The role of alcohol response phenotypes in the risk for alcohol use disorder

Heavy alcohol use is pervasive and one of our most significant global health burdens. Early theories posited that certain alcohol response phenotypes, notably low sensitivity to alcohol (‘low-level response’) imparts risk for alcohol use disorder (AUD). However, other theories, and newer measures of subjective alcohol responses, have challenged that contention and argued that high sensitivity to some alcohol effects are equally important for AUD risk. This study presents results of a unique longitudinal study in 294 young adult non-dependent drinkers examined with alcohol and placebo testing in the laboratory at initial enrolment and repeated 5 years later, with regular follow-up intervals assessing AUD (trial registration: http://clinicaltrials.gov/ct2/show/NCT00961792). Findings showed that alcohol sedation was negatively correlated with stimulation across the breath alcohol curve and at initial and re-examination testing. A higher rather than lower alcohol response phenotype was predictive of future AUD. The findings underscore a new understanding of factors increasing vulnerability to AUD

Creative Approaches to Health Information Ecologies: Summary Report

This report shares findings from Creative Approaches to Health Information Ecologies, a project led by researchers at the University of New South Wales (UNSW Sydney) in collaboration with Health Consumers NSW. This project used creative and qualitative methods to explore how people learn about their bodies and health. A total of 27 people took part in online workshops via Zoom during mid-2022. In these, participants mapped personal forms of health information and discussed the connections between health, wellbeing and the environment. Their discussions and maps provided valuable insight into the forms that health information takes and what matters about information, health and wellbeing in people’s everyday lives

Developing inter-cultural competencies without travelling: Internationalising the curriculum for healthcare students

Healthcare professionals work with increasingly diverse groups of colleagues and patients in their practice, and it is essential that they develop intercultural competence. International experiences in healthcare curricula can help in this development, but healthcare students on courses tend to have limited opportunities for travel. This paper presents data on the use of an online classroom to provide an environment in which physiotherapy students from two countries could work together to review video case studies to enhance their knowledge and understanding of selected patient conditions and compare different approaches to diagnosis and treatment. These activities were integrated into the usual curriculum in both countries. Evaluation of students’ experiences showed that they valued the opportunity to engage with their peers in another country and were readily able to identify professional and academic benefit from participation. They commented on the impact on their professional identity formation, the benefits of widening their community of practice, and of becoming more interculturally competen

Relative bioavailability of iron and folic acid from a new powdered supplement compared to a traditional tablet in pregnant women

<p>Abstract</p> <p>Background</p> <p>Deficiencies of iron and folic acid during pregnancy can lead to adverse outcomes for the fetus, thus supplements are recommended. Adherence to current tablet-based supplements is documented to be poor. Recently a powdered form of micronutrients has been developed which may decrease side-effects and thus improve adherence. However, before testing the efficacy of the supplement as an alternate choice for supplementation during pregnancy, the bioavailability of the iron needs to be determined. Our objective was to measure the relative bioavailability of iron and folic acid from a powdered supplement that can be sprinkled on semi-solid foods or beverages versus a traditional tablet supplement in pregnant women.</p> <p>Methods</p> <p>Eighteen healthy pregnant women (24 – 32 weeks gestation) were randomized to receive the supplements in a crossover design. Following ingestion of each supplement, the changes (over baseline) in serum iron and folate over 8 hours were determined. The powdered supplement contained 30 mg of iron as micronized dispersible ferric pyrophosphate with an emulsifier coating and 600 μg folic acid; the tablet contained 27 mg iron from ferrous fumarate and 1000 μg folic acid.</p> <p>Results</p> <p>Overall absorption of iron from the powdered supplement was significantly lower than the tablet (p = 0.003). There was no difference in the overall absorption of folic acid between supplements. Based on the differences in the area under the curve and doses, the relative bioavailability of iron from powdered supplement was lower than from the tablet (0.22).</p> <p>Conclusion</p> <p>The unexpected lower bioavailability of iron from the powdered supplement is contrary to previously published reports. However, since pills and capsules are known to be poorly accepted by some women during pregnancy, it is reasonable to continue to explore alternative micronutrient delivery systems and forms of iron for this purpose.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov NCT00789490</p

More-than-Human Wellbeing: Materialising the Relations, Affects, and Agencies of Health, Kinship, and Care

