Genomgående i Sverige under de senaste 20 åren så har hot- och våldssituationer ökat för blåljuspersonal. Det är ett problem då det leder till en ökad oro och känsla av otrygghet hos de som arbetar inom yrkesområdet. Studiens författare är verksamma inom ambulansområdet Södra Älvsborgs Sjukhus (SÄS) och med detta arbete är syftet bland annat att undersöka hur ofta som ambulanspersonalen inom området upplever att de har blivit utsatta för hot och våld de senaste 12 månaderna. Fokus ligger även på frågan om huruvida deltagarna i studien önskar få tillgång till ytterligare skyddsutrustning i sitt arbete i form av skyddsväst och en bättre skyddande hjälm, så kallad ballistisk hjälm. Metoden som använts är en kvantitativ enkätstudie som tilldelats personal inom ambulansområdet. Det framkom under studien att personalgruppen utsatts för förhållandevis få hot- och våldssituationer de senaste 12 månaderna. Det finns ingen signifikant skillnad mellan män och kvinnor gällande våldsamma situationer och inte heller någon skillnad jämfört om man arbetat länge eller ej, ej heller skillnad beroende på vilken station personalen arbetar på. En majoritet har svarat att de gärna vill ha tillgång till utrustningen men att den troligtvis enbart används om nödvändigt samtidigt som ett fåtal är negativt inställda. Det finns en förhållandevis liten risk att bli utsatt för hot och våld, men trots detta önskar flertalet tillgång till mer skyddsutrustning för en ökad trygghet och större beredskap för det okända i arbetssituationer. Författarna finner ämnet intressant då det samtalas mycket kring säkerhet och trygghet på arbetsplatser idag och bedömer att det finns mer att forska på i detta ämne. / Throughout Sweden in the past 20 years there has been an increase in incidents of threats and violence towards emergency personnel. This is a problem as it leads to increased concern and a sense of insecurity among those working in the area. The authors of the study who are active in the ambulance sector of SÄS aim to investigate how often ambulance personnel have experienced threats and violence in the past 12 months. The focus is also on whether the participants in this study wish to have additional protective equipment, such as protective vests and better helmets, known as ballistic helmets. The method used is a quantitative survey distributed to ambulance personnel. The study found that the personnel group has experienced relatively few incidents of threats and violence in the past 12 months. There is no significant difference between men and women regarding violent situations and no difference based on the length of service or placement of the workplace. A majority of the respondents express that they have a desire to have access to the equipment but will only use it when necessary while a few have a negative attitude towards it. Despite the relatively low risk of being subjected to threats and violence, the majority still wishes to have access to more protective equipment for increased security and preparedness in unknown work situations. The authors find the topic interesting because of the talk about safety in workplaces today and believe that there is more to research in this area.

Stab resistant body armour had been used throughout history, with examples ranging from animal hide construction to the moulded Polycarbonate units typically used by United Kingdom (UK) Police Officers. Such protective articles have historically, and continue to present a number of issues which have shown to impair the operational performance of its wearer including but not exclusive to poor thermal regulation, large masses, and reduced manoeuvrability. A number of developments have been made in an attempt to minimise the effects of such issues. One potential solution yet to be fully explored is the utilisation of Additive Manufacturing (AM) technologies. In recent years the use of such manufacturing technologies, particularly Laser Sintering, has successfully demonstrated their suitability for a range of high performance applications ranging from Formula 1® to aerospace. Due to the fundamental additive nature of AM build processes, the utilisation of such technologies have facilitated the realisation of design concepts that are typically too expensive, difficult or impossible to create using traditional manufacturing processes. In order for AM technologies to be used for the generation of stab resistant body armour a number of historical issues and performance characteristics fundamental to ensure stab resistance is achieved must be satisfied. This body of research firstly evaluated the stab resistive performance of two of the most common materials suitable for Laser Sintering as highlighted by an initial review of AM technologies. Once an appropriate material had been highlighted it was used as the basis for further experimental testing. Such tests focussed on minimising the material thickness required to maintain an appropriate level of stab resistance within United Kingdom Home Office Scientific Development Branch (HOSDB) KR1-E1 requirement of 24 Joules of stab impact energy. Test results demonstrated that specimens manufactured from Duraform EX® required a minimum single layer thickness of 11.00 mm, and a dual layer total thickness of 9.00 mm to provide an appropriate level of stab protection within the HOSDB KR1-E1 standard. Coupled with the results generated from an investigation identifying the overlapping/imbricated assembly angle required to maintain an appropriate level of coverage across a scale structure, the stab resistant characteristics initially identified were used for the development of an imbricated scale-like assembly. Additional design features were also investigated to further minimise the total thickness of the final element design and corresponding assembled imbricated structure such features included angling strike surfaces and integrating a dual layered structure within individual elements. When the finalised imbricated assemblies were stab tested, they successfully demonstrated levels of stab resistance to the UK HOSDB KR1-E1 impact energy of 24 Joules.

