Abstract
This paper analyses the process of generalisation of an innovative government-led public practice in the healthcare sector. The scaling and embedding involved in this generalisation process are assumed to be dependent on the multiple implementation processes (consecutive or simultaneous) that lead to a routine use of the innovation in different adopters. This paper, therefore, proposes the use of a configurational theory approach to conceptualise each implementation of the innovation during the generalisation process and shed light on the generalisation's scaling and embedding efforts. It suggests a set of recommendations and practices for generalisation managers, most notably: i) they should regard generalisations as organic processes where their main role is to create space for experimentation, learning and negotiation, and ii) they should adopt different modes of governance to identify adequate mechanisms and strategies and guide their actions. This configurational perspective allows them to monitor and manage the evolution of implementations, informs the valuable learning processes that take place in a generalisation and has been found to be a useful tool to support the crucial collaboration among the actors involved in a generalisation.

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.

Abstract
ObjectiveThis systematic review aims to describe the involvement of persons with epilepsy (PWE), healthcare professionals (HP) and caregivers (CG) in the design and development of medical devices is epilepsy.MethodsA systematic review was conducted, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligibility criteria included peer-reviewed research focusing on medical devices for epilepsy management, involving users (PWE, CG, and HP) during the MDD process. Searches were performed on PubMed, Web of Science, and Scopus, and a total of 55 relevant articles were identified and reviewed.ResultsFrom 1999 to 2023, there was a gradual increase in the number of publications related to user involvement in epilepsy medical device development (MDD), highlighting the growing interest in this field. The medical devices involved in these studies encompassed a range of seizure detection tools, healthcare information systems, vagus nerve stimulation (VNS) and electroencephalogram (EEG) technologies reflecting the emphasis on seizure detection, prediction, and prevention. PWE and CG were the primary users involved, underscoring the importance of their perspectives. Surveys, usability testing, interviews, and focus groups were the methods used for capturing user perspectives. User involvement occurs in four out of the five stages of MDD, with production being the exception.SignificanceUser involvement in the MDD process for epilepsy management is an emerging area of interest holding a significant promise for improving device quality and patient outcomes. This review highlights the need for broader and more effective user involvement, as it currently lags in the development of commercially available medical devices for epilepsy management. Future research should explore the benefits and barriers of user involvement to enhance medical device technologies for epilepsy.Plain Language SummaryThis review covers studies that have involved users in the development process of medical devices for epilepsy. The studies reported here have focused on getting input from people with epilepsy, their caregivers, and healthcare providers. These devices include tools for detecting seizures, stimulating nerves, and tracking brain activity. Most user feedback was gathered through surveys, usability tests, interviews, and focus groups. Users were involved in nearly every stage of device development except production. The review highlights that involving users can improve device quality and patient outcomes, but more effective involvement is needed in commercial device development. Future research should focus on the benefits and challenges of user involvement.

Abstract
Fire has major impacts on forest ecosystems, with heightened relevance in a Mediterranean country such as Portugal, which within Europe features the highest number of wildfires and the second larger burnt area. After each significant wildfire, the Portuguese Institute for Nature Conservation and Forests (ICNF) assesses the main environmental impacts and proposes emergency stabilisation measures following specific regulations. This study seeks to improve such assessments by using a data triangulation approach to characterise the impacts of wildfires on ecosystem services in the country. First, a systematic literature review is performed to identify the scientific studies that address the issue. Next, a document analysis of all the emergency stabilisation reports and technical reports available on ICNF's website is performed. Finally, a survey of experts' perceptions on the topic completes the analysis. The Economics of Ecosystems and Biodiversity definitions of ecosystem services were employed to compare the different findings. The results indicate that the experts perceive wildfires to significantly impact all ecosystem services, even though the literature has so far only focused on 12 of them, and ICNF has so far only focused on 7 in its reports. The potential underlying motives are discussed. In particular, some important impacts identified in the literature, as is the case of Climate regulation, a topic of the highest priority in the European environmental agenda, have not so far been a topic of focus in ICNF's reports, which suggests relevant opportunities for enhancing its reporting process in the future.

Abstract
The full realization of the potential of a technology requires good understanding of its imple-mentation. During implementations, lack of compatibility between technology and its adopters require dynamic sequences of alignment. This process is understood to be central to the success in technology assimilation. This paper proposes a configurational model to explain and predict the alignment process during technology implementations, derived from a multiple case research of the implementation of a retinopathy screening program in networks of healthcare providers. It builds on and expands previous research capturing in a holistic way the alignment process and its nature of adaptation over time.