Introduction The concept of ‘wellbeing’ is typically thought of in human-centric ways, referring to the affective feelings and bodily sensations that people may have which inform their sense of health, safety, and connection. However, as our everyday lives, identities, relationships, and embodiments become digitised and datafied, ‘wellbeing’ has taken on new practices and meanings. The use of digital technologies such as mobile and wearable devices, social media platforms, and networks of information mediate our interactions with others, as well as the ways we conceptualise what it means to be human, including where the body begins and ends. In turn, digital health technologies and ‘wellness’ cultures such as those promoted on social media sites such as Instagram, Pinterest, YouTube, TikTok, and Facebook have also shaped our understanding of ‘wellness’ and ‘wellbeing’, their parameters, and how they ought to be practiced and felt (Baker; Lupton Digital Health; Lupton et al.). For millennia, aspects of human bodies have been documented and materialised in a variety of ways to help people understand states of health and illness: including relationships to the environments in which they lived. Indigenous and other non-Western cosmologies have long emphasised the kinds of vibrancies and distributed agencies that are part of reciprocal more-than-human ‘manifestings’ of kinships, and have called for all people to adopt the role of stewards of the ecosystem (Bawaka Country et al.; Hernández et al.; Kimmerer; Rots; Todd; Tynan). In Western cultures, ideas of the human body that reach back to ancient times adopt a perspective that viewed the continuous flows of forces (the four humours) in conjunction with the elements of air, wind, earth, and fire inside and outside the body as contributing to states of health or ill health. It was believed that good health was maintained by ensuring a balance between these factors, including acknowledgement of the role played by climactic, ecological, and celestial conditions (Hartnell; Lagay). A more-than-human approach is beginning to be re-introduced into Western cultures through political activism and academic thinking about the harms to the planet caused by human actions, including global warming and climate crises, loss of habitats and ecological biodiversity, increased incidence of extreme weather events such as bushfires, floods, and cyclones, and emerging novel pathogens affecting the health not only of humans but of other living things (Lewis; Lupton Covid Societies; Lupton Internet of Animals; Neimanis et al.). Contemporary Western more-than-human philosophers argue for the importance of acknowledging our kinship with other living and non-living things as a way of repositioning ourselves within the cosmos and working towards better health and wellbeing for the planet (Abram; Braidotti; Plumwood). As these approaches emphasise, health, wellbeing, and kinship are always imbricated within material-social assemblages of humans and non-digital things which are constantly changing, and thereby generating emergent rather than fixed capacities (Lupton "Human-Centric"; Lupton et al.). In this article, we describe our More-than-Human Wellbeing exhibition. To date, new media, Internet, and communication studies have not devoted as much attention to more-than-human theory. It is this more-than-digital and more-than-human approach to health information and wellbeing that marks out our research program as particularly distinctive. Our research focusses on the many and varied digital and non-digital forms that information about health and bodies takes. We are interested in health data as they are made and form part of the objects and activities of people’s everyday lives and aim to expand the human-centric approach offered in digital health by positioning human health and embodiment as always imbricated within more-than-human ecosystems. We acknowledge that all environments (natural and human-built) are intertwined with humans, and that to a greater or lesser extent, all are configured with and through the often exploitative and extractive practices and ideologies of those living in late modern societies in which people are positioned as superior to and autonomous from other living things. Together with more-than-human scholarship, we take inspiration from work in which arts-based, multisensory, and museum curation methods are employed to draw attention to the intertwining of people and ecologies (Endt-Jones; Howes). Our exhibition was planned as a research translation and engagement project, communicating several of our studies’ findings in arts-based media (Lupton "Embodying"). In what follows, we outline the concepts leading to the creation of our exhibits and describe how these pieces materialise and extend more-than-human concepts of wellbeing and care. Five of the exhibits we created for this exhibition are discussed. They all draw on our research findings across a range of studies, together with more-than-human theory and medical history (Lupton "More-Than-Human"). We describe how we used these pieces to materialise more-than-human concepts of health, wellbeing, and kinship in ways that we hoped would provoke critical thought, affective responses, and open capacities for action for contributing to both human and nonhuman flourishing. The background, thinking, and modes of making leading to the creation of ‘Cabinet of Human/Digital/Data Curiosities’, ‘Smartphone Fungi’, ‘Hand of Signs’, ‘Silken Anatomies’, and ‘Talking/Flowers’ are explained below. Bodily Curios Vaughan Wozniak-O’Connor and Deborah Lupton. Cabinet of Human/Digital/Data Curiosities. Reclaimed timber, found objects, resin 3D prints. 