Bidirectional multiciliated cell extrusion is controlled by Notch-driven basal extrusion and Piezo1-driven apical extrusion.

Xenopus embryos are covered with a complex epithelium containing numerous multiciliated cells (MCCs). During late-stage development, there is a dramatic remodeling of the epithelium that involves the complete loss of MCCs. Cell extrusion is a well-characterized process for driving cell loss while maintaining epithelial barrier function. Normal cell extrusion is typically unidirectional, whereas bidirectional extrusion is often associated with disease (e.g. cancer). We describe two distinct mechanisms for MCC extrusion, a basal extrusion driven by Notch signaling and an apical extrusion driven by Piezo1. Early in the process there is a strong bias towards basal extrusion, but as development continues there is a shift towards apical extrusion. Importantly, response to the Notch signal is age dependent and governed by the maintenance of the MCC transcriptional program such that extension of this program is protective against cell loss. In contrast, later apical extrusion is regulated by Piezo1, such that premature activation of Piezo1 leads to early extrusion while blocking Piezo1 leads to MCC maintenance. Distinct mechanisms for MCC loss underlie the importance of their removal during epithelial remodeling.

A global analysis of One Health Networks and the proliferation of One Health collaborations.

There has been a renewed focus on threats to the human-animal-environment interface as a result of the COVID-19 pandemic, and investments in One Health collaborations are expected to increase. Efforts to monitor the development of One Health Networks (OHNs) are essential to avoid duplication or misalignment of investments. This Series paper shows the global distribution of existing OHNs and assesses their collective characteristics to identify potential deficits in the ways OHNs have formed and to help increase the effectiveness of investments. We searched PubMed, Google, Google Scholar, and relevant conference websites for potential OHNs and identified 184 worldwide for further analysis. We developed four case studies to show important findings from our research and exemplify best practices in One Health operationalisation. Our findings show that, although more OHNs were formed in the past 10 years than in the preceding decade, investment in OHNs has not been equitably distributed; more OHNs are formed and headquartered in Europe than in any other region, and emerging infections and novel pathogens were the priority focus area for most OHNs, with fewer OHNs focusing on other important hazards and pressing threats to health security. We found substantial deficits in the OHNs collaboration model regarding the diversity of stakeholder and sector representation, which we argue impedes effective and equitable OHN formation and contributes to other imbalances in OHN distribution and priorities. These findings are supported by previous evidence that shows the skewed investment in One Health thus far. The increased attention to One Health after the COVID-19 pandemic is an opportunity to focus efforts and resources to areas that need them most. Analyses, such as this Series paper, should be used to establish databases and repositories of OHNs worldwide. Increased attention should then be given to understanding existing resource allocation and distribution patterns, establish more egalitarian networks that encompass the breadth of One Health issues, and serve communities most affected by emerging, re-emerging, or endemic threats at the human-animal-environment interface.

Discrimination, disadvantage and disempowerment during COVID-19: a qualitative intrasectional analysis of the lived experiences of an ethnically diverse healthcare workforce in the United Kingdom.

