Search Results (7,095)

In recent years, with the significant decline in fine particulate matter (PM_2.5) concentrations, ozone (O₃) has emerged as a major composite air pollutant during the warm season in China, attracting increasing attention due to its associated health burden and economic costs. This study focuses on Tianjin, using ozone monitoring data from 2017 to 2023 combined with health statistics to assess the health impacts and economic losses attributable to ozone pollution. First, ozone exposure indicators and compliance criteria were constructed based on national air quality standards, and the interannual variation and spatial differences of O₃ levels were analyzed at both citywide and district scales. Second, multiple machine learning classification models, including logistic regression, decision tree, k-nearest neighbors, and gradient boosting, were developed using ozone and meteorological variables to predict the occurrence risks of five diseases: cardiovascular diseases, respiratory diseases, hand-foot-and-mouth disease (HFMD), influenza, and dengue fever. Finally, excess cases were estimated using health impact functions, and the associated economic losses were quantified by combining the value of a statistical life (VSL) with cost-of-illness and willingness-to-pay (WTP) approaches. The results showed that the annual evaluation value of ozone in Tianjin, defined as the 90th percentile of the daily maximum 8 h average O₃ concentration, exhibited a pattern of initially increasing, then decreasing, and subsequently rebounding. It peaked at 201 µg/m³ in 2018, declined to a minimum of 164 µg/m³ in 2021, and rebounded to 188 µg/m³ in 2023. Machine-learning results indicated that the logistic regression model showed relatively stable overall performance across predictions of different diseases, while the gradient boosting tree model also achieved high accuracy in predicting certain infectious diseases. Overall, ozone pollution exhibits significant heterogeneous effects across different disease types, and the associated health-related economic losses show stage-wise fluctuations in response to pollution levels. Based on these findings, it is recommended to implement refined control measures during periods of high ozone exceedance and in key regions, while strengthening protection for vulnerable populations such as the elderly, children, and patients with respiratory diseases, in order to achieve synergistic improvements in air quality management and public health outcomes. Full article

To study the soil moisture dynamics and rainfall infiltration characteristics of karst sloping farmland and their driving factors, an abandoned farmland was selected for this study, and five monitoring points (from the foot, S1, of the slope to the top, S5) were set along the terrain gradient. The volumetric water content data of the 0–40 cm soil layer was obtained through in situ monitoring for one year. The infiltration characteristics were quantified in combination with a staining tracer test, and the soil properties were determined. The results showed that the soil moisture content increased with the deepening of the soil layer, and there was significant slope differentiation. The moisture content in the downhill slopes (S1, S2) was significantly higher than that in the uphill slopes (S4, S5), and the annual average value of S5 was 27.4% lower than that of S1. The moisture difference (Δθ, the difference in moisture content between hillslope and flatland) changed from positive to negative from the foot of the slope to the top, indicating that moisture was transported downward along the slope surface. A dye tracer showed that from S1 to S5, the water transport pathway gradually shifted from exhibiting deeper vertical penetration and narrower lateral spread to showing shallower vertical penetration and wider lateral spread. The preferential flow index decreased from 46.6 ± 2.3% to 34.7 ± 2.1%, indicating a progressive reduction in rapid vertical channeling, while the lateral flow index reached its peak (21.4 ± 2.7%) in the middle of the slope (S3), suggesting enhanced horizontal water redistribution at this position. Correlation analysis indicated that soil bulk density was extremely significantly negatively associated with infiltration capacity, while capillary porosity, non-capillary porosity, total porosity, organic matter, and high aggregate content were extremely significantly positively associated with infiltration capacity. These results revealed that the topographic gradient affected soil moisture and water infiltration paths by regulating soil physical properties in this karst forest ecosystem. It should be noted that the research results are only applicable to one slope and should not be directly extended to all karst slope agricultural landscapes. Full article

