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- Consensus on covert awareness: a Delphi studyPublication . Schnakers, Caroline; Overbeek, Berno; Fullmer, Niko; Teixeira, Liliana; Zandalasini, Matteo; Yatsko, Kseniia; Morrissey, Ann-Marie; Zasler, Nathan; Estraneo, AnnaIdentifying wilful brain activity in patients with disorders of consciousness is critical, as some patients fail to exhibit behavioural signs of consciousness at the bedside but respond to active tasks via neuroimaging or electrophysiological measures. Standardized terminology for this subgroup is absent while it is essential for advancing research and clinical care. The objective of this study was to determine the level of consensus among a large group of international experts on terminology and definitions for this clinical entity, as described by terms such as covert awareness, cognitive motor dissociation, functional locked-in syndrome, and non-behavioural minimally conscious state. A Delphi study was conducted using REDCap to evaluate expert agreement on terminology and definitions. The study was conducted among international experts, primarily from Europe/UK, the USA and other regions. Ninety-six experts participated. Among these, 75 (78%) completed both rounds. Participants were predominantly clinical scientists (71%) working in rehabilitation settings (63%). A Delphi method was followed. Consensus on terminology and related definitions was defined as a median score of 5, an interquartile range ≤1 and ≥75% agreement (scores of 4 or 5). Within two rounds, consensus was achieved for over two- thirds of the statements. The term ‘Covert Awareness’ and its associated definition were identified as the preferred terminology by an international expert panel. We recommend the use of ‘Covert Awareness’ since our large group of international experts consistently agreed on such preferred term for this subgroup of patients with disorders of consciousness. This consensus (>75% agreement) establishes a foundation both for future research and clinical standardization. The findings have implications for improving diagnostic accuracy and advancing understanding of covert awareness, although further study is needed to refine and apply the agreed-upon definition in clinical practice.
- Optimizing neurobehavioral assessment for patients with disorders of consciousness: Proposal of a comprehensive pre-assessment checklist for cliniciansPublication . Keech, Kristen; Schnakers, Caroline; Murtaugh, Brooke; O’Brien, Katherine; Slomine, Beth; Briand, Marie-Michèle; Formisano, Rita; Thibaut, Aurore; Estraneo, Anna; Noé, Enrique; Gosseries, Olivia; Teixeira, Liliana da Conceição; da Conceição Teixeira, LilianaClinicians are challenged by the ambiguity and uncertainty in assessing level of consciousness in individuals with disorder of consciousness (DoC). There are numerous challenges to valid and reliable neurobehavioral assessment and classification of DoC due to multiple environmental and patient-related biases including behavioral fluctuation and confounding or co-occurring medical conditions. Addressing these biases could impact accuracy of assessment and is an important aspect of the DoC assessment process. A pre-assessment checklist was developed by a group of interdisciplinary DoC clinical experts and researchers based on the existing literature, current validated tools, and expert opinions. Once finalized, the checklist was electronically distributed to clinicians with a range of experience in neurobehavioral assessment with DoC. Respondents were asked to use the checklist prior to completing a neurobehavioral assessment. A survey was also provided to respondents to obtain feedback regarding checklist feasibility and utility in optimizing the behavioral assessments. Thirty-three clinicians completed the survey after using the checklist. Over half of the respondents were a combination of physicians, neuropsychologists, and physical therapists. All respondents served the adult DoC population and 42% percent had over ten years of clinical experience. Eighty percent reported they found the format of the checklist useful and easy to use. All respondents reported the checklist was relevant to preparing for behavioral assessment in the DoC population. Eighty-four percent reported they would recommend the use of the tool to other clinicians. The use of a pre-assessment checklist was found to be feasible and efficacious in increasing interdisciplinary clinician’s ability to optimize the patient and environment in preparation for neurobehavioral assessment. Initial results of clinicians’ perception of the utility of a pre-assessment checklist were positive. However, further validation of the tool is needed with larger sample sizes to improve representation of clinical use across disciplines and care settings.
