Hydrogen integration at Dutch regional energy hubs appears to stall not because of technology but because no institutional arrangement adequately governs the conditions under which projects may operate on financeable terms. Grid access is the binding constraint: investment depends on how many hours a connection permits operation, what curtailment costs, and whether those hours coincide with renewable generation eligibility. At Cluster 6 nodes, outside reinforcement priority plans and lacking near-term access certainty, these interdependencies remain unresolved. This paper identifies five decision uncertainties arising at the boundaries between potential hub developers and network operators, across four coordination requirements: siting, access portfolio construction, curtailment and settlement design, and hub governance in Cluster 6-type contexts. In response, four coordination strategies are identified using existing Dutch regulatory instruments and configured into two lifecycle-sequenced integration pathways matched to observable hub conditions. The analysis indicates that no single instrument, on its own, is likely to secure the institutional conditions associated with financeability; rather, those conditions depend on how instruments are combined across the wider coordination arrangement.

One of the strategies for the control and elimination of schistosomiasis is the control of its snail vectors in an endemic area, as is done in other tropical diseases like malaria. However, the strategy currently practiced for the control of the disease in Nigeria is the annual mass administration of preventive chemotherapy (Praziquantel) among school-age children while neglecting the control of its snail intermediate host and other control components. The neglect of malacology and vector control will slow the elimination targets and timeline of 2030 set by the WHO. In this study, we investigated the abundance and seasonal variations in the snail vectors of schistosomiasis and the relationship between the disease among humans and infected snail vectors. A total of 21,282 snails were collected from 13 sites across the six area councils of the Federal Capital Territory (FCT). Of the collected snails, 1451 (6.8%) belong to three species: Biomphelaria pfeifferi (0.5%), Bulinus truncatus (2.1%) and Bulinus globosus (4.2%), which are known to be vectors of Schistosoma mansoni, Schistosoma haematobium and Schistosoma bovis, respectively. These three species were all shedding cercariae both at the time of collection and afterwards, when they were induced to shed cercariae. The association between the reported prevalence of the disease and the percentage of snails shedding cercaria were heterogenous across different communities. While Takushara, with a disease prevalence of 46%, had 60% of the cercaria shedding snails, Kwaita sabo pukafa and Guduji, with disease prevalences of 56% and 26% respectively, had no cercaria shedding snails. Similarly, Dagiri rafin shahu and Gwako 1, with disease prevalences of 60% and 38%, had cercaria shedding snails of less than 1%. Nonetheless, the presence of Bulinus and Biomphelaria species in these communities indicates a potential risk of infection for humans and other animals who may come in contact with the water. Consequently, integrated multisectoral control and elimination measures that combine malacological monitoring with behavioral, environmental, and historical epidemiological assessments with a deliberate health orientation of the people through sensitization and health education is advocated to reduce exposure to the disease risk factors and contribute towards elimination of the disease.

Background
The healthcare sector contributes substantially to environmental pollution, affecting ecosystems and public health. Circular economy (CE) strategies offer potential solutions, but existing frameworks provide limited guidance for healthcare, overlooking factors such as infection control, decontamination, and staff workload.

Methods
We developed the Circular Healthcare Flows visual, a taxonomy of CE strategies for medical devices, using observations in sterilization departments, recycling facilities, and manufacturing plants; 21 expert interviews; and a systematic review of 1104 studies (68 full-text reviews). Additional stakeholder feedback validated and refined the taxonomy.

Findings
The taxonomy identifies 13 CE strategies—refuse, replace, rethink, reduce, reuse, maintain, repair, refurbish, remanufacture, repurpose, recycle, renew, and recover—and organizes them in a healthcare-specific framework. Iterative feedback ensured that the taxonomy is clear, practically applicable, and addresses sector-specific regulatory, clinical, and operational constraints.

Interpretation
The Circular Healthcare Flows visual provides a practical tool to standardize terminology and guide the implementation of CE strategies in healthcare. By offering conceptual structure and actionable guidance, it supports informed decision-making, facilitates collaboration among stakeholders, and encourages consistent application of circular strategies across the sector.