High-speed railway embankments constructed over karst-prone ground conditions are often challenged by weak soils and subsurface cavities, which can lead to instability and excessive settlement. This study presents a full-scale field investigation conducted in the El-Gharbaniyat area, west of Alexandria, Egypt, where a pile–cap ground improvement system was implemented to support a high-speed railway embankment founded on clayey and silty soils overlying fractured limestone. A comprehensive site investigation program was performed, including 28 boreholes and integrated geophysical surveys using Electrical Resistivity Tomography (ERT) and Seismic Tomography (ST), enabling improved identification of weak zones and cavity-prone formations. Based on these findings, a pile–cap system was designed using reinforced concrete piles of 0.60 m diameter and an average length of 29 m, arranged in a 4 × 4 m grid and capped with reinforced concrete footings to ensure efficient load transfer to deeper competent strata. The system performance was validated through laboratory testing and full-scale in situ pile load tests. The average 28-day compressive strength of 122 tested piles reached approximately 50 MPa, exceeding the design value by approximately 30%. Load test results showed settlements ranging from 1.08 to 2.76 mm at the working load (2200 kN) and 2.16 to 5.10 mm at the maximum load (3300 kN), all well below allowable limits. Comparative evaluation indicated that the proposed system achieves significant material savings (>90%), lower treatment cost (150 USD/m²), reduced carbon emission (5.7 t per pile), and shorter construction duration (7 h per pile). These findings confirm that the pile–cap system provides a robust, cost-effective, and environmentally efficient solution for ground improvement in karst environments. Full article

We present a transdisciplinary Teaching–Learning Sequence (TLS) for lower secondary school students that integrates climate change education with the promotion of gender equality in science. The TLS connects theoretical understanding with practical engagement through laboratory demonstrations, simulations, and accessible experiments. The sequence addresses key topics in sustainability education, including incoming and outgoing radiation, the greenhouse effect, energy transformations, and energy sources, through activities involving the electromagnetic spectrum, infrared imaging, selective transparency, absorption, and albedo. It also includes inquiry-based explorations of electromagnetic induction, miniature hydroelectric and wind power systems, Stirling engines, photovoltaic and concentrated solar technologies, and combustion-related CO₂ acidification. A distinctive feature of the TLS is the explicit integration of the social dimension of sustainability through discussion of the Matilda Effect and the historical case of Eunice Newton Foote, with the aim of challenging persistent gender stereotypes in STEM. The intervention was implemented with 12–13-year-old students and evaluated through pre- and post-tests, written explanations, closed-ended questions, drawings, and the Draw-A-Scientist Test. The results indicate a significant improvement in students’ understanding of climate-related scientific concepts and in their critical awareness of misinformation and climate denial strategies. While the sequence did not significantly increase students’ engagement in climate action, the gender-focused activities promoted strong critical reflection on stereotypes and on the role of women in science. Full article

Diabetic foot ulcers (DFUs) are among the most severe complications affecting diabetic patients, and dressing therapy is one of the standard treatments for DFUs. However, traditional dressings are inadequate for addressing the complex microenvironment of DFUs. Consequently, advanced natural polymer-based dressings have attracted extensive research attention in diabetic foot care due to their biocompatibility, low immunogenicity, and biodegradability. These natural polymer materials include collagen, gelatin, chitosan (CS), hyaluronic acid (HA), alginate, and cellulose. This review systematically analyzes the pathophysiological mechanisms underlying the difficult healing of DFUs and the advantages of natural polymer-based dressings in diabetic wound healing, highlights preclinical studies, and synthesizes evidence from clinical research. Moreover, we pinpoint the challenges associated with these dressings and propose future directions for the improvement of diabetic wound care. Full article

Background: Foot degloving injuries are associated with extensive soft-tissue disruption, compromised perfusion, and a high risk of flap necrosis. Hyperbaric oxygen therapy (HBOT) is known to enhance tissue oxygenation and support flap survival; however, its application in pediatric patients may be limited due to poor cooperation, intolerance to chamber-based treatment, and limited accessibility. Case Presentation: A 7-year-old girl presented with a crush injury to the left foot after being run over by a vehicle, resulting in severe soft-tissue damage. Evaluation revealed a dorsal foot degloving injury, a proximal phalanx fracture of the great toe, and dislocations of the fourth proximal interphalangeal and fifth distal interphalangeal joints. Emergency surgery included open reduction, K-wire fixation, debridement, and artificial dermal grafting using Pelnac. On postoperative day 1, the flap showed signs of compromised perfusion. As HBOT was not feasible, topical oxygen therapy using Natrox was applied continuously for 17 days. Serial wound assessments demonstrated gradual improvement in flap viability. Although ischemic changes developed in the toes, necrosis remained superficial and was successfully managed with local debridement and dressings. Residual skin defects with partial necrosis were treated with split-thickness skin grafting, which healed without major complications. The patient resumed ambulation after splint removal. Conclusions: In pediatric patients with compromised flaps in whom HBOT is not feasible, topical oxygen therapy may serve as a practical adjunctive treatment option. Although its independent effect cannot be established in a single case, this report suggests its potential role in flap salvage and in limiting tissue necrosis. Full article