Introduction: Jusqu’à la moitié des patients souffrant d’angine de poitrine vont continuer à être symptomatiques malgré une revascularisation coronarienne pour leur angine. Par ailleurs, l’évaluation de l’angine souffre du biais d’adaptation au seuil ischémique, phénomène par lequel les patients réduisent leur niveau d’activité physique pour limiter leurs symptômes. L’étude NOVA-SKIN (NCT02591758) utilise une veste intelligente (Hexoskin™) afin de (i) valider l’électrocardiogramme (ECG) de cette veste avec le Holter et l’épreuve d’effort (ii) dériver un “indice de vitalité” à partir des mesures biométriques de la veste, afin d’ajuster les mesures conventionnelles d’angine pour le biais d’adaptation au seuil ischémique et dériver des mesures d’angine digitale et (iii) évaluer si la réadaptation cardiaque à domicile peut être surveillée à distance avec le Hexoskin. Méthodes: Trente patients référés pour angiographie coronarienne pour leur angine réfractaire au traitement médical ont complété une épreuve d’effort et ont porté la veste Hexoskin (avec enregistrement simultané d’Holter) pendant 48 heures, 2 semaines avant leur examen. Les patients furent revus 2 semaines après la revascularisation coronarienne percutanée ou 6 semaines après la chirurgie cardiaque s’ils ont eu des pontages, où ils ont porté la veste Hexoskin avec Holter pendant 48 heures et fait une épreuve d’effort. Nous avons dérivé un indice de vitalité digital (Indice de vitalité = fréquence cardiaque * activité) chez chaque patient pour les deux enregistrements de la veste. Nous avons dérivé des mesures d’angine digitale en divisant ou multipliant (selon la direction de l’effet post coronarographie attendu) les mesures d’angine conventionnelle (classe SCC, pointage de qualité de vie, décompte de nitroglycérine et décompte d’angine) par l’indice de vitalité propre au patient. Nous avons comparé les différences (pré- et post-coronarographie) de mesures d’angine ajustées pour l’indice de vitalité dérivé à partir d’une veste intelligente (« angine digitale ») avec les mesures d’angine conventionnelles non ajustées. Les participants devaient ensuite compléter 6 sessions de réadaptation cardiaque à domicile sur une période de 1 mois. Une corrélation de Pearson fut obtenue entre la fréquence cardiaque de l’ECG de l’Hexoskin et celle du Holter et du tapis roulant. L’indice de vitalité pré et post-angiographie fut comparé en utilisant un test t et nous avons mesuré la taille de l’effet du traitement de l’angine dans le même patient, pour les mesures ajustées et non ajustées d’angine. Résultats: Trente patients, âgés de 68.0±7.0 ans, majoritairement des hommes (n=28; 93.3%) ont subi une angiographie coronarienne et ont été traités, pour leur angine, de façon percutanée (n=20; 66.7%), avec pontages (n=6; 20.0%) ou avec traitement médical (n= 4; 13.3%). Tous les patients étaient en rythme sinusal au départ. La fréquence cardiaque obtenue avec l’ECG de l’Hexoskin avait une corrélation très forte avec celle obtenue avec l’ECG du tapis roulant (r=0.95) et forte avec l’Holter (r=0.85). L’indice de vitalité a augmenté de manière significative (2.30±1.38 pré vs 2.70±1.12 post-traitement de l’angine; p=0.05). Les mesures d’angine digitale ayant montré une différence plus importante que les mesures conventionnelles sont le décompte hebdomadaire de nitroglycérine, l’échelle de santé globale du SF-36, la durée d’effort sur le tapis roulant et le nombre de METS maximal. Par ailleurs, chez les patients classifiés comme non-répondants au traitement de l’angine par mesures conventionnelles, les mesures d’angine digitale suivantes se sont améliorées de façon significative: classe SCC, décompte hebdomadaire d’angine, questionnaire d’angine de Seattle et la durée d’effort pendant l’épreuve d’effort. Aucun évènement cardiovasculaire ne s’est produit durant la réadaptation cardiaque à domicile et 93.3% des patients ont complété les 6 sessions. Conclusion : Dans notre étude pilote, l’ECG de Hexoskin a obtenu des mesures de fréquence cardiaque valides lorsque comparées au Holter et au tapis d’effort. L’incorporation d’un indice de vitalité obtenu à partir d’une veste intelligente a permis d’ajuster des mesures d’angine pour celui-ci et obtenir une angine digitale. La mesure d’angine digitale a une plus grande taille de l’effet post traitement de l’angine par revascularisation et peut détecter davantage de