Funding
IJzenbrandt was partially funded by Erasmus University Rotterdam and the Health and Technology Convergence Alliance of TU Delft, Erasmus MC, and Erasmus University Rotterdam. Hoveling was funded through the DiCE project (EU grant agreement no. 101060184). Opinions expressed are those of the authors and do not necessarily reflect those of the EU or REA.

Access to cervical cancer care remains limited in sub-Saharan Africa, where women face compounded socio-cultural, gendered, and structural barriers. This qualitative study explores the lived experiences of nine women diagnosed with cervical cancer in Ethiopia and develops an empirically grounded patient journey map as a design and process artifact based on semi-structured interviews. The journey map reveals fragmented, non-linear care pathways, showing how barriers accumulate from symptom recognition through diagnosis, treatment, and post-treatment support. By visualizing breakdowns and transitions across the care path, the artifact supports problem framing, reflection, and identification of design opportunities. These disruptions intensify emotional and practical burdens, highlighting critical gaps in health literacy, information access, and continuity of care in the healthcare structure. The journey map defines a design-relevant problem space for context-sensitive digital health interventions. This work provides evidence for HCI researchers and practitioners to address accessibility barriers in cervical cancer care in low-resource settings.

Background
The health care sector is among the most carbon-intensive sectors, contributing to societal problems like climate change. Previous research demonstrated that especially the use of personal protective equipment (e.g., aprons) in critical care contributes to this problem. To reduce personal protective equipment waste, new sustainable policies are needed.

Aims
Policies are only effective if people comply. Our aim is to examine whether compliance with sustainable policies in critical care can be increased through behavioural influencing. Specifically, we examined the effectiveness of two sets of nudges (i.e., a Prime + Visual prompt nudge and a Social norm nudge) on decreasing apron usage in an intensive care unit (ICU).

Study Design
We conducted a field experiment with a pre- and post-intervention measurement. Upon the introduction of the new sustainable policy, apron usage data were collected for 9 days before (132 observations) and 9 days after (114 observations) the nudge interventions were implemented.

Results
Neither the Prime + Visual prompt nudge, nor the Social norm nudge decreased apron usage.

Conclusions
While previous studies have found that primes, visual nudges and social norm nudges can increase sustainable behaviour, we did not find evidence for this in our ICU field experiment. Future research is needed to determine whether this null finding reflects reality, or whether it was due to methodological decisions and limitations of the presented experiment.

Relevance to Clinical Practice
The presented study highlights the importance of studying behavioural interventions that were previously proven successful in the lab and in other field contexts, in the complex setting of critical care. Results previously found in other contexts may not generalize directly to a critical care context. The unique characteristics of the critical care context also pose methodological challenges that may have affected the outcomes of this experiment.

Mitigating environmental impacts is an urgent challenge supported by (scientific) intensive care societies worldwide. However, making green choices without compromising high-quality care for critically ill patients may be challenging. The current paper describes a three-step approach towards green intensive care units. Starting with the measurement of environmental sustainability, intensive care units can identify hotspots, quantify the environmental impacts of products and procedures, and monitor sustainable progress. Subsequently, a multidisciplinary approach is proposed to improve environmental sustainability, including a collaboration of procurement specialists and healthcare professionals, using co-creation and green teams as efficient grassroots change agents. A context-specific approach for enhancing sustainable healthcare practices is key in order to fit local regulatory requirements and create support of professionals. A final step is to share results and create momentum, including publishing initiatives and participating in online (inter)national networks. Based on the core sustainability principles, this three-step approach towards green ICUs provides a valuable tool to professionals worldwide to facilitate change towards environmentally responsible intensive care units.

Purpose
Properly functioning health systems globally require medical devices and equipment for vital care. Despite promising innovations, many medical devices face adoption barriers such as regulatory issues, interoperability and data exchange challenges. In low-resource settings, contextual factors influencing adoption and diffusion have not been synthesized into an overview to guide future medical device and equipment suppliers. Our study provides a scientific inventory of frameworks, theories, models, and guidelines describing the adoption and diffusion of medical devices and equipment in low-resource settings.