- A systematic review of chest-worn sensors in cardiac assessment: technologies, advantages, and limitationsPublication . Machado, Ana; Ferreira, Filipa; Ferreira, Simão; Almeida-Antunes, Natália; Carvalho, Paulo; Melo, Pedro; Rocha, Nuno; Rodrigues, Matilde A.; Rodrigues, Matilde; Martins de Almeida Melo, Pedro MiguelThis study reviews the scientific use of chest-strap wearables, analyzing their advantages and limitations, following PRISMA guidelines. Eligible studies assessed chest-strap devices in adults and reported physiological outcomes such as heart rate, heart rate variability, R–R intervals, or electrocardiographic waveform morphology. Studies involving implanted devices, wrist-worn wearables, or lacking validation against reference standards were excluded. Searches were conducted in PubMed, Scopus, Web of Science, and ScienceDirect for studies published in the last 10 years. The quality of the studies was assessed using the Mixed Methods Appraisal Tool, and results were synthesized narratively. Thirty-two studies were included. The most frequently evaluated devices were the Polar H10 and Zephyr BioHarness 3.0, which showed strong correlations with electrocardiography at rest and during light-to-moderate activity. Reported limitations included motion artefacts, poor strap placement, sweating, and degradation of the skin–electrode interface. None of the devices had CE or FDA approval for clinical use, and most studies were conducted in controlled settings, limiting generalizability. Ergonomic concerns such as discomfort during prolonged wear and restricted mobility were also noted. Overall, chest-strap sensors showed good validity and were widely used in validation studies. However, technical refinements and large-scale field trials are needed for broader clinical and occupational application. This review is registered in PROSPERO and is part of the SIREN project.
- Can lycopene be considered an effective protection against cardiovascular disease?Publication . Rodrigues, João Costa; Pinho, O.; Monteiro, Pedro Ribeiro Rocha; Costa-Rodrigues, Joao; Monteiro, PedroLycopene is a bioactive component mainly found in tomato. It is characterized by a high antioxidant potential, the highest among carotenoids. Mainly due to this property, lycopene has been suggested to display many beneficial effects, including its potential cardioprotective role. Despite some contradictory observations, which appear to be mainly caused by discrepancies in the different experimental protocols applied in the different studies, growing evidence points to clear benefits of lycopene in the maintenance of cardiovascular function and health. The knowledge about lycopene’s preventive effects in atherosclerosis, and other cardiovascular diseases, must be translated into changes in food patterns, aiming to increase the consumption of tomato, tomato-containing products, or other foods with high lycopene content, which can have an important impact on cardiovascular disease, particularly in countries where this represents a major public health concern.
- Assessing carbohydrate counting accuracy: Current limitations and future directionsPublication . Amorim, Débora; Miranda, Francisco; Santos, Andreia; Graça, Luís; Rodrigues, João; Rocha, Mara; Pereira, Maria Aurora; Sousa, Clementina; Felgueiras, Paula; Abreu, Carlos; Costa-Rodrigues, JoaoDiabetes mellitus is a prevalent chronic autoimmune disease with a high impact on global health, affecting millions of adults and resulting in significant morbidity and mortality. Achieving optimal blood glucose levels is crucial for diabetes management to prevent acute and long-term complications. Carbohydrate counting (CC) is widely used by patients with type 1 diabetes to adjust prandial insulin bolus doses based on estimated carbohydrate content, contributing to better glycemic control and improved quality of life. However, accurately estimating the carbohydrate content of meals remains challenging for patients, leading to errors in bolus insulin dosing. This review explores the current limitations and challenges in CC accuracy and emphasizes the importance of personalized educational programs to enhance patients’ abilities in carbohydrate estimation. Existing tools for assessing patient learning outcomes in CC are discussed, highlighting the need for individualized approaches tailored to each patient’s needs. A comprehensive review of the relevant literature was conducted to identify educational programs and assessment tools dedicated to training diabetes patients on carbohydrate counting. The research aims to provide insights into the benefits and limitations of existing tools and identifies future research directions to advance personalized CC training approaches. By adopting a personalized approach to CC education and assessment, healthcare professionals can empower patients to achieve better glycemic control and improve diabetes management. Moreover, this review identifies potential avenues for future research, paving the way for advancements in personalized CC training and assessment approaches and further enhancing diabetes management strategies.
