This review evaluates the potential and limitations of nature-based solutions (NbS), including constructed wetlands and soil- and aquifer-based systems, for the attenuation of per- and polyfluoroalkyl substances (PFAS) in water. It aims to identify which removal and attenuation mechanisms operate under environmentally relevant conditions and to assess the extent to which NbS can contribute to sustainable PFAS management. Recent field- and pilot-scale studies show that PFAS attenuation in NbS is governed mainly by sorption and physical retention and depends strongly on chain length, functional group, and system conditions. Long-chain PFAS are often partially retained, whereas short-chain, ultrashort, and ether-PFAS remain highly mobile. Biological processes appear to contribute primarily to precursor transformation rather than complete mineralisation and may, in some cases, increase terminal PFAS concentrations. NbS function primarily as attenuation and buffering systems rather than complete PFAS removal technologies. Their effective application will likely require hybrid treatment trains, long-term monitoring, and compound-specific system design. These findings highlight key priorities for future research and implementation.
This study aimed to identify the Greatest of All Time (GOAT) athlete in running events held at the Olympic Games and World Athletics championships. The achievements of 1294 men and 824 women who won at least one medal in any sprint, hurdles, or distance event at major global championships since 1896, or set a World Record (WR) since 1912, were collated. A scoring system was used to award points, with Olympic gold medals and WRs ranked joint highest. Fewer points were awarded for Olympic silver and bronze medals and for medals in World Championships (outdoor, indoor, and cross-country). Bonus points were awarded for WR longevity and the setting of WRs during Olympic finals. Athletes were also ranked by event and within historical eras. As of March 2026, Usain Bolt (Jamaica) was ranked as the male GOAT, and the highest-scoring woman was Faith Kipyegon (Kenya). Both athletes notably won “doubles” during their careers (over 100/200 m and 1500 m/5000 m, respectively) and set WRs over both distances. Marathon, steeplechase, and hurdle specialists usually competed in one event only. In an earlier era, Paavo Nurmi (Finland) had the highest combined Olympic Games/WR score across a range of distances. Athletes who successfully competed over physiologically and tactically similar events (“doubles”), such as Bolt and Kipyegon, had a greater opportunity to become the GOAT. An increase in global competition since 1972 meant greater opportunities for winning medals, especially for women. This study provides a foundation on which future performances could be evaluated.
OBJECTIVE:To provide an overview of the effects of exercise for osteoarthritis. DESIGN:Overview. DATA SOURCES:Medline, Embase, Epistemonikos, PEDro, Cochrane and registries from inception to 8 November 2025. ELIGIBILITY CRITERIA:Reviews comparing exercise with placebo, no intervention or other interventions on pain and function for osteoarthritis. Supplementary trials were included to update inconclusive areas. DATA EXTRACTION AND SYNTHESIS:Two independent reviewers extracted data and assessed bias. Data were standardised to a 0-100 scale and reanalysed using random-effects meta-analysis. Certainty was rated using Grading of Recommendations Assessment, Development and Evaluation. RESULTS:Five reviews (κ=100; n=8631) and 28 supplementary trials (knee/hip κ=23, hand κ=3, ankle κ=2; n=4360) were included. Evidence indicated small, short-term effects of exercise versus placebo (mean difference -10.8, 95% CI -19.1 to -2.6) and no-treatment (-12.4, 95% CI -15.6 to -9.2) for knee osteoarthritis pain, but certainty was very low and effects in larger or longer-term trials were smaller. Moderate evidence suggested negligible effects in hip (-6.7 95% CI -9.3 to -4.0) and small effects in hand (-10.0 95% CI -15.5 to -4.5) osteoarthritis. Varying certainty evidence indicated comparable outcomes to education, manual therapy, analgesics, injections and arthroscopy. Single trials in selected populations showed exercise was less effective than knee osteotomy (12.4 95% CI 4.7 to 20.2) and joint replacement (knee 17.1 95% CI 10.4 to 23.8; hip 24.2 95% CI 18.2 to 30.2) at longer term. CONCLUSION AND RELEVANCE:Evidence on exercise for osteoarthritis remains largely inconclusive, suggesting negligible or short-lasting small effects comparable to, or less effective than, other treatments. These findings question its universal promotion and highlight the need to revisit research priorities and clinical discussions around its worthwhileness. REGISTRATION:CRD42023446888.
