Search Results (13,343)

The Federal Institute of Material Research and Testing has performed many impact tests, from very small laboratory tests to very big “free-field” tests with heavy containers on stiff foundations. The first measurements have been done on a big foundation where it should be guaranteed that the foundation is rigid and the container is tested properly. Later, a smaller drop-test facility has been built on the ground inside an existing building. It had to be controlled by prediction and measurements to ensure that the drop test will not damage the building. Tests from different heights on soft, medium, and stiff targets have been done to find out rules which allow to identify acceptable and unacceptable drop tests. Later, the biggest drop test facility has been built for masses up to 200 t. It was necessary for the design of the foundation to estimate the forces which occur during the drop tests. In addition, the acceptable tests should be selected and controlled by measurements where the impact duration is important. Different sensors, accelerometers, accelerometers with mechanical filters, geophones (velocity transducers), strain gauges, and pressure cells have been applied for these tasks. Signal transformations and model calculations have been used to check and understand the dynamic measurements. The simplest law is the conservation of the momentum which is a good approximation if the impact is short. If the soil under the foundation has an influence on the deceleration of the container, the maximum foundation velocity is lower than the simple estimation. Full article

Typhoons are major physical disturbances in marginal seas, yet their event-scale impacts on microbial processes and carbon cycling remain poorly constrained. Here, we investigated the biogeochemical responses to Super Typhoon Maria (2018) in the East China Sea using combined field observations and satellite data. While surface temperature, nutrients, and chlorophyll-a (Chl-a) showed no significant changes, depth-integrated nutrients and Chl-a increased markedly, revealing a clear decoupling between surface and depth-integrated responses driven by vertical mixing and upwelling. Satellite observations further showed that phytoplankton enhancement was short-lived, with Chl-a returning to background levels within one week. This rapid attenuation likely reflects transient nutrient supply and strong grazing pressure. In contrast, microbial responses were characterized by increased bacterial specific growth rate without significant changes in biomass or production, indicating enhanced microbial turnover. Together, these results suggest that typhoon forcing promotes rapid and vertically structured carbon processing through the microbial loop without increasing biomass accumulation. This highlights the importance of temporal resolution and vertical structure in understanding ecosystem responses to episodic disturbances in marginal seas. Full article

Wetlands are vital ecosystems that provide critical provisioning, regulating, cultural, and supporting services that underpin biodiversity conservation and local livelihoods. Despite their importance, ecosystem service valuation is often overlooked in coastal wetland restoration, limiting recognition of their contributions to the United Nations Sustainable Development Goals (SDGs). To address this gap and overcome methodological fragmentation in wetland assessments, this study develops the Integrated Ecosystem Valuation and Management of Wetlands (IEVMW) framework, which integrates the Millennium Ecosystem Assessment (MEA), Drivers–Pressures–State–Impact–Response (DPSIR) framework, IPCC climate risk assessment, and Total Economic Value (TEV) approaches into a unified methodology. The framework was applied to the Kol Wetlands in India to identify ecosystem services, assess climate-related risks, estimate economic values, and develop management recommendations. Results indicate that provisioning services contribute the highest economic value, followed by regulating and cultural services. Climate change was estimated to place approximately 11.7% and 13.0% of ecosystem service value at risk in North Kol and South Kol, respectively, corresponding to a combined economic value at risk of ₹42.9 crore, with provisioning services being the most vulnerable. The IEVMW framework provides a practical and scalable approach for linking ecosystem service valuation, climate risk assessment, and governance, thereby supporting climate-resilient wetland management and biodiversity conservation across diverse socio-environmental contexts. Full article