Chronic limb-threatening ischemia (CLTI) in patients with no conventional targets for revascularization presents a formidable challenge in limb salvage. Deep venous arterialization (DVA) is an emerging endovascular approach that redirects arterial blood flow into the venous system to perfuse the ischemic foot. Despite early promising results, appropriate wound management of the ischemic foot following a DVA procedure has been described in the literature, albeit infrequently and with limited standardization. Here, we present a case of an 85-year-old male with multiple comorbidities, including peripheral artery disease and a prior right above-knee amputation (AKA), who underwent a successful left-sided DVA following an open transmetatarsal amputation (TMA) for infection. A staged wound care approach with guillotine amputation, delayed revision and skin grafting ultimately preserved his only remaining limb and allowed for ambulation. This case underscores the potential of DVA as a limb-saving option in complex “no-option” patients when paired with multidisciplinary care and tailored wound management. Full article

Aeolian sand bodies unrelated either to coastal barrier systems of Holocene or earlier age or to modern beaches have been identified along the central New South Wales coast of southeast Australia. Some of these deposits cap headlands or are located above high sea-cliffs. Others lie below modern sea-levels, whilst one substantial dune field extends 12 km inland. Many of these have previously been interpreted as Early Holocene cliff-top dunes, the product of the migration of beach sands up aeolian sand ramps at the foot of the sea-cliffs of the region and onto the cliff tops. The rising sea-levels of the Middle Holocene eroded the ramps and cut off the supply of sand to the dunes, allowing them to stabilise. But re-investigation shows that these dune fields accumulated at times of low Quaternary sea-levels, with a particle-size distribution suggestive of an inland rather than a coastal origin. We therefore propose an alternative model for the accumulation of these features. At times of low sea-level, sediments exposed on the inner shelf were reworked onto the adjacent coast by onshore winds, where they accumulated in locations unconnected to the modern or the earlier Holocene coastal aeolian sedimentary regime. This model challenges the conventional story that the dominant glacial maximum winds across southeastern Australia were from the west (and thus offshore). This pattern of sediment accumulation and its associated wind regime may have been more stable (continuing for over 30 000 years) and more long-lived (repeated through at least the last two glacial cycles) than has previously been believed. Although the cliff-top dune model has been widely applied, we question its suitability in its type location and suggest a more cautious approach to its application elsewhere. We argue that the products of the landward aeolian reworking of sediment exposed on the continental shelf have been overlooked, despite their potential for the preservation of long-term environmental records. Full article

Animal infectious diseases impose severe economic burdens on livestock industries, threaten wildlife populations, and compromise food security. Although vaccination remains the cornerstone of disease prevention, conventional vaccine platforms are often constrained by safety, efficacy, or manufacturing scalability. This narrative review provides a comprehensive analysis of the state of the art in herpesvirus-vectored vaccines for veterinary applications, focusing on five well-characterized alphaherpesviruses: Bovine herpesvirus type 1 (BoHV-1), Pseudorabies virus (PRV), Marek’s disease virus (MDV), Equine herpesvirus type 1 (EHV-1), and Duck enteritis virus (DEV). The intrinsic characteristics of herpesviruses, including large, stable genomes; the capacity for foreign gene insertion; broad host tropism; and the ability to elicit robust humoral and cellular immunity, are examined, and their performance is compared with that of traditional vaccine platforms. Key advances in vectored vaccine development are highlighted, from proof-of-concept studies to the creation of advanced multivalent constructs. These approaches demonstrate protective efficacy against a range of significant animal pathogens, including foot-and-mouth disease virus, porcine reproductive and respiratory syndrome virus, avian influenza virus, infectious bursal disease virus, and West Nile virus. The literature was identified through systematic searches of PubMed, Google Scholar, and Web of Science (1990–2026), followed by title/abstract screening and reference chaining. Future directions in vector engineering, mucosal delivery, and synthetic biology approaches are considered. Herpesvirus-vectored vaccines represent a versatile platform for enhancing animal health, supporting sustainable agriculture, and mitigating zoonotic risks. Full article

