Mycotoxins are potent fungal toxins that frequently contaminate agricultural crops and foods. Mycotoxin exposure is frequently reported in humans, and children are known to be particularly at risk of exceeding safe levels of exposure. Urinary biomonitoring is used to assess overall dietary exposure to multiple mycotoxins. This study aims to quantify multi-mycotoxin exposure in UK children and to identify major food groups contributing to exposure. Four repeat urine samples were collected from 29 children (13 boys and 16 girls, aged 2.4–6.8 years), and food diaries were recorded to assess their exposure to eleven mycotoxins. Urine samples (n = 114) were hydrolysed with β-glucuronidase, enriched through immunoaffinity columns and analysed by LC-MS/MS for deoxynivalenol (DON), nivalenol (NIV), T-2/HT-2 toxins, zearalenone (ZEN), ochratoxin A (OTA) and aflatoxins. Food diaries were analysed using WinDiet software, and the daily intake of high-risk foods for mycotoxin contamination summarised. The most prevalent mycotoxins found in urine samples were DON (95.6% of all samples), OTA (88.6%), HT-2 toxin (53.5%), ZEN (48.2%) and NIV (26.3%). Intake of total cereal-based foods was strongly positively associated with urinary levels of DON and T-2/HT-2 and oat intake with urinary T-2/HT-2. Average daily mycotoxin excretion ranged from 12.10 µg/d (DON) to 0.03 µg/d (OTA), and co-exposure to three or more mycotoxins was found in 66% of samples. Comparing mycotoxin intake estimates to tolerable daily intakes (TDI) demonstrates frequent TDI exceedances (DON 34.2% of all samples, T-2/HT-2 14.9%, NIV 4.4% and ZEN 5.2%). OTA was frequently detected at low levels. When mean daily OTA intake was compared to the reference value for non-neoplastic lesions, the resulting Margin of Exposure (MoE) of 65 was narrow, indicating a health concern. In conclusion, this study demonstrates frequent exposure of UK children to multiple mycotoxins at levels high enough to pose a health concern if exposure is continuous.

Background: Patients receiving chemotherapy require ongoing symptom monitoring and management to optimize their outcomes. In recent years, digital remote monitoring interventions have emerged to provide enhanced cancer care delivery experiences to patients and clinicians. However, patient and clinician experiential evaluations of these technologies are rare. Therefore, we explored user experiences and perceptions of one such intervention—Advanced Symptom Management System (ASyMS)—after its scaled deployment in the context of the Electronic Symptom Management System Remote Technology (eSMART) trial. The eSMART trial was a large, multicenter randomized controlled trial to evaluate the efficacy of ASyMS in 12 clinical sites in 5 European countries. Objective: In this qualitative study, both patients’ and clinicians’ experiences of using ASyMS for up to 6 cycles of chemotherapy were explored to understand the impact of ASyMS on patients’ experiences, clinical practice, and supportive care delivery. Methods: For this analysis, individual, semistructured, one-to-one interviews with 29 patients with breast, colorectal, and hematological cancers and 18 clinicians from Austria, Greece, Ireland, Norway, and the United Kingdom were conducted. Interviews focused on patients’ and clinicians’ experiences of using ASyMS, care organization and changes in practice following the introduction of ASyMS, perceived changes in care associated with the use of ASyMS, and its potential for future integration into routine chemotherapy care pathways. Results: Thematic analysis identified several themes that describe patients’ and clinicians’ experiences using ASyMS. One central orienting theme—ASyMS as a facilitator of change—was supported by 5 key themes associated with human and technology monitoring: reassurance, enhanced communications and relationships, knowing what is “normal” and what is to be expected, enhancing cancer care experiences, and informing future cancer care. Conclusions: This study is the first to evaluate both patients’ and clinicians’ experiences of using a digital health intervention to remotely monitor chemotherapy symptoms across 5 countries. Experiences with ASyMS were positive from both patients’ and clinicians’ perspectives, although some improvements to support the wider-scale rollout and sustained implementation were identified. Overall, this study demonstrates that real-time remote monitoring systems can help patients feel more reassured during their chemotherapy treatments and can help clinicians provide the right care, at the right time, and in the right place. Trial Registration: ClinicalTrials.gov NCT02356081; https://clinicaltrials.gov/study/NCT02356081 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2016-015016