Methods
We searched both the PubMed and Scopus databases to identify studies within the health and broader non-health domains. Our search yielded 2.124 results after de-duplication. Extended attributes on the type of the paper, adoption and diffusion focus, medical devices and equipment use cases, and country settings revealed patterns of underpinning and emerging frameworks for adoption and diffusion.

Results
We included 28 studies in our review. The most researched device types were telemedicine, telehealth, m-health, and e-health. Among a larger variety, the most utilized underpinning frameworks were the Diffusion of Innovation Framework, and the Technology Acceptance Model. These frameworks led to the development of emerging models, such as a modified version based on Kifle’s Adoption Model or the Intervention-Context-Actors-Mechanism-Outcome Model.

Conclusions
Our findings offer initial insights for further research in identifying mechanisms for improving access to and utilization of medical devices and equipment in low-resource settings. Researchers can use this comprehensive review to guide continued research, addressing gaps in theoretical understanding and empirical evidence on medical device adoption and diffusion in low-resource settings.

Integrating hydrogen into energy systems presents challenges involving social dynamics among stakeholders beyond technical considerations. A gap exists in understanding how these dynamics influence the deployment of hydrogen technologies and infrastructure, particularly in infrastructure development and market demand for widespread adoption. In the Netherlands, despite ambitious strategies and investments, comprehensive explanations of social dynamics' impact on integration processes and market development are lacking. This study addresses this gap by analyzing the hydrogen value chain and stakeholder interactions in the Dutch hydrogen sector. A literature review highlights system integration challenges and the need for decentralized coordination and cross-sector collaboration. Using the Dutch energy grid and its hydrogen initiatives as a case study, social network analysis and semi-structured interviews are applied to analyze over 60 hydrogen initiatives involving more than 340 stakeholders. Initiatives are categorized into large-scale centralized and decentralized local types based on scale and stakeholder involvement, allowing targeted analysis of stakeholder interactions in different contexts. Findings reveal that centralized networks may limit innovation due to concentrated influence, while decentralized networks encourage innovation but require better coordination. These insights guide strategic planning and policymaking in hydrogen energy initiatives, aiming to enhance scalability and efficiency of hydrogen technologies for sustainable energy solutions.

Due to the significant environmental impact of healthcare, there is an urgent need to accelerate its circular transition. We provide an overview of the ESCH-R project study design and methodology for accelerating the transition from a linear to a circular healthcare sector through the development and implementation of circular interventions in the Netherlands. Using a transdisciplinary approach, we will apply the 10-R ladder framework for a circular economy to hospitals. Methods are presented to analyze current clinical practices, policies and requirements for sustainable behavioral change, from material flows and operations to policy and regulations. We describe methods for the development of circular interventions, including business models, contract templates, and product redesigns. Finally, our approach to dissemination and education is presented. The described study design and methods can be used by other hospital (settings) to identify environmental hotspots for circular interventions in their own healthcare practice and for the cross-transfer of knowledge and anticipated challenges in implementing circular strategies. Ultimately, the ESCH-R project will deliver innovative, scalable approaches for hospitals to reduce procurement of raw materials, retain value of medical products, and reduce waste streams, CO2 emissions and pollution.

Negative Pressure Wound Therapy (NPWT) is a treatment that promotes healing of chronic wounds. Despite high prevalence of chronic wounds in Low- and Middle-Income Countries (LMICs), NPWT devices are not available nor affordable. This study aims to improve chronic wound care in LMICs by presenting the Wound Care (WOCA) system, designed for building, testing and use in LMICs. Design requirements were formulated using input from literature, ISO standards, and wound care experts. The WOCA design was developed to provide safe, portable, user-friendly and affordable NPWT to patients in LMICs. The design features an adjustable operating pressure ranging from −75 to −125 mmHg, a battery for portability, a 300 ml canister, overflow protection, and system state alarms. An Arduino controls the pressure and monitors the system state. Three prototypes were developed and built in Nepal, and their performance was evaluated. Pressure control was 125 ± 10 % mmHg, internal leakage was 7.5 ± 4.3 mmHg/min, reserve capacity was 189 ± 16.9 ml/min, and overflow protection and alarm systems were effectively working. Prototype cost was approximately 280 USD. The WOCA demonstrates to be a locally producible NPWT device that can safely generate a stable vacuum. Future research will include clinical trials situated in LMICs.