CD19-directed chimeric antigen receptor (CAR) T-cell therapy has fundamentally transformed the treatment landscape for relapsed and refractory B-cell malignancies, yet antigen escape remains a persistent therapeutic challenge that limits long-term remission durability. While antigen loss is typically considered a somatic event acquired during tumor evolution under therapeutic selective pressure, germline CD19 polymorphisms could theoretically influence CAR-binding kinetics, alter epitope presentation, and modulate therapeutic outcomes in ways that remain largely not characterized. Unfortunately, Middle Eastern populations are underrepresented in pharmacogenomic databases and CAR-T clinical trials, creating a knowledge gap that may perpetuate global health disparities in access to precision immunotherapy. We analyzed publicly available whole-exome sequencing data from 1196 individuals of Arab origin to comprehensively characterize CD19 variants with potential relevance to CAR T-cell immunotherapy. The L174V (rs2904880) variant stood out, and showed the Valine/Valine (V/V) genotype frequency was 65.3%, corresponding to a V174 allelic frequency of 76.6%, while the minor allele, L174, has a frequency of 23.4%. The missense mutation (c.520C > G) responsible for this variant results in a leucine-to-valine (L174V) substitution at position 174 of the CD19 protein, relative to the reference genome. The cohort genotypes (CC, CG, and GG) exhibited a significant deviation from Hardy–Weinberg equilibrium (p < 0.00001). While this deviation is consistent with the high consanguinity rates (25–60%) amongst Arab populations, it remains not fully explained, and may be attributed to population structure, relatedness, or technical factors. We further emphasize that our computational analysis cannot establish any direct clinical or functional impact due to this variant, and therefore we refrain from suggesting any specific actions at the current time. In light of these findings, we hypothesize that the distinctive genetic architecture of consanguineous populations should not be viewed as a confounding variable. Instead, it presents a unique opportunity to investigate the clinical relevance of germline variation in the context of precision oncology, particularly at therapy-relevant loci, pending functional validation. Full article

Background: The Postural Control System is affected by sensory inputs in stabilizing posture. The impact of postural receptors can be quantitatively evaluated by baropodometry. The lack of a standardized testing environment can decrease the reliability of baropodometric results. Virtual reality (VR) might represent a useful standardization tool. This study aimed to investigate the effects of virtual environment on plantar pressure and postural stability parameters by using a Head-Mounted Display (HMD). Methods: 50 healthy young adults underwent a baropodometric exam in upright standing under four conditions: Open Eyes (OE), Closed Eyes (CE), open (HMD-OE) and closed eyes (HMD-CE) conditions while wearing an HMD. Results: a negligible effect of VR on intrasubject variability of plantar pressure and stabilometric parameters. Moreover, no significant differences in the latter ones were found between OE conditions without and with headset (OE vs. HMD-OE), highlighting no impact of VR; instead, a significant increase in body sway was found in the closed eyes condition compared to OE ones with and without headset (CE vs. OE, CE vs. HMD-OE), underlining the effect of visual deprivation, whereas no significant difference was observed between the HMD-CE and OE conditions and a significant decrease in HMD-CE compared to the CE condition, showing the sensory-proprioceptive effect of the HMD. Eventually, no significant differences in plantar pressure parameters were generally found in different conditions. Conclusions: These findings highlighted the specific effect of visual afferents differently from proprioceptive ones by headset use and the absence of the VR impact on postural stability, suggesting a possible role of virtual reality in standardizing instrumental postural exam. Full article

To tackle the intermittency of renewable energy and realize the repurposing of abandoned oil and gas wells, this study proposes a compressed air energy storage (CAES)-based cogeneration system integrated with geothermal energy and abandoned oil and gas wells, and conducts a five-dimensional comprehensive analysis covering exergy, exergoeconomic, exergoenvironmental, economic and environmental performance. The optimal operating parameters are determined as air compressed to 200 bar, an ORC turbine inlet pressure of 16 bar and an inlet temperature of 110 °C. The system’s annual total power generation is 2,971,416.5 kWh during low-power daytime operation, and 20,131,785 kWh during high-power nighttime operation. Compared with conventional CAES systems, the proposed system reduces total exergy destruction by 4121.35 kW and increases exergy efficiency from 48.49% to 63.38%. Coolers, geothermal heat exchangers and compressors are the main sources of exergy destruction cost and capital investment, while COM1, HE1 and HOT1 are the key components causing environmental impacts. The system realizes cogeneration of power, hydrogen and pure water, with a static payback period of about 5.4 years and significantly reduced TEWI value at elevated turbine inlet pressure. This system achieves multi-objective synergies in energy efficiency, economy and environment, providing a feasible scheme for the green repurposing of abandoned oil and gas wells and cascaded utilization of renewable energy. Full article

