Abstract

Abstract
In Mediterranean Europe, one of the expected consequences of climate change is the intensification of wildfire events. Given the importance of forests in helping regulate climate and the many ecosystem services they provide, it is crucial to identify how wildfires might impact them. In this context, the present work aims to identify the wildfire impacts caused to the ecosystem services in Portugal. This is done through a survey directed to Portuguese fire experts. Using The Economics of Ecosystems and Biodiversity (TEEB) definitions, experts were asked to share their perceptions on the fire impacts to forest ecosystem services in the short and long-term and indicate which services they feel require more policies to mitigate the impacts. The results showed that all ecosystem services are impacted to various degrees and different lengths of time. Regulating services were overall the most affected group and the most in need of specific policies. This study helped identify fire impacts, policy needs, and priorities in the perception of the experts in Portugal, which is valuable for guiding future research in various knowledge fields, especially related to raising awareness about behavioral adaptation to prevent and mitigate wildfire impacts in a changing climate. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023.

Abstract
Objectives: As epilepsy management medical devices emerge as potential technological solutions for prediction and prevention of sudden death in epilepsy (SUDEP), there is a gap in understanding the features and priorities that should be included in the design of these devices. This study aims to bridge the gap between current technology and emerging needs by leveraging insights from persons with epilepsy (PWE) and caregivers (CG) on current epilepsy management devices and understanding how SUDEP awareness influences preferences and design considerations for potential future solutions. Methods: Two cross-sectional surveys were designed to survey PWE and CG on medical device design features, SUDEP awareness, and participation in medical device research. Data analysis included both qualitative thematic analysis and quantitative statistical analysis. Results: The survey revealed that among 284 responses, CG were more aware of SUDEP than PWE. Comfort was identified as the primary concern regarding wearable medical devices for epilepsy management with significant differences between PWE and CG regarding acceptance and continuous use preferences. The thematic analysis identified integration with daily life, aesthetic and emotional resonance, adaptability to seizure characteristics, and user-centric design specifications as crucial factors to be considered for enhanced medical device adoption. The integration of a companion app is seen as an important tool to enhance communication and data sharing. Discussion: This study reveals that while SUDEP awareness can promote the development of future SUDEP predictive and preventive medical devices, these should be designed to mitigate its impact on daily life and anxiety of both PWE and CG. Comfort and acceptance are seen as key priorities to support continuous use and are seen as a technical requirement of future medical devices for SUDEP prediction and prevention. Widespread adoption requires these technologies to be customizable to adapt to different lifestyles and social situations. A holistic approach should be used in the design of future medical devices to capture several dimensions of PWE and CG epilepsy management journey and uphold communication between healthcare professionals, PWE and CG. Conclusion: Data from this study highlight the importance of considering user preferences and experiences in the design of epilepsy management medical devices with potential applicability for SUDEP prediction and prevention. By employing user-centered design methods this research provides valuable insights to inform the development of future SUDEP prediction and prevention devices.