To improve the amphibious locomotion capability of robots in aquatic and terrestrial environments, this paper proposes a novel frog-inspired hybrid-driven amphibious robot inspired by the amphibious locomotion characteristics of frogs. Unlike existing frog-inspired robots limited to single-mode jumping or swimming, this robot adopts an innovative hybrid actuation mechanism to simultaneously achieve frog-like swimming and jumping capabilities. On land, it uses a combustion-driven hindlimb propulsion mechanism paired with a linkage-based forelimb posture adjustment mechanism to realize frog-like jumping; in water, it employs a cable-driven linked hindlimb mechanism combined with a controllable soft extension-driven webbed foot to accomplish frog-like swimming. Furthermore, the instantaneous combustion thrust during frog-like jumping and the hydrodynamic thrust during swimming are calculated. The mapping relationships between the take-off attitude angle, hydrogen–oxygen mixture charge, and jumping performance, as well as the motion pattern between hindlimb motion parameters and swimming thrust, are derived. Finally, experimental results demonstrate that the robot achieves a swimming speed of 79 mm/s, a jumping height of 560 mm, and a jumping distance of 1200 mm, while being capable of performing continuous amphibious locomotion. Full article

Background and Objectives: In degenerative spine disease, compensatory mechanisms are activated to maintain upright posture, extending beyond the spine to involve the pelvis, lower limbs, and feet. These adaptations may be accompanied by differences in foot alignment, which could be associated with sagittal balance. The aim of this study is to investigate the relationship between foot alignment and spinal posture in patients with degenerative spine disease and evaluate whether foot deformities are associated with sagittal imbalance in degenerative spine disease. Materials and Methods: We retrospectively reviewed 98 patients with degenerative spine disease who underwent preoperative standing EOS imaging between 2017 and 2025 at a single academic spine centre. Meary’s angle, talocalcaneal angle, and calcaneal pitch were measured on lateral EOS images to classify feet as flat, normal, or cavus. Spinopelvic parameters were extracted from EOS and conventional radiographs. Differences in spinal parameters across foot groups were compared using ANOVA, and linear regression evaluated associations between sagittal vertical axis (SVA) and foot angles. Results: Among spinopelvic parameters, only SVA significantly differed between foot groups, with flatfoot patients showing greater forward imbalance (p = 0.035). Regression analysis demonstrated an inverse relationship between SVA and both talocalcaneal angle (p = 0.003) and calcaneal pitch (p = 0.034), suggesting that greater forward trunk inclination was associated with flatter feet. Degenerative scoliosis patients demonstrated a bimodal pattern with more flat and cavus feet (p = 0.006), while herniated disc patients more often exhibited flatfoot (p = 0.031). Conclusions: Foot posture abnormalities, particularly flatfoot, are associated with sagittal spinal imbalance, suggesting foot posture may be associated with global alignment and could reflect distal postural adaptations. Full article

Background: Sorafenib remains an important treatment option for patients with radioiodine-refractory differentiated thyroid cancer (RAI-R DTC). This study evaluated real-world outcomes and prognostic factors in patients treated with sorafenib. Materials and Methods: This retrospective multicenter study included 176 patients with RAI-R DTC treated with sorafenib between 2000 and 2024 across sixteen centers. Clinical, pathological and treatment-related variables, including metastatic sites, radiotherapy, dose reduction, inflammatory markers (neutrophil-to-lymphocyte ratio [NLR] and platelet-to-lymphocyte ratio [PLR]) and pretreatment thyroglobulin (Tg), were analyzed. Progression-free survival (PFS) was evaluated using Kaplan–Meier analysis. Prognostic factors were assessed using univariate and multivariate Cox regression analyses. Results: The median follow-up duration was 24 months and the median PFS was 21 months (95% CI: 15.5–26.5). Partial response was observed in 82 patients (46.6%), stable disease in 55 (31.3%) and progressive disease in 35 (19.9%). Patients who underwent dose reduction had longer PFS than those without dose reduction (42 vs. 19 months, p = 0.030), and absence of dose reduction remained independently associated with progression risk. Patients who received radiotherapy had shorter PFS than those who did not receive radiotherapy (16 vs. 37 months, p = 0.002), and radiotherapy-related variables remained independent predictors of progression. Patients with PLR values >138.2 had shorter PFS than those with PLR values ≤ 138.2 (19 vs. 34 months, p = 0.047), although this association was not maintained in Cox regression analysis. Similarly, associations between NLR and Tg values and PFS did not reach statistical significance (p = 0.112 and p = 0.072, respectively). Hand–foot syndrome was the most common toxicity, occurring in 59 patients (33.5%), while Grade 3 hand–foot syndrome was observed in 7 patients (4.0%). Conclusions: Sorafenib provided meaningful disease control with a median PFS of 21 months in this real-world cohort. Dose reduction was associated with longer PFS, whereas radiotherapy requirement appeared to reflect a higher-risk subgroup. Toxicities were generally manageable. Full article

