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BackgroundSelf-management is endorsed in clinical practice guidelines for the care of musculoskeletal pain. In a randomized clinical trial, we tested the effectiveness of an artificial intelligence–based self-management app (selfBACK) as an adjunct to usual care for patients with low back and neck pain referred to specialist care. ObjectiveThis study is a process evaluation aiming to explore patients’ engagement and experiences with the selfBACK app and specialist health care practitioners’ views on adopting digital self-management tools in their clinical practice. MethodsApp usage analytics in the first 12 weeks were used to explore patients’ engagement with the SELFBACK app. Among the 99 patients allocated to the SELFBACK interventions, a purposive sample of 11 patients (aged 27-75 years, 8 female) was selected for semistructured individual interviews based on app usage. Two focus group interviews were conducted with specialist health care practitioners (n=9). Interviews were analyzed using thematic analysis. ResultsNearly one-third of patients never accessed the app, and one-third were low users. Three themes were identified from interviews with patients and health care practitioners: (1) overall impression of the app, where patients discussed the interface and content of the app, reported on usability issues, and described their app usage; (2) perceived value of the app, where patients and health care practitioners described the primary value of the app and its potential to supplement usual care; and (3) suggestions for future use, where patients and health care practitioners addressed aspects they believed would determine acceptance. ConclusionsAlthough the app’s uptake was relatively low, both patients and health care practitioners had a positive opinion about adopting an app-based self-management intervention for low back and neck pain as an add-on to usual care. Both described that the app could reassure patients by providing trustworthy information, thus empowering them to take actions on their own. Factors influencing app acceptance and engagement, such as content relevance, tailoring, trust, and usability properties, were identified. Trial RegistrationClinicalTrials.gov NCT04463043; https://clinicaltrials.gov/study/NCT04463043

The complex sorption mechanisms of carbon adsorbents for the diverse group of persistent, mobile, and potentially toxic contaminants (PMs or PMTs) present significant challenges in understanding and predicting adsorption behavior. While the development of quantitative predictive tools for adsorbent design often relies on extensive training data, there is a notable lack of experimental sorption data for PMs accompanied by detailed sorbent characterization. Rather than focusing on predictive tool development, this study aims to elucidate the underlying mechanisms of sorption by applying data analysis methods to a high-quality dataset. This dataset includes more than 60 isotherms for 22 PM candidates and well-characterized high-surface-area activated carbon (AC) materials. We demonstrate how tools such as distance correlation and clustering can be used effectively to identify the key parameters driving the sorption process. Using these approaches, we found that aromaticity, followed by hydrophobicity, are key sorbate descriptors for sorption, overshadowing steric and charge effects for a given sorbent. Aromatic PMs, although classified as mobile contaminants based on their sorption to soil, are well adsorbed by AC as engineered adsorbent via π-π interactions. Non-aromatic and especially anionic compounds show much greater variability in sorption. The influence of ionic strength and natural organic matter on adsorption was considered. Our approach will help in the analysis of solute-sorption systems and in the development of new adsorbents beyond the specific examples presented here. In order to make the approach accessible, the code is freely available and described on GitHub (https://github.com/Laura-Lotteraner/PM-Sorption), following the FAIR data principles., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Through the application of C-CF 3 -containing plant protection products (PPP) in agriculture, a substantial quantity of trifluoroacetate (TFA) can be formed and emitted. We here present estimations of TFA formation potentials from PPP across three important economical regions, namely Europe, the United States of America and China. PPP with TFA formation potential vary in type and use profile across those regions, but can be found throughout, with the estimated maximum TFA emissions ranging from 0 to 83 kg/km 2 per year. Therein, some PPP are only used for specific crops in specific regions, while others are used more widely. The importance of PPP as a TFA source is supported by the field data from a region in Germany, which revealed a significant increase in TFA groundwater concentrations with agriculture compared to other land uses. Substance-specific TFA formation rates and field studies are necessary to characterize the formation of TFA from precursors under environmental conditions and to rank and prioritize PPP of concern for potential (regulatory) action., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

When chemical pollutants enter the environment, they can undergo diverse transformation processes, forming a wide range of transformation products (TPs), some of them benign and others more harmful than their precursors. To date, the majority of TPs remain largely unrecognized and unregulated, particularly as TPs are generally not part of routine chemical risk or hazard assessment. Since many TPs formed from oxidative processes are more polar than their precursors, they may be especially relevant in the context of persistent, mobile, and toxic (PMT) and very persistent and very mobile (vPvM) substances, which are two new hazard classes that have recently been established on a European level. We highlight herein that as a result, TPs deserve more attention in research, chemicals regulation, and chemicals management. This perspective summarizes the main challenges preventing a better integration of TPs in these areas: (1) the lack of reliable high-throughput TP identification methods, (2) uncertainties in TP prediction, (3) inadequately considered TP formation during (advanced) water treatment, and (4) insufficient integration and harmonization of TPs in most regulatory frameworks. A way forward to tackle these challenges and integrate TPs into chemical management is proposed.