changements, au-delà des mesures d’angine conventionnelles. Cela est plus marqué chez les patients initialement classifiés comme “non-répondants” au traitement de l’angine. La réadaptation cardiaque à domicile fut sécuritaire et complétée par la majorité des patients. / Introduction : Up to half of coronary artery disease patients will remain symptomatic of angina, despite coronary revascularization. Moreover, the assessment of angina suffers from the ischemic threshold adaptation bias where patients will restrict their physical activity level in order to minimize their angina symptoms. The NOVA-SKIN study (NCT02591758) was designed to use a novel “smart clothing” (Hexoskin™) to (i) validate the electrocardiogram (ECG) signal of against traditional Holter and Treadmill stress tests (ii) to derive a ‘vitality index’ using the biometric measures obtained from the Hexoskin in order to adjust conventional angina assessment metrics to account for the ischemic threshold adaptation bias and derive a digital measure of angina and to (iii) assess if home cardiac rehabilitation can be remotely monitored using the Hexoskin system. Methods: Thirty stable angina patients referred for coronary angiography for refractory angina underwent a treadmill stress test and then simultaneously wore the Hexoskin vest and a traditional Holter monitor for 48 hours, 2 weeks before their exam. The patients were followed up 2 weeks after the percutaneous coronary intervention and 6 weeks after their cardiac surgery if they had coronary artery bypass graft. During the follow-up visit, they wore the vest with a Holter monitor for 48 hours and underwent another treadmill stress test. We obtained an average vitality index pre- and post-angiogram (Vitality index=heart rate * activity) using recordings from the vest. We also obtained health related questionnaires during the same timeframe. We compared differences in conventional angina metrics adjusted for the vitality index (“digital angina”) with the conventional metrics unadjusted for the vitality index, pre- and post-coronary angiography. Patients then had to complete 6 home cardiac rehabilitation sessions during a 1-month period. Pearson correlation was obtained between the heart rate (HR) derived from the ECG of the vest and the HR of the Holter and treadmill stress test. The vitality index pre and post-angiography was compared using a t-test. We derived digital angina metrics by dividing or multiplying (according to the direction of the effect expected post-coronarography) the conventional angina metrics. Then we measured the effect size of the angina treatment and compared it between adjusted and unadjusted metrics within the same patient. Results: Thirty patients aged 68.0±7.0 years (93.3% men; n=28) were enrolled in the study. Patients were treated with percutaneous coronary intervention (n=20; 66.7%), coronary artery bypass grafting (n=6; 20.0%) or medical therapy (n=4; 13.3%). The heart rate from ECG signal of the Hexoskin demonstrated a very strong correlation with that of the treadmill stress test ECG (r=0.95) and a strong correlation with the Holter (r=0.85). The vitality index increased significantly from 2.30±1.38 to 2.70±1.12 (p=0.05). The digital angina metrics (adjusted for the vitality index) that were found to be more responsive to the treatment of the angina than conventional were: the weekly nitroglycerin count, the global health sub-scale of the SF-36, the treadmill stress test length and the peak METs. Furthermore, in patients classified as non-responders to the treatment of angina by conventional metrics, the digital angina measures improved significantly, when looking at the CCS class, the weekly angina count, the Seattle Angina Questionnaire metrics and the duration of exercise on the treadmill stress test. No adverse events occurred during home cardiac rehabilitation and 28 patients completed all 6 sessions wearing the Hexoskin. Conclusion : In our pilot study, the Hexoskin ECG was well correlated with standard HR measurement using a treadmill ECG or a Holter. Adjusting conventional metrics for the vitality index allows for greater sensitivity in gauging the effect of revascularization on angina than conventional metrics alone, particularly for patients who would be considered non-responders to their treatment based on conventional metrics. Home cardiac rehabilitation was safe and was completed by most patients.