Detonation-based combustion systems for application in gas turbines (GTs) have received growing attention in recent decades. Such a technology leads to higher thermodynamic cycle efficiency compared to the conventional deflagrative solution as a result of pressure rise occurring during the heat addition process. This study aims to implement pressure gain combustion (PGC) into a thermodynamic cycle where the main compressor is operated at a lower pressure ratio compared to the Brayton–Joule cycle. In detail, this study focuses on the impact of the secondary air system (SAS) compressor, which is necessary to correctly feed the blade cooling circuits with adequate pressure as well as to deliver high-pressure air for cooling the PGC system. A parametric analysis based on different amounts of cooling air to the PGC system is proposed and discussed. In detail, the power demand by the SAS compressor can be as high as 5–6% of the net PGC GT power output, with maximum demands calculated in the range from 16 to 22 MW for a 335 MW F-class gas turbine. These figures are significant because the higher they are, the greater the risk of reducing the performance advantage introduced by the pressure gain combustion. In addition, the effects of SAS compressor efficiency are investigated and a preliminary assessment of both size and rotational speed of the SAS compressor is proposed as well. Full article

Congestion is a major driver of symptoms, hospitalization, and adverse outcomes in heart failure (HF), yet its clinical assessment remains challenging. Traditional approaches based on physical examination, biomarkers, and isolated imaging surrogates often fail to capture the complexity of systemic venous congestion and its impact on organ function. In HF, congestion should be interpreted as a multifactorial process resulting from the interaction between intravascular volume burden, venous compliance, cardiac filling pressures, neurohormonal activation, blood volume redistribution, and organ-specific susceptibility. In this context, point-of-care ultrasound has emerged as a promising adjunctive tool for bedside congestion assessment. The Venous Excess Ultrasound (VExUS) score integrates inferior vena cava assessment with Doppler analysis of hepatic, portal, and intrarenal veins, allowing for the evaluation of venous pressure transmission and organ-level congestion. Observational studies suggest that VExUS and related venous Doppler abnormalities correlate with invasive hemodynamic parameters and are associated with acute kidney injury, diuretic response, heart failure hospitalization, and mortality. Serial changes in venous congestion may provide additional information regarding treatment response and clinical trajectory. However, the available evidence remains heterogeneous across acute HF, ambulatory HF, cardiorenal syndrome, and critical care populations, and randomized trials evaluating VExUS-guided management are lacking. Therefore, VExUS should be interpreted as a complementary tool within a multimodal assessment that includes echocardiography, lung ultrasound, biomarkers, renal function, urine output, physical examination, and response to therapy. By integrating fluid burden with venous pressure transmission and organ perfusion, multimodal ultrasound may support more individualized congestion assessment and risk stratification in HF. Full article

As the Italian hop industry undergoes consolidation, assessing the environmental pressure of diverse cultivation and processing models is essential for sustainable growth. This study characterizes the Product Environmental Footprint (PEF) of Italian hop production through a multi-case analysis of eight representative farms. A primary data collection tool was utilized to quantify resource inputs, including water management, nutritional strategies, and phytosanitary defense. Following a rigorous thermodynamic consistency screening of the field data to eliminate unrepresentative parameters, the life cycle inventory focused on two validated regional anchor cases. The findings reveal a high degree of management heterogeneity, with dry cone yields ranging from 400 to 1673 kg of dry matter per hectare. Two functional units were defined: 1 kg of fresh hop cones (FU1) to assess cultivation impacts, and 1 kg of processed products (FU2) at the brewery gate to evaluate the full supply chain. Integrating deterministic life cycle impact outputs with a probabilistic Monte Carlo uncertainty analysis, the results indicate that the environmental impact varies significantly across commercial formats: Cryogenic Powder (2.33 ± 0.34 mPt/kg) represents the most resource-intensive format, while Raw Bales and T90 Pellets from high-yield models exhibit scores as low as 1.36 and 1.55 mPt/kg, respectively. The study identifies the agricultural phase as the primary environmental hotspot, driven predominantly by water deprivation. To address these burdens, a Sustainable Italian Hop (SIH) integrated scenario was developed. By combining precision irrigation, thermal decarbonization via biomass valorization, and a direct-to-pellet processing flow, this model achieved a 70% total reduction in the environmental footprint score (0.465 ± 0.076 mPt/kg) and an 86% reduction in water use impacts. Finally, the socio-technical and financial barriers to implementing the SIH framework are qualitatively evaluated. These results provide actionable benchmarks for aligning the emerging Italian hop supply chain with European Union climate neutrality objectives. Full article