BACKGROUND: Healthcare workers (HCWs) in the United Kingdom (UK) have faced many challenges during the COVID-19 pandemic, some of these arising out of their social positions. Existing literature explicating these challenges (e.g., lack of appropriate PPE, redeployment, understaffing) have highlighted inequities in how these have been experienced by HCWs based on ethnicity, gender or, job role. In this paper, we move a step ahead and examine how the intersection of these social positions have impacted HCWs' experiences of challenges during the pandemic. METHODS: We collected qualitative data, using interviews and focus groups, from 164 HCWs from different ethnicities, gender, job roles, migration statuses, and regions in the United Kingdom (UK) between December 2020 and July 2021. Interviews and focus groups were conducted online or by telephone, and recorded with participants' permission. Recordings were transcribed and a hybrid thematic analytical approach integrating inductive data-driven codes with deductive ones informed by an intersectional framework was adopted to analyse the transcripts. RESULTS: Thematic analysis of transcripts identified disempowerment, disadvantage and, discrimination as the three main themes around which HCWs' experiences of challenges were centred, based on their intersecting identities (e.g., ethnicity gender, and/or migration status). Our analysis also acknowledges that disadvantages faced by HCWs were linked to systemic and structural factors at the micro, meso and macro ecosystemic levels. This merging of analysis which is grounded in intersectionality and considers the ecosystemic levels has been termed as 'intrasectionalism'. DISCUSSION: Our research demonstrates how an intrasectional lens can help better understand how different forms of mutually reinforcing inequities exist at all levels within the healthcare workforce and how these impact HCWs from certain backgrounds who face greater disadvantage, discrimination and disempowerment, particularly during times of crisis like the COVID-19 pandemic.

Assessment of physical activity and its facilitators and barriers among Syrian refugees living in Amman City, Jordan: a cross-sectional study.

BACKGROUND: Physical inactivity is one of the major risk factors for non-communicable diseases. Few studies about physical activity have been conducted among refugees from neighbouring countries. Given changes in the situation of Syrians, assessment of physical activity among Syrian refugees is required to understand their situation. This study aimed to evaluate the degree of self-reported physical activity and to identify perceived facilitators of and barriers to physical activity among Syrian refugees living in Amman, Jordan, in 2017. METHODS: This community-based cross-sectional study was conducted using a structured questionnaire and the short form of the International Physical Activity Questionnaire. Participants were eligible for the study if they were Syrian refugees aged 18-64 years, living in Amman city, and were either registered with the United Nations High Commissioner for Refugees, waiting for their registration, or had a service card issued by the Jordanian Ministry of Interior. The relationship between physical activity level and sex was assessed using the chi-square test and Cochran-Armitage tests. The Mann-Whitney U test was performed to assess the relationship between the median metabolic equivalent scores of physical activity and gender. Backward stepwise logistic regression analysis was used to analyse the association between predictors of physical inactivity and physical activity level. RESULTS: Among the 173 participants, the majority (91.9%) reported moderate to a high level of physical activity, and 8.1% were physically inactive. The metabolic equivalent scores for the walking activity of males (median: 1039.5, IQR: 0, 2772) was significantly higher than that of females (median: 396, IQR: 0, 1188) (p < 0.01). "Perceived change in the amount of physical activity" was a significant predictor of physical inactivity (adjusted OR = 3.00; 95%CI: 1.27-7.26). Common facilitators of physical activity were "psychological wellbeing"(49.7%) and "prevent diseases"(46.8%). The greatest barriers to physical activity were "time limitation"(43.4%) and "high cost"(57.8%). CONCLUSION: This study revealed the physical activity level among Syrian refugees in Amman. The perceived facilitators and barriers to physical activity identified among Syrian refugees were similar to those in previous studies conducted among non-refugees. These results provide a valuable baseline for future examinations of physical activity level and to verify its possible facilitators and barriers.

Amlodipine as adjuvant therapy to current chelating agents for reducing iron overload in thalassaemia major: a systematic review, meta-analysis and simulation of future studies.

BACKGROUND AND OBJECTIVES: Iron overload in thalassaemia is a crucial prognostic factor and a major cause of death due to heart failure or arrhythmia. Therefore, previous research has recommended amlodipine as an auxiliary treatment to current chelating agents for reducing iron overload in thalassaemia patients. MATERIALS AND METHODS: A systematic review and meta-analysis of the results of three randomized clinical trials evaluating the use of amlodipine in thalassaemia patients through 12 databases were carried out. RESULTS: Our final cohort included 130 patients. Insignificant difference in decreasing liver iron concentrations was found between amlodipine and control groups {weighted mean difference = -0·2, [95% confidence interval = (-0·55-0·15), P = 0·26]}. As regards serum ferritin, our analysis also showed no significant difference in serum ferritin between amlodipine and control groups {weighted mean difference [95% confidence interval = -0·16 (-0·51-0·19), P = 0·36]}. Similarly, there was insignificant difference in cardiac T2* between amlodipine and control groups {weighted mean difference [95% confidence interval = 0·34 (-0·01-0·69), P = 0·06]}. CONCLUSIONS: Despite the growing evidence supporting the role of amlodipine in reducing iron overload in thalassaemia patients, our meta-analysis did not find that evidence collectively significant. The results of our simulation suggest that when more data are available, a meta-analysis with more randomized clinical trials could provide more conclusive insights.