Background: Schistosomiasis (SCH) and soil transmitted helminthiasis (STH) have been targeted for elimination as a public health problem (EPHP) within the World Health Organization (WHO)’s Roadmap for Neglected Tropical Diseases (NTDs) 2021–2030. One of the global strategies for the control and elimination of these diseases is the mass administration of praziquantel and albendazole/mebendazole without prior individual diagnosis. To measure the progress towards the 2030 target, we conducted an assessment to determine the impact of the 3–5 rounds of annual mass drug administration among school age children in Ekiti State. Such scientific insights into the impact of these treatments will facilitate improved planning and targeting of resources towards reaching the last mile. Methodology: This assessment was conducted in 16 local government areas (LGAs) of Ekiti State between October and November 2023. Samples were collected from pupils in 166 primary and junior secondary schools across 166 wards of the State. Urine and stool samples were collected from 7670 pupils of ages 5 to 14 years, following standard laboratory procedures. Urine membrane filtration techniques were used for urine preparation while the Kato–Katz technique was used for stool preparation. A novel AiDx digital microscope was used to examine the presence of any ova in the prepared specimen. Parasite ova in urine were reported as the number of ova/10 mL of urine, and were categorized as light infection (˂50 ova/10 mL of urine) or heavy infection (>50 ova/10 mL of urine) while ova of parasites in stool samples were reported as eggs per gram of stool (EPG) and categorized into light, moderate and heavy infection. Results: Overall, 0.76% (0.56–0.95) at 95% CI of the 7670 respondents were infected with Schistosomia haematobium. No Schistosoma mansoni infection was recorded in the study. Similarly, 3.9% (3.43–4.29) at 95% CI were infected with STHs. The overall prevalence of schistosomiasis had significantly reduced from 8.2% in 2008 to 0.8%, while the overall prevalence of STHs significantly reduced from 30.9% to 3.9% with Ascaris lumbricoides being the dominant species of STH. In the 16 LGAs assessed, Ekiti West had the highest S. haematobium prevalence of 4.26%. Ise/Orun and Oye ranked second and third with a prevalence of 3.48% and 2.40% respectively, while all other LGAs had <1% prevalence. The prevalence of STHs was highest in Ekiti-West with a prevalence of 10.45% while Emure and Ikole Local Governments had the lowest prevalence of 0.31% and 0.38%, respectively. There was no significant difference in the prevalence of schistosomiasis between male (0.76%) and female (0.75%) as p ≥ 0.05. Similarly, the difference in prevalence for STH among males (3.95%) was not significantly different from their female counterparts (3.77%), p ≥ 0.05. Conclusions: Based on the WHO guidelines, this study demonstrated that only three LGAs require continued MDA every 2/3 years, seven require only surveillance while six are now non-endemic for schistosomiasis. Similarly, two of the LGAs require one round of MDA yearly, eight LGAs need one round of MDA every two to three years and six LGAs are now below the treatment threshold and no longer require treatment for STH.

Purpose (stating the main purposes and research question): Anthropogenic resource use contributes to pollution, violent conflict over scarce resources, loss of biodiversity, and diminished quality of life for humans. Moreover, the “safe” amount of carbon dioxide—350 parts per million—has been exceeded. The health care industry is responsible for 4–5% of total world emissions,[i] which is similar to the global food sector.[ii] Health care carbon emissions come from health care infrastructures, supply chains and health care delivery. Increasingly, health care delivery is reliant on technologies which require the use of artificial intelligence to provide supportive care, such as triage algorithms, electronic patient records, and robotics.[iii] While these technological innovations have advanced health care significantly, they also contribute to the negative effects on the environment, among others, through carbon emissions. The environmental impacts of artificial intelligence (AI) in health care—in particular—are understudied. This research seeks to fill this gap. Methods: Our team ran an exploratory search in Scopus and PubMed to identify studies that integrate environmental sustainability, artificial intelligence, and health. Results: Our research initially yielded 735 studies. 77 of these studies focused on an environmental concern of a health technology or AI-application in a health care setting, but most of the articles in this subset addressed lowering energy consumption of a specific technology, such as a sensor or monitoring technology. Conclusions: While there have been studies looking at AI in health care; sustainability in AI; and sustainability in health care, little attention has been paid to the interface between all three. [i] Karliner, J., Slotterback, S., Boyd, R., Ashby, B., & Steele, K. 2019. Health Care’s Climate Footprint: How the Health Sector Contributes to the Global Climate Crisis and Opportunities for Action Healthcare Without HarmARUP; September. [ii] Pichler, P. P., Jaccard, I. S., Weisz, U., & Weisz, H. 2019 International Comparison of Health Care Carbon Footprints, Environmental Research Letters 14, no. 6: 064004. [iii] Khaliq, Abdul, Ali Waqas, Qasim Ali Nisar, Shahbaz Haider, and Zunaina Asghar. 2022. Application of AI and robotics in hospitality sector: A resource gain and resource loss perspective. Technology in Society 68: 101807.