Optimizing the injection molding of short-fiber-reinforced thermoplastics (SFRTs) is a persistent challenge due to the complex interplay between processing parameters and final mechanical performance. To address this, we developed and validated a machine learning (ML) pipeline to maximize both the tensile strength and Charpy impact resistance in polyamide 6 with 30% glass fiber (PA6-GF30). Through a designed experimental campaign, we systematically varied four key process parameters—melt temperature (260–300 °C), injection pressure (600–1000 bar), packing pressure (400–800 bar), and cooling time (15–35 s). The resulting dataset was used to train and compare three different regression models: Random Forest (RF), Gradient Boosting (GB), and Support Vector Regression (SVR). Our findings indicate that the Gradient Boosting (GB) algorithm yielded the most reliable predictions, significantly outperforming the other evaluated models. Further analysis using SHAP (Shapley Additive exPlanations) identified packing pressure as the dominant factor influencing tensile strength (contributing approximately 40% to the prediction), while melt temperature emerged as the key driver for impact resistance (around 35% contribution). By integrating our best-performing GB model with a multi-objective genetic algorithm, we identified an optimal set of parameters that simultaneously enhances both mechanical properties. Among the evaluated models (Random Forest, Support Vector Regression, and Gradient Boosting), the Gradient Boosting algorithm achieved the highest predictive accuracy. Compared to the baseline condition (280 °C melt temperature, 800 bar injection pressure, 600 bar packing pressure, 25 s cooling time), experimental validation of these optimized settings demonstrated substantial improvement: tensile strength increased from 145 MPa to 171 MPa (an 18% enhancement), and impact resistance rose from 45 kJ/m² to 55 kJ/m² (a 22% gain). This work establishes that an integrated ML and optimization framework can serve as a transformative approach for high-precision manufacturing of advanced engineering polymers. The primary novelty of this work lies in the development of a fully integrated, bias-free methodological framework that explicitly couples physical interpretability with multi-objective optimization, bridging the critical gap between black-box predictions and actionable industrial insights. Full article

This study examines the impact of imprisonment on the families of incarcerated men in England and Wales. Drawing on mixed-methods survey data collected in collaboration with the Prison Advice and Care Trust (PACT), the research is based on responses from 42 participants. The sample comprised 21 partners/spouses, 11 parents, 5 adult children, 2 siblings, 1 other relative and 1 friend of an incarcerated individual, with 1 participant preferring not to disclose their relationship. The study explores the financial, social, emotional and relational consequences associated with imprisonment. Findings indicate that financial strain was a significant pressure for many participants, driven by loss of income alongside the costs associated with maintaining contact. Participants also described experiences of stigma, social withdrawal, emotional distress and changes to family responsibilities, highlighting the multiple challenges associated with imprisonment for family members. Consistent with emerging research highlighting the wider emotional and psychological consequences of imprisonment for family members, the findings suggest that these pressures were often experienced as interconnected aspects of participants’ experiences rather than in isolation. The study illustrates the value of the symbiotic harms framework for understanding the relational and interconnected dimensions of family members’ experiences of imprisonment in a UK context and highlights the practical and emotional labour involved in maintaining family relationships during imprisonment. The findings underscore the importance of recognising families as individuals directly affected by imprisonment and by the wider consequences of penal policy. Full article