2023. Fig. 1: Cabinet of Human/Digital/Data Curiosities. Fig. 2: Detail from Cabinet of Human/Digital/Data Curiosities. The objects we have placed in Cabinet of Human/Digital/Data Curiosities (figs. 1 and 2) mix together such things from the past as prosthetic human eyeballs and teeth used in medicine and dentistry in earlier eras. This collection of found and manufactured objects, both old and new, draws on the concept of the ‘cabinet of curiosities’, also known as cabinets of wonder, which first became popular in the sixteenth century. Artefacts were assembled together for viewing in a room or a display case. The items were chosen for being notable in some way by the curator, including objects from natural history, antiquities, and religious relics, as well as works of art. These collections, purchased, curated, and assembled by members of the nobility or the wealthy as a marker of refinement, knowledge, or social status, were the precursor of museums (Endt-Jones). We see digital devices such as mobile phones as one of a multitude of ways that operate to document and preserve elements of human embodiment – indeed, as contemporary ‘cabinets of curiosities’. Our cabinet also refers to the tradition of medical museums, which display preserved human organs, body parts, and tissue in glass bottles for pedagogical purposes. Under this model of health, specimens of both ‘ideal’ health and also ‘ill’ health – abnormalities in the flesh – were documented as a means of categorising wellbeing. Museums such as these would often treat diseased and disabled bodies as oddities and artefacts of ‘curiosity’. In this work, we reimagine and wind back this way of thinking, through displaying and drawing attention and curiosity towards signs of the body and the everyday. We are showing that wellbeing is more than a process of categorisation, comparison, or measurement of ‘ideal’ or ‘abnormal’; it is in the traces we leave behind us when we return to the earth. Our information data are human remains, moving as endless constellations of the interior and exterior of the body (Lupton Data Selves). In this artwork, both reclaimed wood and 3D-printed resin were used as a synergy between the natural and synthetic. Taking our cue from the manner of display of these items in medical museums, we have added our own curios, including 3D-printed body organs sprouting fungi (fig. 2), as a way of demonstrating the entanglements between humans and the fungal kingdom. Interspersed among these relics of human bodies is a discarded mobile phone with its screen badly shattered. It is displayed as a more recent antiquated object for making images and collecting, storing, and displaying information and images about human bodies, which itself is subject to disastrous events despite its original high-tech veneer of glossy impermeability. Technologies are more-than-flesh as human-made simulacra of body parts. Our wellbeing is sensed and made sense of through bodies’ entanglements of human and nonhuman. These curios both materialise traces of our bodies and wellbeing and extend our bodies into the physical spaces we inhabit and through which we move. Reading the Traces and Signs Vaughan Wozniak-O’Connor and Deborah Lupton. Smartphone Fungi. Recycled European oak, 3D printed resin, CNC carved plywood. 2023 Vaughan Wozniak-O’Connor and Deborah Lupton. Hand of Signs. Laser-etched walnut and plywood. 2023. Fig. 3: Smartphone Fungi. / Fig. 4: Detail from Smartphone Fungi. Wellbeing is also a process of mark-making, realised through the reciprocal impressions we leave on each other and the world around us. In Smart Phone Fungi (figs. 3 and 4) we capture the idea of ‘recording’ that takes place between people, technologies, and the natural world. It was inspired by a huge tree which members of our team noticed on a bush walk in the Blue Mountains, near Sydney, Australia. Growing from this tree were fungi of similar size and shape to the smartphone that was used to capture the image. In our interpretation, a piece of reclaimed timber was used to represent the tree, itself marked by its human use, and fungal shapes replicating those on the tree were produced using computer numerical controlled (CNC) carving. The central timber post is covered with human and more-than-human traces, such as old tool marks, weather damage, and wood borer holes. Alongside these traces, the CNC-carved fungi forms add a conspicuously digital layer of human intervention. Fig. 5: Hand of Signs. In Hand of Signs (fig. 5), we extend this idea of both organic and digital data traces as something that can be ‘read’ or interpreted. Inspired by the practice of palmistry, this work re-interprets line reading, the historical wooden anatomical model, and human body scanning as ways of reading for signs of wellbeing in past and future. Palm readers interpret people’s character, health, longevity, and other aspects of their lives through the creases and traces of development, wear, and deteriorations in the skin of our hands (Chinn). Life leaves its traces on our palms. The piece also refers to the newer tradition of digitising human bodies (Lupton Quantified Self; Lupton et