Background: There is wide variation in antibiotic prescribing across care-homes for older people, with implications for resident outcomes and antimicrobial resistance. Objective: To quantify variation in antibiotic prescribing and associations with resident, care-home and general practice characteristics. Design: Population-based analyses using administrative data. Setting and subjects: 148 care-homes in two Scottish regions, with 6633 residents registered with 139 general practices. Methods: Prescriptions for any antibiotic and for broad-spectrum antibiotics between 1 April 2016 and 31 March 2017 were analysed using cross-classified multilevel negative binomial regression. Results: For any antibiotics, the mean prescription rate was 6.61 (SD 3.06) per 1000 resident bed-days (RBD). In multivariate analysis, prescribing was associated with resident age [incidence rate ratio (IRR) 1.30 [95% confidence interval 1.19 to 1.41] for 90+ versus 7 versus <3.5 samples per 1000 RBD), with residual unexplained variation between care-homes (median IRR 1.29 [1.23 to 1.36]) and general practices (1.11 [1.05 to 1.18]). For broad-spectrum antibiotics, the mean rate was 0.98 (0.92) per 1000 RBD. Broad-spectrum prescribing was also associated with resident age, sex, comorbidity and sampling rate, with larger residual unexplained variation between care-homes (1.56 [1.36 to 1.77]) and general practices (1.51 [1.31 to 1.72]). Conclusion: Variation in prescribing was influenced by resident case-mix, but there is significant unexplained variation between care-homes and between general practices, indicating a need for antibiotic stewardship to target both.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Interest in the application of predictive risk models (PRMs) in healthcare to identify people most likely to experience disease and treatment-related complications is increasing. In cancer care, these techniques are focused primarily on prediction of survival or life-threatening toxicities (e.g. febrile neutropenia). Fewer studies focused on use of PRMs for symptoms or supportive care needs. The application of PRMs to chemotherapy-related symptoms (CRS) would enable earlier identification and initiation of prompt, personalised and tailored interventions. While some PRMs exist for CRS, few were translated into clinical practice and human factors associated with their use were not reported. Objective: Explore patients’ and clinicians’ perspectives of the utility and real-world application of PRMs to improve the management of CRS. Methods: Focus groups (n=10) and interviews (n=5) were conducted with patients (n=28) and clinicians (n=26) across five European countries. Interactions were audio-recorded, transcribed verbatim and analysed thematically. Results: Both clinicians and patients recognized the value of having individualised risk predictions for CRS and appreciated how this type of information would facilitate the provision of tailored preventative treatments and/or supportive care interactions. However cautious and skeptical attitudes towards the use of PRMs in clinical care were noted by both groups particularly in relationship to the uncertainty regarding how the information would be generated. Visualisation and presentation of PRM information in a usable and useful format for both patients and clinicians was identified as a challenge to their successful implementation in clinical care. Conclusions: Findings from this study provide information on clinicians’ and patients’ perspectives on the clinical use of PRMs for the management of CRS. These international perspectives are important because they provide insight into the risks and benefits of using PRMs to evaluate CRS. In addition, they highlight the need to find ways to more effectively present and use this information in clinical practice. Further research that explores the best ways to incorporate this type of information while maintaining the human side of care is warranted. Clinical Trial: This paper reports on a secondary objective from a larger programme of work Trial Registration: Clinical Trials.gov NCT02356081

Limited data exists on the combined nutritional and phytochemical profiles of UK commercially available plant-based foods, limiting comprehensive compositional data available for dietary assessment and food formulation. This study addresses this gap by providing thorough compositional analysis of quinoa (red, black, organic), chia seeds (organic, white), pumpkin seeds (conventional, organic), flaxseeds (brown, golden, organic), and triticale grain (organic, cereal meal, rolled), profiling macronutrients, dietary fiber, amino acids, fatty acids, essential minerals, and bioactive phytochemicals. Pumpkin seeds exhibited the highest protein (29–36%) and fat (42–46%) contents, markedly exceeding quinoa and triticale, highlighting their role as a plant-based protein and energy source. Flaxseeds and chia seeds provided the greatest dietary fiber (15 g/100 g), while mineral analysis identified pumpkin seeds as particularly rich in phosphorus and magnesium, and white chia seeds as a rich source of calcium and iron. Targeted LC-MS/MS and HPLC screening (171 molecules) revealed substantial variation in phytochemical composition among products with red quinoa, golden flaxseed, and white chia seed containing the highest concentrations of quantified phytochemicals (up to 97.2 mg/100 g). These findings provide integrated data on the nutrient and phytochemical composition of selected commercially available products, reinforcing the practical importance of crop diversity for enhancing dietary nutrient and phytochemical diversity and informing future research, food innovation, and dietary assessment initiatives involving plant-based foods.

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