Chiang Mai, Thailand, experiences seasonal fine particulate matter (PM_2.5) pollution associated with metabolic diseases, but the underlying mechanisms remain unclear. This prospective observational study compared plasma metabolomes of 25 healthy adults in Samoeng District, a highly affected area, between low and high PM_2.5 exposure seasons using proton nuclear magnetic resonance (¹H-NMR) spectroscopy. Twenty-six metabolites differentiating haze and non-haze seasons were identified using PLS-DA (VIP > 1.5). During the haze season, 11 were elevated, whereas 15 were decreased. Among the elevated metabolites, the top five—maleylacetoacetic acid, deoxyribose 5-phosphate, betaine, 3-hydroxyanthranilic acid, and 1-methyladenosine—were associated with inflammation, increased reactive oxygen species, nitric oxide inhibition, and altered amino acid metabolism. The top five decreased metabolites—deoxyguanosine, D-arabitol, glycerophosphocholine, ophthalmic acid, and oxaloacetic acid—were involved in several metabolic pathways, particularly those involved in energy metabolism. A total of 56 metabolic pathways were altered by high PM_2.5 exposure, including pathways related to amino acids, lipids, sugars, nucleotides, vitamins, and energy metabolism. High PM_2.5 exposure disrupts metabolites and pathways, inducing inflammation, oxidative stress, impaired lipid/energy metabolism, insulin resistance, and high blood pressure. These alterations may increase the risk of metabolic and cardiovascular diseases, with dysregulated metabolites serving as potential biomarkers. These findings highlight the molecular impact of air pollution in affected populations and may support preventive strategies and public health policy development in affected regions. Further studies are needed to clarify these findings. Full article

The integration of collaborative robots into industrial environments requires rigorous safety validation under the Power and Force Limiting (PFL) regime. This review article systematically maps the technological and normative development of certified Pressure and Force Measurement Devices (PFMDs) and experimental biofidelic instruments for Physical Human–Robot Interaction (pHRI) between the years 2011 and 2026. A quantitative screening of 68 studies revealed a publication peak in impact metrology in 2021. This peak occurred with a five-year latency after the release of the ISO/TS 15066 technical specification. Although global interest in collaborative robotics steadily grows, the publication trend indicates a gradual shift in scientific focus from reactive testing toward proactive prevention. A methodological deconstruction of four Research Questions (RQs) identifies persistent limitations in safety evaluation. The findings demonstrate that the internal structure of conventional sensors induces nonlinear shock filtering and parasitic oscillations (RQ1). Furthermore, the rigid fixation of test stands generates unrealistic pressure spikes. This physical limitation forces a transition to flexible and pendulum-based configurations (RQ2). Commercial flat films physically fail due to sensor saturation and introduced stiffness. Such failures accelerate the development of conformable electronic skins (e-skins) and multimodal test manikins (RQ3). To ensure interlaboratory reproducibility within the current ISO 10218-2:2025 standard, the text defines imperative metrological parameters. These parameters strictly include frequency response, calibration protocols, and volumetric mapping of inertial masses (RQ4). Furthermore, the analysed publications were systematically stratified into distinct technological categories, strictly reflecting their primary engineering domains, ranging from empirical metrological evaluation and sensor hardware design to advanced numerical modeling. Finally, the vision for future research anticipates a definitive shift toward proactive anti-collision technologies, encompassing Artificial Intelligence (AI), machine vision, and Augmented Reality/Virtual Reality/Mixed reality (AR/VR/MR). Future methodologies must also consider demographic anisotropies and the cognitive fatigue of the human operator. Full article

Seawater intrusion presents a significant risk to coastal aquifers, particularly in low-lying locations where groundwater resources are intensively exploited. This study assesses the vulnerability of the Keta Strip aquifer in Southeastern Ghana to seawater intrusion using the GALDIT model; a widely applied index-based approach that evaluates seawater intrusion risk based on six key hydrogeological indicators: groundwater occurrence (G), aquifer hydraulic conductivity (A), groundwater level above sea level (L), distance from the shoreline (D), impact of existing intrusion (I), and aquifer thickness (T). These parameters were analyzed using data from 105 monitoring wells within a Geographic Information System (GIS) environment. The resulting vulnerability index was spatially grouped into four categories: low, moderate, high, and very high vulnerability. Results indicate that very high and high vulnerability regions are predominantly clustered along the coastal margins and central portions of the study area, driven mainly by low hydraulic gradients, proximity to the shoreline, and high hydraulic conductivity. Moderate vulnerability zones dominate inland areas, while low vulnerability zones are limited and confined to northern sections. Sensitivity analysis reveals that hydraulic head (L) and distance from shoreline (D) are the most influential parameters, whereas TDS exhibits relatively low contribution to overall vulnerability. The findings highlight the critical role of hydrogeological controls and anthropogenic pressures in shaping seawater intrusion risk and provide a scientific basis for sustainable groundwater management in the Keta Strip and similar coastal environments. 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