al.), employing scanning and data visualising technologies, which uses spatial GPS data to deduce patterns of human activity. For both palmistry and in more contemporary monitoring technologies, one’s wellbeing can be deduced through the map: the lines of the palm and the errant traces collected by satellites and sensors. To reflect this relation between mapping and palmistry, our updated anatomical model references both the contours of 3D geospatial data and of the human palm. However, this piece looks to represent more layers of data beyond those captured by GPS data. By using reclaimed wood to construct this human hand model, we are again making an analogy between the marks of growth and life that timber displays and those that the human body bears and develops as people move through more-than-worlds throughout their lifespans. The piece also seeks to draw attention to the various ‘signs’ that have been used across centuries to interpret the current and future health and wellbeing of humans (once markings on or morphologies of the body, now often the digitised visualisations of the internal operations and physical movements of the body that are generated by digital health technologies), superimposing older and newer modes of corporeal knowledge. Layers of Mediation Megan Rose. Silken Anatomies. Digital print on satin and yoryu silk chiffon. 2023. Ash Watson. Talking/Flowers. Collage and digital inkjet on paper. 2023. Fig. 6: Detail from Silken Anatomies. The ways that we come to sense and understand wellbeing are also mediated through the reproductive interplay of natural and technological elements. Silken Anatomies (fig. 6) was inspired by anatomical prints from the Renaissance showing details of the interiors of human bodies and organs together with living things and objects from the natural world. These webs of interconnectivity were thought to be key to wellbeing and health. Produced at scale through metal engraving and woodblock printing, these natural history and compendia took on major importance as part of these educational resources (Kemp; Swan). In an effort to extend the reach of artefacts beyond their tangible presence, libraries globally have sought to create open access digital scans of historic medical and botanical illustrations. The images reconfigured in Silken Anatomies were downloaded from the Wellcome Trust’s online archive and have been reimagined through digital enhancement and sublimation dye techniques. Referencing shrouds, the yoryu silk panels enfold exhibition visitors, who were able to touch and pass through the silks, causing them to billow in response to human movement. We bring together an animal-made material (crafted by silkworms) with more-than-human images featuring both humans and other living creatures. The vibrancies of these beautifully engraved and coloured anatomical images are given a new life and a new feel, both affectively and sensuously, through this piece. We can both see and touch these more-than-human illustrations that speak to us of the early modern natural science visualisations that underpin contemporary digital images of the human body and the more-than-human world. The vibrancies of these beautifully engraved and coloured anatomical plates are given a new life and a new feel, both affectively and sensuously. The digital is returned to the tangible. Fig. 7: Detail from Talking/Flowers. Even in increasingly digitised healthcare environments, paper and other printed materials remain central documents in the landscape of health and wellbeing. Zines are small-scale, DIY, and typically handcrafted publications, which are often made to express creators’ thoughts and feelings about health and wellbeing (Lupton "Health Zines"; Watson and Bennett). Talking/Flowers (fig. 7), a zine of visual and textual work, explores the materialities of health information and healthcare encounters by creatively layering a diverse range of materials: clippings from MRI scans, digitally warped and recoloured images from medical infographics, and found poetry made from research publications. In this way, the zine remixes and reconstitutes key documents of authority in health institutions which continue to take primacy as evidence. While vital in the pipeline of diagnosis and treatment, such documents can become black boxes of meaning, and serve to distance health professionals from consumers and consumers from agentic understandings of their own health. These evidentiary materials are brought together here with other imagery, textures, and recollections of personal experience; the pages also feature leaves, flowers, fungi, and oceanic tones. Oceans, pools, rivers, lakes, and other coastal forms or waterways offer all-consuming sensory spaces in which people can find calm, balance, buoyancy, and connection with the wider world. Aqua tides, purple eddies, and misshapen pearls flow through the pages as the golden thread of the zine’s aesthetic theme. Also featured are three original poems. The first and third poems, ‘talking to a doctor’ and ‘talking to other people’, explore moments of relational vulnerability. The second poem, ‘untitled’, is a found poem made from the conclusions of sociologist Talcott Parsons’s 1975 article on the sick role reconsidered. In each of these poems, information and communication jar the encounters and more-than-human metaphors hold space for complex feelings. The cover similarly merges imagery from