- Total sacrectomy rehabilitation: Implementation of the international classification of functioning, disability, and health model – A case reportPublication . Lopes, Alfredo A.; Mesquita, Inês; Torres, Rui; Torres, Rui; Lopes, Alfredo; Mesquita, InêsThis study aims to outline an evaluative diagnostic process and intervention for a patient who underwent total sacrectomy based on the International Classification of Functioning, Disability, and Health (ICF) model. A 70-year-old male with a history of an aggressive sacral chordoma experiencing intense pain, constipation, and polyuria without the sensation of bladder filling, underwent a total sacrectomy. Two evaluations at two-time points were conducted 12 weeks apart. The patient then underwent an individualized rehabilitation program tailored to address impairments, activity limitations, and participation restrictions. The care plan was adjusted based on the patient’s health status and relevant personal and environmental factors. The Barthel Scale scores improved from 60 to 80. Motor scores on the American Spinal Injury Association scale increased from 62 to 66, while sensory scores for light touch improved from 86 to 96. However, pain scores remained stable at 86. Functional reach tests showed notable enhancements, with anterior reach increasing from 16.4 cm to 23.7 cm and lateral reach from 9.6 cm to 15.2 cm. The patient also showed progress in mobility, increasing the number of steps taken from 0 to 10. This case report highlights the positive therapeutic outcomes achieved, illustrating improvements in functional activities and patient independence, thereby underscoring the effectiveness of the ICF model in managing patients undergoing total sacrectomy.
- The cardiometabolic impact of rebaudioside a exposure during the reproductive stagePublication . Bracchi, Isabella; Morais, Juliana; Coelho, João Almeida; Ferreira, Ana Filipa; Alves, Inês; Mendes, Cláudia; Correia, Beatriz; Gonçalves, Alexandre; Guimarães, João Tiago; Falcão-Pires, Inês; Keating, Elisa; Negrão, RitaSince foods rich in refined sugars promote obesity, the use of non-caloric sweeteners has gained popularity, and their consumption by pregnant women has increased. Stevia (a non-caloric sweetener) consumption was considered safe for humans by the European Food Safety Authority in a dose of up to 4 mg/kg body weight/day. However, the World Health Organization recommended in 2023 the restraint of these sweeteners at any life stage, highlighting the need for research on pregnant women and early stages of development. So, we aimed to study the effects of chronic consumption of the main sweetener compound of stevia (Rebaudioside A) during the reproductive stage. Female rats were treated with Rebaudioside A (4 mg steviol equivalents/kg body weight/day) in the drinking water from 4 weeks before mating until weaning. Food and water consumption, blood glucose and lipids, as well as heart structure, function and mitochondrial function, were assessed. Rebaudioside A decreased heart size, cardiomyocyte area and fibrosis without repercussions on cardiac or mitochondrial function. Both fasting blood glucose and cholesterol decreased. This work suggests that stevia consumption at this dose may be safe for females during the reproductive stage. However, more studies are mandatory to explore the effects of stevia consumption on offspring’s health.
- Preparing the certification of software as a medical device: a european regulatory analysis and case study on the Clynx®PlatformPublication . Mesquita Montes, António; Pinto, Joana F.; Silva, Hugo P. da; Chambel, Gonçalo; Clemente, Carolina; Silva, Diogo C. F.; Montes, António M.; Simões, Daniela; Silva, Diogo C. F.The primary objective of this study is the preparation of the certification of the Clynx® Platform, a physiotherapy software, as a Class IIa medical device software in accordance with the regulatory framework outlined in Medical Device Regulation 2017/745 (MDR). The methodology involves a comprehensive analysis of European Union medical device regulations and guidelines, with a specific focus on the certification process essential for obtaining a Conformité Européenne (CE) marking for Class IIa medical device software. This section explores the intricate aspects of the certification process, emphasizing the compilation of Technical Documentation, the nuances of Clinical Evaluation, and the establishment of a Quality Management System. The approach aligns closely with the stipulations of MDR 2017/745. The study includes an industry case study featuring the Clynx® Platform, developed by Clynx® Health. Insights derived from the MDR are applied to categorize an in-development version of the software as a Class IIa medical device. The preparation of certification of this product involves the meticulous creation of Intended Use, Classification, General and Safety Performance Requirements, and Clinical Evaluation files, the presentation of an experimental protocol to validate the software’s technical performance for inclusion in the Clinical Evaluation, and a description of an Internal Audit performed on the Quality Management System. The certification of Class IIa medical device software necessitates the compilation of thorough Technical Documentation, including an extensive Clinical Evaluation, and the implementation of a robust Quality Management System. The certification process is conducted in collaboration with Notified Bodies, ensuring adherence to the stringent requirements set forth by the regulatory framework.