Background and Objectives: Conventional supramalleolar osteotomy (SMO) often involves a concomitant fibular osteotomy (FO), which carries risks, such as nonunion and nerve injury. We evaluated the clinical and radiological outcomes of a fibula-preserving SMO (FP-SMO) combined with arthroscopic modified Broström operation (MBO) in patients with medial compartment varus ankle osteoarthritis and chronic lateral ankle instability. Materials and methods: We retrospectively reviewed 22 patients who underwent medial opening wedge FP-SMO and arthroscopic MBO between 2014 and 2019. Clinical outcomes were assessed using the Visual Analog Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score, and Foot and Ankle Outcome Score (FAOS). Radiological evaluation included the anterior drawer test (ADT), talar tilt angle, tibiotalar surface (TTS) angle, medial distal tibial angle (MDTA), tibial lateral surface (TLS) angle, Takakura stage, and International Cartilage Regeneration and Joint Preservation Society (ICRS) grade assessed during second-look arthroscopy. Results: At a mean follow-up of 17.22 months, the mean VAS, AOFAS, and FAOS scores improved significantly (p< 0.001). Radiologically, the mean ADT decreased from 5.98 mm to 4.70 mm (p = 0.015), and the mean talar tilt angle decreased from 9.85° to 6.09° (p< 0.001). The mean TTS angle increased from 80.46° to 84.86° (p = 0.021), and the mean MDTA increased from 85.03° to 91.26° (p< 0.001). The TLS angle showed no significant change from 81.17° to 81.54° (p = 0.238). Takakura stage and ICRS grade improved or remained stable in all patients. No major complications, including nonunion, were observed. Conclusions: FP-SMO combined with arthroscopic MBO demonstrated favorable short-term clinical and radiological outcomes in selected patients with medial compartment varus ankle osteoarthritis and chronic lateral ankle instability. This combined approach may be a feasible joint-preserving option that addresses coronal malalignment and lateral ankle instability without requiring FO; however, longer-term comparative studies are needed to confirm its durability and clinical utility. Full article

Reaction time (RT) is widely used as a fundamental indicator of central nervous system processing speed. Numerous studies have shown that RT increases with age, generally interpreted as a decline in information processing efficiency. However, most previous studies have focused on absolute RT values, and it remains unclear whether aging also alters the relative relationships between responses under different task conditions. The present study investigated whether aging affects the relative difference between inside and outside pedal reaction times in a Foot Psychomotor Vigilance Test (Foot PVT). A total of 44 participants were analyzed, including 20 younger adults (24 ± 3 years) and 24 older adults (73 ± 5 years). Participants responded to visual stimuli by pressing either the left or right pedal with the right foot. The difference between inside and outside RT (dRT) was calculated for each participant as an index of relative response structure. Group comparisons and correlation analyses were conducted to examine associations with age, height, physical activity level (PAL), and sleep-related factors. As expected, RTs were consistently longer in older adults across conditions. In contrast, dRT did not differ significantly between younger and older groups, with negligible effect sizes (|d| < 0.1). Furthermore, dRT showed no significant correlations with height, PAL, or sleep-related indices. These findings indicate that while aging affects the overall speed of motor responses, the relative temporal structure between response conditions is preserved. This dissociation between global slowing and stable response structure may represent a fundamental characteristic of neuromotor aging. Full article