Objective Clinical relevance is an umbrella term that encompasses methods used to determine thresholds of relevant effects from the perspectives of patients, clinicians, and/or researchers. However, what represents a clinically relevant effect remains contentious. We provide an overview of current challenges and potential solutions for defining and interpreting the clinical relevance of between-group differences in osteoarthritis (OA) trials. Design Narrative review. Results We review common methods used to determine thresholds of clinical relevance and outline their limitations in interpreting between-group differences in OA trials. As a conceptually more appropriate method, we suggest considering the “smallest worthwhile effect” (SWE): the smallest beneficial effect of a treatment in comparison to another that justifies its costs, risks, and inconveniences. It incorporates all proposed necessary features of clinical relevance: the patients’ perspectives, consideration of intervention-specific characteristics, and a focus on outcome-specific between-group differences. We summarize the results of existing studies estimating the SWE, illustrate its potential for re-interpreting trials and meta-analyses in the field, and outline directions for future research and application of the SWE concept. Conclusion Commonly used methods to determine clinical relevance are conceptually and methodologically limited to interpret between-group differences in trials of patients with OA. To advance the field, we propose greater development and consideration of the SWE, given its conceptual advantages. While promising, the SWE is a multi-domain construct that can be challenging to apply and interpret. Therefore, further methodological work, empirical research in OA populations, and careful application are needed to ensure its proper implementation in OA trials.
Die heterogene Verwendung von Begriffen mit Bezug zur interprofessionellen Zusammenarbeit im Gesundheitswesen ist ein wiederkehrendes Thema und damit Anlass für eine vertiefte Begriffsanalyse. Ziel ist es, die definitorischen Merkmale und Charakteristika der Begriffe Kollaboration, Kooperation, Koordination, Netzwerk- und Teamarbeit in einem interprofessionellen Kontext zu analysieren und Gemeinsamkeiten und Abgrenzungen zwischen den Begriffen zu identifizieren. Im Zeitraum von 2000–2020 erfolgte eine umfassende Literaturrecherche in den Datenbanken PubMed, CINAHL, Livivo, Psyndex, PsycINFO. Im nächsten Schritt wurde eine thematische Analyse vorgenommen, um definitorische Merkmale und Charakteristika aus den eingeschlossenen Artikeln herauszuarbeiten und in regelmäßigen Analysesitzungen zu diskutieren. Anschließend wurden Gemeinsamkeiten und Unterschiede der Begrifflichkeiten auf Grundlage des Input-Prozess-Output-Modells zugeordnet. Nach der Recherche und Prüfung der Volltexte auf Eignung wurden 118 Artikel in die thematische Analyse eingeschlossen. Dabei zeigt sich, dass die Begriffe unterschiedlich verwendet werden. Auffällig ist insbesondere, dass die Begriffe Kollaboration, Kooperation und Teamarbeit in den eingeschlossenen Artikeln nahezu inflationär genannt werden. In der Folge wird ihre begriffliche Trennschärfe deutlich reduziert, sodass eine klare Abgrenzung zwischen diesen Begriffen kaum möglich ist. Die systematische Zuordnung der jeweiligen Charakteristika anhand des Input-Prozess-Output-Modells (IPO-Modell) erlaubt es jedoch, Gemeinsamkeiten und Unterschiede der Begriffe strukturiert herauszuarbeiten. Insgesamt werden die analysierten Begrifflichkeiten kaum trennscharf verwendet. Einheitliche Formulierungen und Definitionen sind jedoch zentral in der interprofessionellen Ausbildung der Gesundheitsberufe, beispielsweise auf der Ebene von Kompetenzbeschreibungen. Im Rahmen weiterer Forschungsarbeiten ist eine Operationalisierung der Begrifflichkeiten anzustreben.