- In vitro metabolism of steroid hormones by ovary and hepatopancreas of the crustacean Penaeid shrimp Marsupenaeus japonicusPublication . Summavielle, Teresa; Monteiro, Pedro Ribeiro Rocha; Reis-Henriques, Maria Armanda; Coimbra, João; Monteiro, Pedro; Summavielle, TeresaRadioimmunoassay (RIA) was applied to identify selected metabolites obtained in in vitroincubations of ovarianand hepatopancreatic tissues from female Marsupenaeus japonicusin previtellogenic and vitellogenic maturation stages. Depend-ing on the precursors used, progesterone, 17α-hydroxyprogesterone or testosterone, it was possible to observe the presence of sev-eral enzymatic activities through metabolites detected in incubations. The present study provides evidence that the ovary of theshrimpM. japonicusis capable of synthesising 17β-estradiol from progesterone, evidencing the presence of 17α-hydroxy-lase, C17-C20lyase, 17β-hydroxysteroid dehydrogenase (17β-HSD) and aromatase. Enzymatic activities of aromatase, 3β-HSD and 17α-hydroxylase were detected in hepatopancreas, but not that of C17-C20lyase. These results suggest that 17β-estradiol could be the vitellogenesis stimulating ovarian hormone (VSOH), and together with former in vivoand in vitrostudies this leads us to propose that in fact there may be a physiological role for steroid hormones in the maturation cycleof crustaceans.
- Presence of pain shows greater effect than tendon structural alignment during landing dynamicsPublication . Silvia, Ortega-Cebrián; Silva, Diogo C. F.; Carneiro, Daniela F.; Zárate, Victor; Alves, Leonel A. T.; Guedes, Diana C.; Zárate-Tejero, Carlos A.; Cadellans-Arróniz, Aïda; Montes, António Mesquita; Mesquita Montes, António; Silva, Diogo C. F.; C. Guedes, Diana"Eccentric loading during landing is considered a key factor in the development of patellar tendinopathy and is associated with stiff landings and patellar tendinopathy. This study aims to investigate the relationship between tendon structure, presence of pain, and sex differences in landing kinematics and kinetics during countermovement jumps (CMJ) and tuck jump tests (TJT) in professional volleyball players. Professional volleyball players aged 18 to 30 years old (14 females and 25 males) participated in a cross-sectional study. Data included the Victorian Institute of Sport Assessment Patellar Tendon (VISA-P) questionnaire; patellar tendon ultrasound characterization tissue (UTC) scans, in order to identify groups with misaligned tendon fibers (MTF) or aligned tendon fibers (ATF); and biomechanical assessments for CMJ and TJT. The joint angle (JA) at the lower limb was measured at peak ground reaction force (peak_vGRF) and maximal knee flexion (max_KF). A general linear model was used to evaluate joint JA differences between tendon alignment, pain, and sex variables. Sample t-tests compared peak_vGRF, load time, load rate, and area based on tendon alignment, pain presence, sex, and jump. The statistical significance of p-value is >0.05, and the effect size (ES) was also calculated. The MTF group revealed decreased knee JA during TJT at peak_vGRF (p = 0.01; ES = −0.66) and max_KF (p = 0.02; ES = −0.23). The presence of pain was associated with increased JA during the CMJ, particularly at peak_vGRF and max_KF for trunk, hip, and ankle joints. Females showed decreased peak_vGRF than males. Landing with misaligned tendon fibers showed longer load times compared to aligned tendon fibers (p = 0.021; ES = −0.80). The TJT exhibited a greater load rate than the CMJ (p = 0.00; ES = −0.62). Pain is a critical factor influencing greater JA during landing, particularly at the trunk, hip, and ankle joints in CMJ. Misaligned tendon fibers compromise landing dynamics by increasing trunk JA during TJT. Kinetics varied significantly by sex and jump type, while pain and tendon structure revealed limited differences. "