Primary lymph node sites in Hodgkin lymphoma and the risk of second primary cancers: a population-based study.

Aim: Little is known about the association between specific primary lymph node (LN) sites and the risk of developing second primary cancers in Hodgkin lymphoma (HL) patients. Materials & methods: To fill this knowledge gap, we used the multiple primary standardized incidence ratio function of the SEER*stat program to explore such an association for multiple latency periods. Results: Several SPCs occurred at various time points following different primary LN presentations of HL. Conclusion: HL survivors may benefit from a tailored primary LN site-specific follow-up screening.

Survey on Implementation of One Health Approach for MERS-CoV Preparedness and Control in Gulf Cooperation Council and Middle East Countries.

In 2015, a One Health Working Group was established in Qatar to conduct a survey in the Gulf Cooperation Council countries, Egypt, and Jordan to monitor preparedness of public health and veterinary health authorities in response to the Middle East respiratory syndrome coronavirus epidemic. All but 1 country indicated they established joint One Health policy teams for investigation and response. However, the response to the questionnaires was largely limited to veterinary authorities. Critical barriers and limitations were identified. National and regional leaders, policy makers, and stakeholders should be prompted to advocate and enhance adoption of the One Health framework to mitigate the risk for Middle East respiratory syndrome and other emerging zoonotic diseases.

Assessment of Craniometric Sexual Dimorphism Using Multidetector Computed Tomographic Imaging in a Sample of Egyptian Population.

Sex determination is an initial and essential component of any medicolegal investigations. However, sometimes only cranial remains are available. The objective of this study was to determine sex using 12 craniofacial measurements in multidetector computed tomographic images of 150 Egyptian subjects (80 men and 70 women), with age ranging from 18 to 60 years. The results revealed a significant increase in the mean of all craniofacial measurements in men in comparison with women (P < 0.05). Bizygomatic breadth was the single most discriminant dimorphic parameter with an accuracy of 74%. Multiple discriminant functional analysis for sex prediction showed increased accuracy to 78.7% in all cases. Using multiple stepwise discriminants, functional analysis showed that the most predictive variables selected were maximal cranial breadth, minimal frontal breadth, bizygomatic breadth, orbital height, bimastoidale, and basion-prosthion length, which showed an accuracy of 80%. On the basis of this study, it is concluded that the cranial measurements obtained from multidetector computed tomographic images could be useful for forensic sex determination in Egyptians, especially in cases of skeletal remains.

Effect of wooden floorboards on the vibration of timber floor.

This study is aimed at investigating those parameters related to timber flooring that can affect the acceptability of vibration behaviour of a timber floor in a residential building in view of the criteria stated in Eurocode EC5. The timber floor investigated is made of OSB/3 floorboards and timber joists. The parameters that are investigated in this study are thickness of flooring, floor joist span, joist spacing and connection of floorboards to the joists. In this context, two cases are considered. First: the flooring is nailed or screwed to the joists and no composite action or interaction is obtained between joists and floorboards. Second: the flooring is glued sufficiently to the joists and full interaction is obtained. The result suggests that glued floorboards perform much better with respect to natural frequency, static deflection and peak floor velocity than nailed or screwed floorboards. In almost all cases of glued floorboards, the result complies fully with the Eurocode 5 design vibration requirements. However, as floor lengths increase, the static deflection will increase beyond the allowable limit, especially for relatively thin floor panels and relatively widely spread joists. For both cases, increasing floorboards thickness and decreasing the joist span by adding more beams can yield even better results to satisfy the requirement of vibration comfort.

