apresentou maior média foi \"Aspectos Sociais\", e a menor, \"Aspectos Físicos\". Utilizando o AQUAREL, o domínio de maior média foi \"Arritmia\", e o de menor, \"Dispneia\". Quanto às associações, as mulheres apresentaram menores médias nos domínios \"Capacidade Funcional\", \"Estado Geral de Saúde\", \"Vitalidade\", \"Saúde Mental\" e \"Componente Mental\" do SF-36, bem como nos domínios \"Arritmia\" e \"Dispneia\" do AQUAREL, com significância estatística. Os pacientes sem companheiro apresentaram menores médias nos domínios \"Capacidade Funcional\", \"Vitalidade\" e \"Aspectos Sociais\" do SF-36, e nos domínios \"Arritmia\" e \"Dispneia\" AQUAREL, com significância estatística. Quanto à idade, as correlações foram significativas com os domínios \"Capacidade Funcional\" e \"Aspectos Físicos\" do SF-36, com baixa força de correlação. Quanto ao tempo de implante de MCP, as correlações foram significativas com o domínio \"Capacidade Funcional\" do SF-36 e com o domínio \"Arritmia\" do AQUAREL, com baixa força da correlação. Quanto à correlação da QVRS com os sintomas de ansiedade, foi significativa com os oito domínios do SF-36 e com os dois componentes, negativa, de forte magnitude no domínio \"Saúde Mental\" e no Componente Mental, e moderada em outros seis domínios. A correlação da ansiedade com os três domínios do AQUAREL foi negativa, significativa e de moderada magnitude. Quanto à correlação da depressão com a QVRS, foi significativa com os oito domínios do SF-36 e com os dois componentes, negativa, de forte magnitude no domínio \"Saúde Mental\" e moderada magnitude em quatro domínios e no Componente Mental. A correlação da depressão com os três domínios do AQUAREL foi negativa, significativa e de moderada magnitude. Conclusão: Os pacientes apresentaram pior QVRS nos domínios que avaliaram o quanto as condições físicas interferem no dia-a-dia. As mulheres, os pacientes sem companheiro e com maior sintomatologia de ansiedade e depressão apresentaram pior avaliação. / Introduction: Artificial cardiac stimulation aims to offer a better quality of life to those with severe cardiac problems. However, the lack of knowledge of the patients and the lack of preparation of health professionals can influence the life habits and lead to the surfacing of potential complications. Objective: Evaluating the health-related quality of life (HRQOL) of patients who have pacemakers (PM) and explore the associations between HRQOL and sociodemographic and clinical variables and symptoms of anxiety and depression. Method: Observational, analytical and cross-sectional study, conducted in a teaching hospital in the countryside of the state of São Paulo. A consecutive non-probabilistic sample was created including male and female patients above 18 years old who had had an MP for at least a month. To evaluate their HRQOL, a generic (SF-36) and a specific (AQUAREL) instruments were used. To investigate the association of HRQOL with sex and marital status, Student\'s t-test was used, and to analyze its relationship to age, time since MP implantation, and depression and anxiety symptoms, Pearson\'s Correlation Coefficient was used. The significance level was 0.05. Results: 88 patients participated, most were male and had partners. Age average was 64.3 (SD=13.0). The SF-36 domain with the highest average was \"Social Aspects\", and the one with the lowest, \"Physical Aspects\". The greatest average among AQUAREL domains was \"Arrythmia\", and the lowest, \"Dyspnea\". As to associations, women presented lower averages in the domains \"Functional Capabilities\", \"General Health State\", \"Vitality\", \"Mental Health\" and \"Mental Component\" of the SF-36. The same was true for AQUAREL domains \"Arrythmia\" and \"Dyspnea\", all these correlations statistically significant. Patients with no partners had statistically significant lower averages in the SF-36 domains \"Functional Capabilities\", \"Vitality\" and \"Social Aspects\", and in the AQUAREL domains \"Arrythmia\" and \"Dyspnea\". As to their age, correlations were significant with the SF-36 domains \"Functional Capabilities\" and \"Physical Aspects\", with low-strength correlations. As to the time passed since the PM implantation, low-strength correlations were significant in the SF-36 domain \"Functional Capabilities\" and the AQUAREL domain \"Arrythmia\". As to the correlation of HRQOL to anxiety symptoms, it was significant for the eight SF-36 domains and its two components, being negative and strong in the \"Mental Health\" domain and in the Mental Component, and moderate in the other domains. Anxiety was negatively, significantly and moderately correlated to all three AQUAREL domains. The correlation of depression to HRQOL, was significant in the eight SF-36 domains and its two components, negative and strong in the \"Mental Health\" domain and moderately strong in four Mental Component domains. Depression was negatively, significantly and moderately correlated to all three AQUAREL domains. Conclusion: Patients had lower HRQOL in the domains which evaluated how do physical conditions interfere in their daily lives. Women, patients with no partners and more anxiety and depression symptoms had worse results in the evaluation.

