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. ... Read more

Additive manufacturing offers rapid and customizable production, yet conventional plastic-based methods remain energy-intensive and environmentally harmful, often resulting in higher impacts per part than traditional manufacturing. The goal of this study was to evaluate whether upcycled biomaterials, specifically oyster shells, pistachio shells, and clay, could be used as lower-impact alternatives to PLA in 3D printing. The scope included detailed measurement of print parameters for each material and a full life cycle assessment (LCA) of the printed elements, covering printer manufacturing, raw material extraction, transport, operation, and end of life. The results show that ambient-temperature extrusion of these upcycled biomaterials can reduce energy consumption by up to 89% and overall environmental impact by up to 94% (as measured by ReCiPe Endpoint H points) compared to PLA printing. These reductions were observed for the Netherlands and EU contexts, where electricity mixes are relatively clean and recycling rates are high; even greater improvements were observed for the US. Although the printed biomaterial objects exhibit lower mechanical strength, limited waterproofness, and reduced print resolution, they are already suitable for low-load applications such as prototypes and architectural models. Overall, the findings demonstrate that upcycled biomaterial extrusion has strong sustainability potential, outperforming both conventional plastics and bioplastics such as PLA in terms of material impacts and energy use. Continued development of material formulations as well as pre- and post-processing techniques could further expand functionality and support the broader adoption of low-impact 3D printing across a wide range of applications. ... Read more

Objective
This study aims to calculate the global warming potential, in carbon dioxide (CO2) equivalent emissions, from all in-scope activities involved in phase 1, 2, 3 and 4 clinical trials spanning multiple disease areas.

Design
The study design involved a retrospective analysis of completed clinical trials.

Setting
Select set of seven clinical trials conducted between 2018 and 2023 and sponsored by Johnson & Johnson Innovative Medicine: TMC114FD1HTX1002, 77242113PSO2001, 42756493BLC2002, 54767414MMY3012, VAC18193RSV3006, R092670PSY3016 and 28431754DIA4032

Participants
While participants and the public were involved in all seven trials, the life cycle assessments (LCAs) were performed as an independent retrospective analysis after the clinical trials were completed. As a retrospective analysis, we leveraged clinical trial documentation and interviews with the sponsor trial staff and trial site staff. None of the participating trial subjects were involved specifically in the LCA analysis, nor was any personal identifying information from the trial subjects collected or shared.

The underlying clinical trials were performed in accordance with the Declaration of Helsinki and Guidelines for Good Pharmacoepidemiology Practice. All participating investigators were required to obtain full governing board approval for conducting research involving humans. Sponsor approval and continuing review were obtained through the appropriate Institutional Review Board/Ethics Committee (IRB) and Health Authority channels. For academic investigative sites that did not receive authorisation to use the central IRB, full board approval was obtained from their respective governing IRBs, and documentation of approval was submitted to Johnson & Johnson Innovative Medicine, LLC, before the site’s participation and initiation of any trial procedures. All registry participants provided written informed consent and authorisation before participating.

Primary outcome measure
Primary outcome measure CO2 equivalents (CO2e) for in-scope clinical trial activities calculated according to Intergovernmental Panel on Climate Change 2021 impact assessment methodology.

Results
The TMC114FD1HTX1002 phase 1 trial was the smallest trial both in terms of number of patients (39) and sites (1) and had the smallest emissions at 17 648 kgCO2e. The 54767414MMY3012 phase 3 trial was not the largest trial in terms of number of participating patients (517) but had the largest number of participating sites (129) and had the largest emissions at 3 107 436 kg CO2e. Across all seven trials analysed, the mean emissions per patient were 3260 kg CO2e. When the overall trial footprints are broken down by phase, the phase 2 mean per patient was 5722 kg CO2e and the phase 3 mean per patient emissions were 2499 kg CO2e. The five largest contributors of greenhouse gas (GHG) emissions were drug product (50% mean), patient travel (10% mean), travel for on-site monitoring visits (10% mean), collection and processing of laboratory samples (9% mean) and sponsor staff commuting (6% mean). Patient travel was the only consistent GHG hotspot across all seven trials, as other hotspots appeared intermittently in some trials but not others based on variations in trial design. Across the multisite phase 2, 3 and 4 trials we analysed, a combination of the observed five largest contributors to GHG emissions were responsible for no less than 79% of GHG emissions for any one trial.

Conclusions
Based on our LCAs of seven clinical trials spanning all four phases of development and multiple disease areas, there are five activities that drive no less than 79% of the average clinical trial’s GHG footprint. These are drug product manufacture, packaging, and distribution; patient travel; on-site monitoring visit travel; the collection, transport and processing of laboratory samples; and sponsor staff commuting between their homes and the office. Understanding the activities that drive GHG emissions in clinical trials can both guide trial designers in avoiding or minimising reliance on these activities when designing new trials and guide trial sponsors in taking targeted actions to reduce GHG emissions from these activities where their use cannot be avoided. ... Read more

Using design principles of nature is much faster and easier than researching mentor organisms, though it does not provide the deeper connection to nature.
To ideate from principles, find a list of biological design principles, such as Biomimicry 3.8’s “Life’s Principles.” Steven Vogel’s list in Cats’ Paws and Catapults, or this chapter. Select one or more relevant principle. Brainstorm buildable ideas from that principle. Repeat as necessary.
Principles can also be used to assess how biomimetic a design idea is, though this is highly subjective.
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Fogg’s model of behavior change says: motivation is whether people want to change, ability is whether people can change, and prompts are stimuli that provoke actual change.

Ajzen’s theory of planned behavior says: attitude is what a person thinks and feels, subjective norms are what that person thinks others believe, and perceived behavioral control is how easy or hard they think it is to change their behavior.

Lockton’s “Design with Intent” tool includes these and many more theories of change with 101 persuasion tactics grouped into eight theoretical “lenses.”

To encourage better behavior with your design, focus on the user experience, make it easy and compelling for the user to act better.
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