Pollution by chemicals and waste impacts human and ecosystem health on regional, national, and global scales, resulting, together with climate change and biodiversity loss, in a triple planetary crisis. Consequently, in 2022, countries agreed to establish an intergovernmental science-policy panel (SPP) on chemicals, waste, and pollution prevention, complementary to the existing intergovernmental science-policy bodies on climate change and biodiversity. To ensure the SPP's success, it is imperative to protect it from conflicts of interest (COI). Here, we (i) define and review the implications of COI, and its relevance for the management of chemicals, waste, and pollution; (ii) summarize established tactics to manufacture doubt in favor of vested interests, i.e., to counter scientific evidence and/or to promote misleading narratives favorable to financial interests; and (iii) illustrate these with selected examples. This analysis leads to a review of arguments for and against chemical industry representation in the SPP's work. We further (iv) rebut an assertion voiced by some that the chemical industry should be directly involved in the panel's work because it possesses data on chemicals essential for the panel's activities. Finally, (v) we present steps that should be taken to prevent the detrimental impacts of COI in the work of the SPP. In particular, we propose to include an independent auditor's role in the SPP to ensure that participation and processes follow clear COI rules. Among others, the auditor should evaluate the content of the assessments produced to ensure unbiased representation of information that underpins the SPP's activities.

Access to a clean and healthy environment is a human right and a prerequisite for maintaining a sustainable ecosystem. Experts across domains along the chemical life cycle have traditionally operated in isolation, leading to limited connectivity between upstream chemical innovation to downstream development of water-treatment technologies. This fragmented and historically reactive approach to managing emerging contaminants has resulted in significant externalized societal costs. Herein, we propose an integrated data-driven framework to foster proactive action across domains to effectively address chemical water pollution. By implementing this integrated framework, it will not only enhance the capabilities of experts in their respective fields but also create opportunities for novel approaches that yield co-benefits across multiple domains. To successfully operationalize the integrated framework, several concerted efforts are warranted, including adopting open and FAIR (findable, accessible, interoperable, and reusable) data practices, developing common knowledge bases/platforms, and staying vigilant against new substance "properties" of concern., Competing Interests: DECLARATION OF INTERESTS The authors declare no competing interests.

The objective of this study was to investigate the transport behavior of two organic and persistent contaminants (alachlor and pentachlorobenzene) on Danube alluvial sediment in the absence and in the presence of microbially inoculated biochar produced at 400 °C and three hydrochars produced at 180, 200, and 220 °C. Stainless steel columns were used for the sorption experiments in nonequilibrium conditions. Obtained results were modeled using the advective-dispersive equation under nonequilibrium conditions. Transport of these compounds through the alluvial sediment column showed that the retention time increased with increasing molecular hydrophobicity. Inoculated biochar increases the retardation of both compounds: twofold for pentachlorobenzene compared with alachlor as a consequence of a higher hydrophobicity. Obtained results indicate that the highest biodegradation coefficient was observed for pentachlorobenzene (λ = 10) in alluvial sediment with addition of an inoculated hydrochar, which is assumed to be a consequence of biosorption. Moreover, all experiments on the columns indicate that the addition of inoculated chars yields a significantly higher R d coefficient for pentachlorobenzene than for alachlor. Bacterial counts increased in all of the column experiments, which indicates the successful adaptation of microorganisms to experimental conditions and their potential for the removal of a large number of organic pollutants. Thus, addition of inoculated chars to contaminated sediments has the potential as a remediation technique to inhibit the leaching of pollutants to groundwaters. Integr Environ Assess Manag 2023;19:933-942. © 2022 SETAC., (© 2022 SETAC.)