Effects of dietary inclusion of Moringa oleifera leaf meal on growth performance of Muscovy ducklings (Cairina moschata).

OBJECTIVE: The current experiment was performed to investigate the influence of different dietary levels of Moringa oleifera leaf meal (MOLM) on productive performance, nutrient digestibility, blood parameters, immune response, caecal microbiota, and carcass characteristics of Muscovy ducks (Cairina moschata) during 7 to 63 d of age. METHODS: A total of 240 unsexed 7-d-old ducklings were distributed into five (treatment) groups; each one contained six replicates with eight ducklings each. Birds of the first group were fed basal diet without MOLM and served as control, while the other four groups were fed basal diet with 0.25%, 0.50%, 1.0%, and 2.0% MOLM inclusion level, respectively. RESULTS: The obtained results revealed that including MOLM in the diets significantly improved body weight, body weight gain, feed conversion ratio and economic efficiency compared with the control group. Among the different MOLM inclusion treatments, increasing MOLM inclusion level decreased (p<0.05) such previous parameters. Decreasing MOLM inclusion levels in duckling diets increased (p>0.05) the digestibility of organic matter, crude protein, ether extract, and nitrogen free extract, however all MOLM treatments were significantly higher than the control group. Results also revealed that feeding ducks lower MOLM inclusion levels (0.25% or 0.50%) improved blood parameters (p<0.05) compared with the higher inclusion levels (1.0% or 2.0% MOLM) and the control group. Ducks fed different MOLM levels had significantly higher phagocyte index and activity, immunoglobulin G (IgG), IgM, total antioxidant capacity, glutathione peroxidase activity, and superoxide dismutase activity compared with control group. CONCLUSION: Despite the beneficial effects of all MOLM treatments on growth performance, nutrient digestibility, physiological status, and immune response of duckling, the increasing MOLM inclusion level in the diet had deleterious effects on such studied traits, consequently 0.25% was the best MOLM inclusion level in duckling diets.

Adoption of Electronic Medical Records in Healthcare Facilities in the Emirate of Dubai.

OBJECTIVES: This paper aimed to assess the adoption of electronic medical records (EMRs) in healthcare facilities in Dubai, the largest city in the United Arab Emirates (UAE) and a location where extensive healthcare services are provided. It explored the challenges, milestones, and accomplishments associated with this process. METHODS: A situation analysis was conducted by contacting 2,089 healthcare facilities in Dubai to determine whether they had implemented EMR in their medical practices and to identify the challenges they faced during this process. Additionally, the Electronic Medical Record Adoption Model (EMRAM) was utilized to measure the maturity level of hospitals in terms of EMR adoption. The EMRAM stages were rated on a scale from 0 to 7, with 0 representing the least mature stage and 7 the most mature. RESULTS: By September 2023, all hospitals (100%, n = 54) and 75% of private clinics (n = 1,460) in Dubai had implemented EMRs. Several challenges were identified, including the absence of EMRs within the healthcare facility, having an EMR with a low EMRAM score, or the lack of a unified interoperability standard. Additionally, the absence of a clear licensing program for EMR vendors, whether standalone or cloud-based, was among the other challenges noted. CONCLUSIONS: EMR implementation in healthcare facilities in Dubai is at a mature stage. However, further efforts are required at both the decision-making and technical levels. We believe that our experience can benefit other countries in the region in implementing EMRs and using EMRAM to assess their health information systems.

Improving heating uniformity of pathological tissue specimens inside a domestic microwave oven.