Background: The management of diabetic foot disease and knee osteoarthritis (OA) with smart orthotics holds significant importance during the early stages of these conditions, given their potential consequences, including functional impairment, chronic pain, and economic burden. Real-time monitoring of plantar foot pressure enables early detection of abnormal force distribution and gait biomechanics, allowing for the redirection of forces away from affected ulcers or arthritic joints. This is the first systematic review to synthesise clinical evidence for smart orthotics technology with real-time plantar pressure sensor biofeedback across both diabetic foot ulcer prevention and knee osteoarthritis management simultaneously. A search of the PROSPERO register confirmed no existing registration covers this specific combination. Objectives: To examine the clinical evidence for the use of standard and smart orthotics in the prevention and management of diabetic foot ulcers (DFUs) and knee OA, and to evaluate their impact on plantar pressure redistribution, ulcer recurrence, pain, biomechanics, and economic burden. Eligibility criteria: Studies published in English involving human adult participants (≥18 years) with a clinical diagnosis of diabetes mellitus (at risk of DFU or with peripheral neuropathy) or knee OA, where the intervention involved any orthotic device or smart/intelligent insole with clinical outcomes reported, were included. Studies on healthy individuals only, those not reporting participant age, and non-weight-bearing protocols not differentiated from weight-bearing were excluded. Information sources: Five databases were searched: CINAHL (EBSCO Information Services, Ipswich, MA, USA), PubMed Advanced (National Library of Medicine, Bethesda, MD, USA), Wiley Online Library (John Wiley & Sons, Hoboken, NJ, USA), Cochrane Library (Cochrane Collaboration, London, UK), and Google Scholar (Google LLC, Mountain View, CA, USA). Searches were completed in May 2026. Methods: We conducted a comprehensive literature review. This review was structured and reported with reference to the PRISMA 2020 statement (Preferred Reporting Items for Systematic Reviews and Meta-Analysis; University of Ottawa, Ottawa, ON, Canada) to guide transparency of reporting. It does not constitute a full Cochrane-style systematic review; risk of bias assessment was applied to key included studies and GRADE (Grading of Recommendations Assessment, Development and Evaluation; McMaster University, Hamilton, ON, Canada) certainty ratings were applied informally and narratively rather than as formal per-outcome evidence profiles. Five databases were searched yielding 92,637 records. After removal of 398 duplicates by Rayyan, 92,239 records remained. A subsequent automated keyword-based relevance filter applied within Rayyan (Rayyan AI, Doha, Qatar), prior to human screening, excluded 84,572 records that did not contain any terms related to orthotics, diabetic foot, or knee osteoarthritis, yielding 7667 records for human title/abstract screening. A narrative synthesis approach was adopted owing to the heterogeneity of study designs and outcome measures across included studies, which precluded meta-analysis. This review was not prospectively registered. A complete list of all 78 included studies, including those not individually discussed in the results and discussion. Results: The available clinical studies report promising findings for orthotics and smart orthotics in pain reduction, ulcer prevention, and potential reduction in economic burden, though conclusions are limited by small sample sizes, heterogeneity, and predominantly open-label designs. Recent research found that orthotics can be used to alter the gait pattern that influences knee OA by reducing excessive force on the affected joint. A randomised controlled trial demonstrated an 80% relative risk reduction in DFU recurrence (RR = 0.20; 95% CI: 0.06–0.79; p = 0.022), with absolute event rates of 6.3% in the intervention group versus 30.8% in controls (ARR = 24.5%); a second trial reported a 71% reduction in ulcer incidence over 18 months; and a third randomised controlled trial demonstrated statistically significant plantar pressure reduction (p < 0.01) in patients with diabetic neuropathy. Conclusions: The available evidence suggests that orthotics may be associated with improved pressure redistribution, reduced ulcer incidence, and benefit in the management of knee OA. Although the number of studies directly comparing smart orthotics with standard orthotics remains limited, the limited comparative studies suggested that smart orthotics showed promising results in reducing ulcer incidence, providing the patient with real-time feedback to offload via their electronic devices. These findings, while preliminary, highlight the potential of smart orthotic technology as an adjunct to standard orthotic care in reducing the overall burden of diabetic foot disease and knee osteoarthritis. Limitations: The primary methodological limitation of this review is the open-label design of all included smart orthotic trials, which precludes participant blinding and introduces performance bias. However, this limitation is structural and inherent to the wearable technology field—analogous to surgical trials—and is substantially mitigated by the use of objective primary outcome measures (plantar pressure and ulcer recurrence) across the three included RCTs, the consistency of effect direction across independent RCTs conducted in different countries, and a narrative sensitivity analysis confirming robustness of findings (Risk of Bias Across Studies Section). Formal per-outcome GRADE evidence profiles were not produced; overall certainty of evidence was assessed narratively with reference to GRADE domains and is judged to be low to moderate for smart orthotics in DFU prevention and low for knee OA management, consistent with the Level 2–3 evidence base and open-label study designs. Future adequately powered, multi-site RCTs with standardised outcome reporting, minimum 24-month follow-up, and integrated health economic modelling are the highest priority to extend these preliminary findings. Registration: This review was not prospectively registered. Full article