botanical and historical medical illustrations with a silver shell, evoking the morphological dimensions that connect the more-than-human. Exhibition visitors were able to turn the pages of the original copy of the zine, and were invited to take a printed copy away with them. Conclusion More-than-Human Wellbeing is an exhibition which aims to expand the horizons of how we understand wellbeing and our entanglements with the world. Our exhibition was designed to draw on our research into the more-than-human dimensions of health and wellbeing in the context of an increasingly digitised and datafied world. We wanted to attune visitors to the relational connections and multisensory ways of knowing that develop with and through people’s encounters and entanglements with creatures, things, and spaces. We sought to demonstrate that in this digital age, in which digital devices and software are often considered the most accurate and insightful ways to monitor and measure health and wellbeing, multisensory and affective engagements with elements of the natural environment remain crucial to understanding our bodies and health. Through engagements with our artworks, we hoped that new capacities for visitors’ learning and thinking about the relational and distributed dimensions of more-than-human wellbeing would be opened. While traditionally thought of as human-centered, we explore human health and wellbeing as interconnected with both the natural and technological. We used materials from the natural world – timber, paper materials, and silk fabric – in our artworks to capture both the multigenerational traces and entanglements between humans and plant matter. Recent works of natural and cultural history have drawn attention to the mysterious and important worlds of the fungi kingdom and its role in supporting and living symbiotically with other life on earth, including humans as well as plants (Sheldrake; Tsing). We also made sure to acknowledge this third kingdom of living things in our artworks. We combined these images and materials from nature with digitised modes of printing and fabrication to highlight the intersections of the digital with the non-digital in representations and sensory feelings of health and wellbeing. We disrupt and make strange signs of traditional human-centric medicine through reconfigurations, bricolage, and re-imaginations of more-than-human wellbeing. As humans we are interconnected with the natural world, and the signs of these meetings can be traced and read. Through our artistic creations, we hope to re-orient people towards this more open way of thinking about wellbeing. Working with arts practices and creative data visualisations, both digital and analogue, we bring to the fore the role that more-than-human agents play in mediating and making these convivial more-than-digital connections. Acknowledgments This research was funded by the ARC Centre of Excellence for Automated Decision-Making and Society (CE200100005) and a Faculty of Arts, Design &amp; Architecture collaboration grant. UNSW Library provided financial and curatorial support for the mounting of the exhibition. References Abram, David. "Wild Ethics and Participatory Science: Thinking between the Body and the Breathing Earth." Planet. Volume 1. Kinship: Belonging in a World of Relations. Eds. Gavin van Horn et al. Center for Humans &amp; Nature Press, 2021. 50-62. Baker, Stephanie Alice. Wellness Culture: How the Wellness Movement Has Been Used to Empower, Profit and Misinform. Emerald Group, 2022. Bawaka Country, et al. "Working with and Learning from Country: Decentring Human Author-Ity." cultural geographies 22.2 (2015): 269-283. DOI: 10.1177/1474474014539248. Braidotti, Rosi. "'We' Are in This Together, But We Are Not One and the Same." Journal of Bioethical Inquiry 17 (2020): 465-469. DOI: 10.1007/s11673-020-10017-8. Chinn, Sarah E. Technology and the Logic of American Racism: A Cultural History of the Body as Evidence. Continuum, 2000. Endt-Jones, Marion. "Cultivating ‘Response-Ability’: Curating Coral in Recent Exhibitions." Journal of Curatorial Studies 9 (2020): 182-205. DOI: 10.1386/jcs_00020_1. Hartnell, Jack. Medieval Bodies: Life, Death and Art in the Middle Ages. Profile Books, 2018. Hernández, K.J., et al. "The Creatures Collective: Manifestings." Environment and Planning E: Nature and Space 4.3 (2020): 838-863. DOI: 10.1177/2514848620938316. Howes, David. "Introduction to Sensory Museology." The Senses and Society 9.3 (2014): 259-267. DOI: 10.2752/174589314X14023847039917. Kemp, Martin. "Style and Non-Style in Anatomical Illustration: From Renaissance Humanism to Henry Gray." Journal of Anatomy 216.2 (2010): 192-208. DOI: 10.1111/j.1469-7580.2009.01181.x. Kimmerer, Robin. "Restoration and Reciprocity: The Contributions of Traditional Ecological Knowledge." Human Dimensions of Ecological Restoration: Integrating Science, Nature, and Culture. Eds. Dave Egan et al. Springer, 2011. 257-276. Lagay, Faith. "The Legacy of Humoral Medicine." AMA Journal of Ethics 4.7 (2002): 206-208. Lewis, Bradley. "Planetary Health Humanities—Responding to Covid Times." Journal of Medical Humanities 42.1 (2021): 3-16. DOI: 10.1007/s10912-020-09670-2. Lupton, Deborah. Covid Societies: Theorising the Coronavirus Crisis. Routledge, 2022. ———. Data Selves: More-than-Human Perspectives. Polity Press, 2019. ———. Digital Health: Critical and Cross-Disciplinary Perspectives. Routledge,