Persistent, Mobile, and Toxic (PMT) and very persistent and very mobile (vPvM) substances are a growing threat to water security and safety. Many of these substances are distinctively different from other more traditional contaminants in terms of their charge, polarity, and aromaticity. This results in distinctively different sorption affinities towards traditional sorbents such as activated carbon. Additionally, an increasing awareness on the environmental impact and carbon footprint of sorption technologies puts some of the more energy-intensive practices in water treatment into question. Commonly used approaches may thus need to be readjusted to become fit for purpose to remove some of the more challenging PMT and vPvM substances, including for example short chained per- and polyfluoroalkyl substances (PFAS). We here critically review the interactions that drive sorption of organic compounds to activated carbon and related sorbent materials and identify opportunities and limitations of tailoring activated carbon for PMT and vPvM removal. Other less traditional sorbent materials, including ion exchange resins, modified cyclodextrins, zeolites and metal-organic frameworks are then discussed for potential alternative or complementary use in water treatment scenarios. Sorbent regeneration approaches are evaluated in terms of their potential, considering reusability, potential for on-site regeneration, and potential for local production. In this context, we also discuss the benefits of coupling sorption to destructive technologies or to other separation technologies. Finally, we sketch out possible future trends in the evolution of sorption technologies for PMT and vPvM removal from water., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Purpose: Accumulating evidence from epidemiological studies that pediatric computed tomography (CT) examinations can be associated with a small but non-zero excess risk for developing leukemia or brain tumor highlights the need to optimize doses of pediatric CT procedures. Mandatory dose reference levels (DRL) can support reduction of collective dose from CT imaging. Regular surveys of applied dose-related parameters are instrumental to decide when technological advances and optimized protocol design allow lower doses without sacrificing image quality. Our aim was to collect dosimetric data to support adapting current DRL to changing clinical practice., Method: Dosimetric data and technical scan parameters from common pediatric CT examinations were retrospectively collected directly from Picture Archiving and Communication Systems (PACS), Dose Management Systems (DMS), and Radiological Information Systems (RIS)., Results: We collected data from 17 institutions on 7746 CT series from the years 2016 to 2018 from examinations of the head, thorax, abdomen, cervical spine, temporal bone, paranasal sinuses and knee in patients below 18 years of age. Most of the age-stratified parameter distributions were lower than distributions from previously-analyzed data from before 2010. Most of the third quartiles were lower than German DRL at the time of the survey., Conclusions: Directly interfacing PACS, DMS, and RIS installations allows large-scale data collection but relies on high data-quality at the documentation stage. Data should be validated by expert knowledge or guided questionnaires. Observed clinical practice in pediatric CT imaging suggests lowering some DRL in Germany is reasonable., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Climate change, biodiversity loss, and chemical pollution are planetary-scale emergencies requiring urgent mitigation actions. As these "triple crises" are deeply interlinked, they need to be tackled in an integrative manner. However, while climate change and biodiversity are often studied together, chemical pollution as a global change factor contributing to worldwide biodiversity loss has received much less attention in biodiversity research so far. Here, we review evidence showing that the multifaceted effects of anthropogenic chemicals in the environment are posing a growing threat to biodiversity and ecosystems. Therefore, failure to account for pollution effects may significantly undermine the success of biodiversity protection efforts. We argue that progress in understanding and counteracting the negative impact of chemical pollution on biodiversity requires collective efforts of scientists from different disciplines, including but not limited to ecology, ecotoxicology, and environmental chemistry. Importantly, recent developments in these fields have now enabled comprehensive studies that could efficiently address the manifold interactions between chemicals and ecosystems. Based on their experience with intricate studies of biodiversity, ecologists are well equipped to embrace the additional challenge of chemical complexity through interdisciplinary collaborations. This offers a unique opportunity to jointly advance a seminal frontier in pollution ecology and facilitate the development of innovative solutions for environmental protection., (© 2023 The Authors. Global Change Biology published by John Wiley & Sons Ltd.)

Remediation of residually contaminated soils remains a widespread problem. Biochar can immobilize polycyclic aromatic hydrocarbons (PAH). However, studies on its ability to immobilize PAH and N, S, and O substituted PAH (hetero-PAH) in real soils, and benchmarking with commercial activated carbon are missing. Here, we compared the ability of pristine biochar (BC), steam-activated biochar (SABC), and commercial activated carbon (AC) to immobilize PAH and hetero-PAH. The three carbons were tested on soils from four different contaminated sites in Austria. Different amendment rates (w/w) of the carbons were investigated (BC: 1.0, 2.5, and 5%; SABC: 0.5, 1.0, and 2.0%; AC: 1%) in batch experiments to cover meaningful ranges in relation to their performance. SABC performed better than AC, removing at least 80% PAH with the lowest application rate of 0.5%, and achieving a complete removal at an application rate of 1.0%. BC performed slightly worse but still acceptable in residually contaminated soils (40 and 100% removal at 1 and 5% amendment, respectively). The ability of BC and SABC to immobilize PAH decreased as the PAH-molar volume increased. PAH with three or more rings were preferentially removed by AC compared to SABC or BC. This can be explained by the difference in pore size distribution of the carbons which could limit the accessibility of PAH and hetero-PAH to reach sorption sites for π- π electron donor-acceptor interactions, which drive PAH and hetero-PAH sorption to carbons. Column percolation tests confirmed the results obtained in batch tests, indicating, that decisions for soil remediation can be derived from simpler batch experiments. In soil samples with 1% BC, a reduction of over 90% in the total concentration of PAH in the leached water was observed. Overall, BC and SABC were demonstrated to be valid substitutes for AC for stabilizing residually contaminated soils., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