As the effort of today’s industries to continuously move towards lean production, pull production system has been developed as one possible solution of lean. It is popularly known in the industry world, and is indeed a proven technique to achieve substantial savings on inventory, production cost incurred by manufactures all over the world. However, a careful understanding of pull production systems is required to access its suitability to a particular production setup. It is necessary to develop a proper way to implement pull production systems.             This study is based on a real life scenario in a leading driveline manufacturing company. The production system is studied in detail as regard to its production characteristic. A theoretical review is first made as research foundation. A careful analysis study within the company is conducted with all the existing constrains to figure out improvement opportunities. Eventually, from the applicability point of view, proposals of future pull production system implementation have been developed. The objective of the proposals is to minimize the identified weaknesses of the current system, including long lead time, low flexibility and unconnected flow.

Die bildgebende Diagnostik im Magnetresonanztomographen ist für Träger implantierter, nicht MR-fähiger Herzschrittmacher und Cardioverter/Defibrillatoren potentiell risikoreich. Durch das starke externe Magnetfeld und die elektromagnetischen Signale des MRT-Gerätes können die antibradykarden und –tachykarden Therapiesysteme in ihrer korrekten Funktion erheblich gestört und durch die Antennenwirkung der Sonden myokardiale Schädigungen hervorgerufen werden. In der vorliegenden Arbeit sind bei Trägern derartiger Implantate deren wichtigste Funktionsparameter vor und nach einer jeweiligen Untersuchung im MRT telemetrisch ermittelt worden. Anhand der statistischen Auswertung der prä- und postprozedualen Messwerte für Wahrnehmung (Sensing), Reizschwelle und Elektrodenimpedanz wurde der Einfluss einer MRT-Untersuchung auf die regelrechte Funktion der Herzschrittmacher- und ICD-Aggregate untersucht. Ein weiteres Augenmerk galt im Allgemeinen der grundsätzlichen Durchführbarkeit des Verfahrens und eventuellen Komplikationen hinsichtlich unzureichender Patientensicherheit. Zum einen konnte gezeigt werden, dass nach sorgfältiger Abwägung von Risiko und Nutzen der Untersuchung, sowie entsprechenden Sicherheitsvorkehrungen, die MRT komplikationslos durchführbar ist. Weiterhin konnte keine Beeinträchtigung der regelrechten Funktion der Aggregate nachgewiesen werden.

Membrane diversity associated with variation in body mass and body temperature of hymenopterans was investigated. Body mass of organisms affects most aspects of their biology, including physiological traits. One trait influenced by mass is metabolic rate, but the basis for its variation among organisms remains unclear. Recent work revealed that membrane phospholipid composition varies systematically with body mass: smaller vertebrates with higher mass-specific metabolic rates have more fluid membranes containing more long chains of polyunsaturated fatty acids (PUFA) and less monounsaturated fatty acids (MUFA). This “membrane pacemaker” theory of metabolism has recently been challenged by a lack of link between metabolic rate and membrane composition. To test this relationship, we have quantified the membrane lipid composition of 22 species of Panamanian orchid bees with a 22-fold range in mass. Results incorporating phylogenetic analysis show significant relationships for 18:1 (MUFA) and 18:3 (PUFA) with body mass that are consistent with the “pacemaker” theory, and unexpected relationships with saturated fatty acids (SFA). Moreover, changes in membrane fatty acid composition with temperature are a strategy in ectothermic poïkilotherms that is part of the “homeoviscous adaptation” model. Here, we report systematic variations in fatty acid composition linked with thoracic temperature excess in North American Hymenopterans, a novel discovery in these heterotherms. These findings are discussed in the context of diet, metabolism and lifespan.

The interactions of the radio frequency (RF) fields in magnetic resonance imaging (MRI) with a human body model are investigated. In particular, the interactions of these fields with an implanted pacemaker are studied. The specific absorption rate (SAR) levels in a heterogeneous body model are evaluated in two different birdcage coils - a resonant and a non-resonant coil - at a magnetic field of 1.5 T. The enhancement of the SAR due to an implanted cardiac pacemaker and the effect of the conductivity of the pacemaker lead on the SAR levels are investigated. The finite difference time domain (FDTD) technique is used to model these interactions. The SAR levels are found to be low in the heart region, and thus the SAR enhancement due to the pacemaker lead is relatively low. Modeling of the pacemaker leads as perfect conductors results in greater SAR enhancements than those produced by actual conductive leads.

Diss. (sammanfattning) Stockholm : Tekn. högsk. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 6 uppsatser.

Diss. Linköping : Univ.

Thesis (Ph. D.)--University of Hong Kong, 2008. / Includes bibliographical references (leaves 156-176) Also available in print.