Integrating nursing theory, practice and research through collaborative research

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75657/1/j.1365-2648.1989.tb00912.x.pd

Development of NASA's Sample Cartridge Assembly: Summary of GEDS Design, Development Testing, and Thermal Analyses

NASA's Sample Cartridge Assembly (SCA) project is responsible for designing and validating a payload that contains materials research samples in a sealed environment. The SCA will be heated in the European Space Agency's (ESA) Low Gradient Furnace (LGF) that is housed inside the Material Science Research Rack (MSRR) located on the International Space Station (ISS). The first Principle Investigator (PI) to utilize the SCA will focus on Gravitational Effects on Distortion in Sintering (GEDS) research. This paper will give a summary of the design and development test effort for the GEDS SCA and will discuss the role of thermal analysis in developing test profiles to meet the science and engineering requirements. Lessons learned will be reviewed and salient design features that may differ for each PI will be discussed

Circulating Unmetabolized Folic Acid: Relationship to Folate Status and Effect of Supplementation

There are increasing concerns that exposure to unmetabolized folic acid, which results from folic acid intakes that overwhelm the liver's metabolic capacity, may be associated with adverse effects. In this paper, we examined the folic acid status of women of reproductive age in relation to dietary intake and the effect of folic acid supplementation (1.1 mg or 5 mg). Plasma unmetabolized folic acid was not significantly correlated with folate intake estimated by food frequency questionnaire or biomarkers. The proportion of women with detectable levels of unmetabolized folic acid increased from 65% to 100% after twelve weeks of supplementation (P<0.05); however, the increase in concentrations did not reach statistical significance and the effect was not sustained. Moreover, there were no significant differences between the two doses. This suggests that there are mechanisms by which the body adapts to high folic acid intakes to limit exposure to unmetabolized folic acid

Systematic review of the evidence on orthotic devices for the management of knee instability related to neuromuscular and central nervous system disorders

Objectives To assess the effectiveness of orthotic devices for the management of instability of the knee in adults with a neuromuscular disorder or central nervous system disorder. Design A systematic review of primary studies. Setting Community. Participants Adults with a neuromuscular disorder or central nervous system disorder and impaired walking ability due to instability of the knee. Interventions Orthoses with the clinical aim of controlling knee instability, for example, knee-ankle-foot orthoses, ankle-foot orthoses and knee orthoses or mixed design with no restrictions in design or material. Primary and secondary outcome measures Conditionspecific or generic patient-reported outcome measures assessing function, disability, independence, activities of daily living, quality of life or psychosocial outcomes; pain; walking ability; functional assessments; biomechanical analysis; adverse effects; usage; patient satisfaction and the acceptability of a device; and resource utilisation data. Results Twenty-one studies including 478 patients were included. Orthotic devices were evaluated in patients with postpolio syndrome, poststroke syndrome, inclusion body myositis and spinal cord injury. The review included 2 randomised controlled trials (RCTs), 3 non-randomised controlled studies and 16 case series. Most were small, single-centre studies with only 6 of 21 following patients for 1 year or longer. They met between one and five of nine quality criteria and reported methods and results poorly. They mainly assessed outcomes related to gait analysis and energy consumption with limited use of standardised, validated, patient-reported outcome measures. There was an absence of evidence on outcomes of direct importance to patients such as reduction in pain and falls. Conclusions There is a need for high-quality research, particularly RCTs, of orthotic devices for knee instability related to neuromuscular and central nervous system conditions. This research should address outcomes important to patients. There may also be value in developing a national registr