Introduction: Schistosomiasis is a public health concern and there is a need for reliable field-compatible diagnostic methods in endemic settings. The AiDx Assist, an artificial intelligence (AI)-based automated microscope, has shown promising results for the detection of Schistosoma haematobium eggs in urine. It has been further developed to detect Schistosoma mansoni eggs in stool.

Methods: In this study, we evaluated the performance of the AiDx Assist for the detection of S. mansoni eggs in stool samples and further validated the performance of the AiDx Assist for the detection of S. haematobium eggs in urine samples. Additionally, the potential of the AiDx Assist for the detection of other helminths in stool samples was explored. In total, 405 participants from an area endemic for both S. mansoni and S. haematobium provided stool and urine samples which were subjected to AiDx Assist (semi- and fully automated), while conventional microscopy was used as the diagnostic reference.

Results: Only samples with complete test results were included in the final analysis, resulting in 375 stool and 398 urine samples, of which 38.4% and 65.3% showed Schistosoma eggs by conventional microscopy. The collected images of the stool samples were retrospectively examined for other helminth eggs via manual analysis. For the detection of S. mansoni eggs, the sensitivity of the semi-automated AiDx Assist (86.8%) was significantly higher compared to the fully automated AiDx Assist (56.9%) while the specificity was comparable, with 81.4% and 86.8%, respectively. Retrospectively, eggs of Ascaris lumbricoides and Trichuris trichiura were visualized. For the examination of urine samples, a comparable sensitivity in the detection of S. haematobium eggs was found between the semi-and the fully automated modes of the AiDx Assist, showing 94.6% and 91.9%, respectively. Furthermore, the specificity was comparable, with 90.6%and 91.3% respectively.

Discussion: The AiDx Assist met the World Health Organization Target Product Profile criteria in terms of diagnostic accuracy for the detection of S. haematobium eggs in urine samples and performed modestly in the detection of S. mansoni eggs in stool samples. With some further improvements, it has the potential to become a valuable diagnostic tool for screening multiple helminth parasites in stool and urine samples.

Background
Intensive care units (ICUs) contribute significantly to healthcare's environmental footprint, with medications playing a major role. This study performed a comprehensive Material Flow Analysis (MFA) of medications in a large academic ICU to quantify material flows and identify opportunities for sustainability.

Methods
A single-center MFA was conducted at a 50-bed ICU, analyzing all medications delivered in 2023. Medication and packaging components were weighed and categorized by active pharmaceutical ingredients (APIs), excipients, and packaging type. Total annual mass as well as daily medication and packaging waste per patient were calculated.

Results
The annual medication inflow totaled 234,337 kg, including 194,411 kg of medication content (5287 kg APIs, 189,124 kg excipients) and 39,923 kg of packaging. APIs constituted only 2.3% of the total medication mass. On average, patients received 89.5 medication units daily, totaling 5.0 kg of medication and generating 1.7 kg of packaging waste. Waste outflow comprised 194,413 kg to the sewage system, 21,894 kg for incineration, and 18,030 kg recycled, consisting primarily of continuous renal replacement therapy (CRRT) bags.