In Europe alone, >200 million m 3 of river sediments are dredged each year, part of which are contaminated to such an extent that they have to be landfilled. This study compares the use of biochar and hydrochar for the remediation of sediment contaminated with pentachlorobenzene, hexachlorobenzene, lindane, trifluralin, alachlor, simazine, and atrazine with the motivation to make sediments contaminated by such priority substances usable as arable land for growing energy crops. Biochar and hydrochar originating from Miscanthus giganteus and Beta vulgaris shreds were compared for their potential to reduce contaminant associated risk in sediments. Specifically, by investigating the effects of sorbent amendment rate (1, 5, and 10 %) and incubation time (14, 30, and 180 d) on contaminant bioaccessibility, toxicity to the bacteria Vibrio fischeri, as well as toxicity and plant uptake in Zea mays. Biochar reduced contaminant bioaccessibility up to five times more than hydrochar. The bioaccessibility of contaminants decreased up to sevenfold with increasing incubation time, indicating that the performance of carbonaceous sorbents may be underestimated in short-term lab experiments. Biochar reduced contaminants toxicity to Vibrio fischeri, whereas hydrochar was itself toxic to the bacteria. Toxicity to Zea mays was determined by contaminant bioaccessibility but also sorbent feedstock with cellulose rich Beta vulgaris based sorbents exhibiting toxic effects. The plant uptake of all contaminants decreased after sorbent amendment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Biochars can remove potentially toxic elements, such as inorganic mercury [Hg(II)] from contaminated waters. However, their performance in complex water matrices is rarely investigated, and the combined roles of natural organic matter (NOM) and ionic composition in the removal of Hg(II) by biochar remain unclear. Here, we investigate the influence of NOM and major ions such as chloride (Cl - ), nitrate (NO 3 - ), calcium (Ca 2+ ), and sodium (Na + ) on Hg(II) removal by a wood-based biochar (SWP700). Multiple sorption sites containing sulfur (S) were located within the porous SWP700. In the absence of NOM, Hg(II) removal was driven by these sites. Ca 2+ bridging was important in enhancing removal of negatively charged Hg(II)-chloro complexes. In the presence of NOM, formation of soluble Hg-NOM complexes (as seen from speciation calculations), which have limited access to biochar pores, suppressed Hg(II) removal, but Cl - and Ca 2+ could still facilitate it. The ability of Ca 2+ to aggregate NOM, including Hg-NOM complexes, promoted Hg(II) removal from the dissolved fraction (<0.45 μm). Hg(II) removal in the presence of Cl - followed a stepwise mechanism. Weakly bound oxygen functional groups in NOM were outcompeted by Cl - , forming smaller-sized Hg(II)-chloro complexes, which could access additional intraparticle sorption sites. Therein, Cl - was outcompeted by S, which finally immobilized Hg(II) in SWP700 as confirmed by extended X-ray absorption fine structure spectroscopy. We conclude that in NOM containing oxic waters, with relatively high molar ratios of Cl - : NOM and Ca 2+ : NOM, Hg(II) removal can still be effective with SWP700.

Permanently charged and ionizable organic compounds (IOC) are a large and diverse group of compounds belonging to many contaminant classes, including pharmaceuticals, pesticides, industrial chemicals, and natural toxins. Sorption and mobility of IOCs are distinctively different from those of neutral compounds. Due to electrostatic interactions with natural sorbents, existing concepts for describing neutral organic contaminant sorption, and by extension mobility, are inadequate for IOC. Predictive models developed for neutral compounds are based on octanol-water partitioning of compounds ( K ow ) and organic-carbon content of soil/sediment, which is used to normalize sorption measurements ( K OC ). We revisit those concepts and their translation to IOC ( D ow and D OC ) and discuss compound and soil properties determining sorption of IOC under water saturated conditions. Highlighting possible complementary and/or alternative approaches to better assess IOC mobility, we discuss implications on their regulation and risk assessment. The development of better models for IOC mobility needs consistent and reliable sorption measurements at well-defined chemical conditions in natural porewater, better IOC-, as well as sorbent characterization. Such models should be complemented by monitoring data from the natural environment. The state of knowledge presented here may guide urgently needed future investigations in this field for researchers, engineers, and regulators.