Conclusions
This MFA highlights significant opportunities to enhance ICU medication sustainability by targeting CRRT-related waste, optimizing fluid formulations to reduce excipient use, and minimizing packaging. These findings support the development of targeted interventions to reduce the environmental footprint of critical care.

Introduction: One of the global strategies for the elimination of schistosomiasis is by Mass Drug Administration (MDA) of a single oral dose of praziquantel (40 mg/kg) without a prior individual diagnosis, with a target of >75% treatment coverage among school-aged children. This study was conducted to determine the endemicity of schistosomiasis among school-aged children and adults in Abuja, Nigeria. Methods: A total of 1370 participants were recruited, which consisted of 667 (48.67%) males and 703 (51.31%) females. Urine and stool specimens were collected from each participant and analyzed using standard procedures. Results: The overall prevalence of schistosomiasis was 27.5% in this study with Abuja Municipal having the highest prevalence of 49%, while the least (6.1%) was reported in Bwari LAC. The prevalence of schistosomiasis significantly differs (p < 0.05) between the area councils. The location of communities significantly affected the prevalence of schistosomiasis in Abaji, AMAC, and Gwagwalada LACs (p < 0.005). The Schistosoma recovered in this study were S. haematobium and S. mansoni. The prevalence of schistosomiasis increased from the baseline of 21.1% to 49% in Gwagwalada LAC. Gender significantly affected the prevalence of schistosomiasis as more males were infected (33.1%) than their female counterparts (22.2%) (p < 0.05). The prevalence of schistosomiasis was 31% and 23.9% among SAC and adults, respectively. The participants’ activities in the river significantly affected the prevalence of schistosomiasis in this study (p < 0.05). Conclusions: The clamour for urgent government and non-government intervention through alternate sources of water like boreholes or pipe-borne water, as well as implementing a behavioural change campaign across the communities to prevent the recurrence, are advocated.

In this work, we developed an automated system for the detection and classification of soil-transmitted helminths (STH) and Schistosoma (S.) mansoni eggs in microscopic images of fecal smears. We assembled an STH and S. mansoni dataset comprising over 3,000 field-of-view (FOV) images containing parasite eggs, extracted from more than 300 fecal smear prepared using the Kato-Katz technique. These images were acquired using Schistoscope—a cost-effective automated digital microscope. After annotating the STH and S. mansoni eggs, we employed a transfer learning approach to train an EfficientDet deep learning model, using 70% of the dataset for training, 20% for validation, and 10% for testing. The developed model successfully identified STH and S. mansoni eggs in the FOV images, achieving weighted average scores of Precision, Sensitivity, Specificity, and F-Score across four classes of helminths (A. lumbricoides, T. trichiura, hookworm, and S. mansoni). Our system highlights the potential of the Schistoscope, enhanced with artificial intelligence, for detecting STH and S. mansoni infections in remote, resource-limited settings and for supporting the monitoring and evaluation of neglected tropical disease (NTD) control programs.

This project aims to reduce the environmental impact of the Intensive Care Unit (ICU) of the Erasmus Medical Center (EMC). Systemic design research was executed to map the current waste flow created by the ICU. Literature review, interviews and observations were performed to gather information about the healthcare protocols, hospital procurement process, intubation practices and used devices and consumables. This resulted in a set of challenges which were used to ideate from different perspectives to improve the sustainability of the ICU. A set of opportunities to introduce circularity within the ICU were defined. These opportunities ranged from waste separation to the reduction of the disposal of unused products. The selected circular opportunity was intubation, needed when patients cannot breathe by themselves. For this, a video laryngoscope, which is composed of various plastics, a video camera, and a led light, is used for only a few minutes and disposed of (and incinerated) directly afterwards. The aim of the second part of this research project was: Can we design a circular intubation procedure as a catalyzer for systemic change towards circular ICUs? One of the proposed circular strategies for the video laryngoscope is the reprocessing of intubation devices used at the ICU itself. A transition model toward reprocessing using UV-C radiation technique was further developed. Compared to current reprocessing procedures, UV-C disinfection consumes no water and less electricity and offers the possibility of decentralized reprocessing within the ICU department itself. This project aims to provoke conversations between the hospital, manufacturers and other stakeholders about how the healthcare sector could start reprocessing valuable medical devices towards a circular ICU.

Traditionally, automated slide scanning involves capturing a rectangular grid of field-of-view (FoV) images which can be stitched together to create whole slide images, while the autofocusing algorithm captures a focal stack of images
to determine the best in-focus image. However, these methods can be timeconsuming due to the need for X-, Y- and Z-axis movements of the digital microscope while capturing multiple FoV images. In this paper, we propose a solution to minimise these redundancies by presenting an optimal procedure for automated slide scanning of circular membrane filters on a glass slide. We achieve this by following an optimal path in the sample plane, ensuring that only FoVs overlapping the filter membrane are captured. To capture the best infocus FoV image, we utilise a hill-climbing approach that tracks the peak of the mean of Gaussian gradient of the captured FoVs images along the Z-axis. We implemented this procedure to optimise the efficiency of the Schistoscope, an automated digital microscope developed to diagnose urogenital schistosomiasis by imaging Schistosoma haematobium eggs on 13 or 25 mm membrane filters. Our improved method reduces the automated slide scanning time by 63.18%and 72.52% for the respective filter sizes. This advancement greatly supportsthe practicality of the Schistoscope in large-scale schistosomiasis monitoringand evaluation programs in endemic regions. This will save time, resources andalso accelerate generation of data that is critical in achieving the targets for schistosomiasis elimination.

Design thinking is an innovation approach for organisations aiming to solve complex and open-ended problems, including those arising in the transition from a linear to a circular economic system. Although the importance has been recognised in business and academia, to date, insight is lacking on how design thinking can be applied within circular innovation specifically. We investigate the following research question: How can design thinking tools catalyse sustainable circular innovation? Based on the literature, we first create a framework that characterises design thinking principles, criteria and phases that could support circular innovation. The design thinking phases are ideate and design, implement and test, and evaluate and improve. The criteria include desirability, feasibility, viability and sustainability, and circularity. Finally, we identify the following principles that make design thinking suitable to tackle complex circular innovation challenges: human-centred, future-oriented, holistic, co-creative, and experimental. Consequently, against this framework, we map 11 tools that are suitable to catalyse circular innovation theory into practice through design thinking. Finally, we reflect on the future of research and practice around this subject.

Introduction: Millions of women worldwide annually undergo manual vacuum aspiration (MVA) with no pain medication, which is a violation of their basic human dignity. We designed a novel device (Chloe SED®) to administer paracervical block (PCB) during MVA in countries where pain medication is not typically given due to the high cost of the necessary tools.

Methods: We conducted a single-blinded, randomized controlled non-inferiority trial including 61 patients at two hospitals in Kisumu, Kenya, to validate Chloe SED® for administration of PCB during MVA. PCB administered with Chloe SED® was compared to PCB administered with a standard spinal needle. Patients requiring MVA were block randomized in blocks of six, each provider completing six PCBs—three with the Chloe SED® and three with the standard spinal needle. The trial was registered with the Kenya Pharmacy and Poisons Board, ECCT/19/03/01 (https://ctr.pharmacyboardkenya.org/applications/index/protocol_no:RUNDVC8xOS8wMy8wMQ__/filter:/investigator:/sites:/pages:5/start_date:/end_date:/disease_condition:/users:/ercs:/stages). An intention-to-treat analysis was completed. The primary outcome was the non-inferiority of the pain score during uterine evacuation with a non-inferiority margin of 2 points on an 11-point numerical rating scale. Secondary outcomes included the non-inferiority of the pain score at four other time points and patient satisfaction.

Results: Chloe SED® showed non-inferiority of the primary outcome with a mean pain score during evacuation of 3.8 [90% confidence interval (CI): 3.1–4.6] compared with the spinal needle at 4.1 (90% CI: 3.5–4.7). Non-inferiority of the pain score was shown at all time points. Most patients expressed a desire for the continued use of the device to administer PCB for MVA. No adverse events were noted.

Conclusion: In summary, the Chloe SED® appears non-inferior to the spinal needle and desirable for the administration of PCB during MVA.