A 3D coupled electromagnetic thermal model was developed using COMSOL 4.0 to predict the electromagnetic field distribution and temperature profile in pathological tissue samples immersed in a reagent inside the oven cavity. The effect of the volume of reagent on the mean heating rate and heating uniformity within the tissue sample was investigated. Also, the effect of using a water load, as a method of temperature control, is emphasized. A well insulated K type thermocouple connected to a PC is used for model validation. Good agreement is found between experimental and simulated temperature profiles. Results show that as the volume of reagent increases, the mean heating rate decreases and temperature homogeneity increases. Also, it is possible to minimize overshooting temperature values inside the tissue sample and enhance tissue uniformity by about 27% using 100 ml of water load and 42.26% using 150 ml. Domestic microwave oven is a low cost economical tool that can speed up tissue processing steps. Achieving uniform heating inside the microwave oven is the key factor for improving workflow inside pathological labs and maintaining tissue quality and integrity.

One Health early warning and response system for zoonotic diseases outbreaks: Emphasis on the involvement of grassroots actors.

BACKGROUND: Emerging and reemerging zoonotic diseases have become a global concern due to their frequent occurrence. Large delays between onset of emerging zoonotic disease outbreaks and their reporting and control are indicative of weak animal and human health systems. OBJECTIVES: The objective of this paper is to tackle the time delay by suggesting a One Health Early Warning and Response System (OH-EWRS) aiming at improving the surveillance and notification of zoonotic diseases by strengthening 'bottom-up' approaches and systems for early detection, especially in hot spot areas where they emerge. METHODS: In this conceptual paper, we searched online database including PubMed, Google and Google Scholar to explore the scientific landscape for zoonotic diseases and One Health Early Warning and Response Systems published in English up to December, 2020. In addition, the authors made use of their own expertise and critically reviewed the retrieved papers that were found to be of relevance as the three authors are experts in their own fields, coming from different backgrounds, but are all working to improve the prevention and control of zoonotic disease outbreak. RESULTS: The OH-EWRS advocates for collaboration between relevant stakeholders including nongovernmental organisations, country offices of international and intergovernmental technical organisations, governmental bodies, research institutes, the private sector and local communities with the aim of an integrated One Health prevention and control system. The OH-EWRS considers various priorities and objectives of the different stakeholders, taking into account possible conflict of interests and considering the need for trust, transparency and mutual benefits. CONCLUSIONS: Although the operationalisation, governance and institutionalisation of the OH-EWRS should be the responsibility of government bodies, inputs from and feedback to relevant stakeholders through a bottom-up and top-down approach are essential elements for the application of the successful operationalisation of a OH-EWRS.

Novel centriolar defects underlie a primary ciliary dyskinesia phenotype in an adenylate kinase 7 deficient ciliated epithelium.

The skin of Xenopus embryos contains numerous multiciliated cells (MCCs), which collectively generate a directed fluid flow across the epithelial surface essential for distributing the overlaying mucous. MCCs develop into highly specialized cells to generate this flow, containing approximately 150 evenly spaced centrioles that give rise to motile cilia. MCC-driven fluid flow can be impaired when ciliary dysfunction occurs, resulting in primary ciliary dyskinesia (PCD) in humans. Mutations in a large number of genes (~50) have been found to be causative to PCD. Recently, studies have linked low levels of Adenylate Kinase 7 (AK7) gene expression to patients with PCD; however, the mechanism for this link remains unclear. Additionally, AK7 mutations have been linked to multiple PCD patients. Adenylate kinases modulate ATP production and consumption, with AK7 explicitly associated with motile cilia. Here we reproduce an AK7 PCD-like phenotype in Xenopus and describe the cellular consequences that occur with manipulation of AK7 levels. We show that AK7 localizes throughout the cilia in a DPY30 domain-dependent manner, suggesting a ciliary function. Additionally, we find that AK7 overexpression increases centriole number, suggesting a role in regulating centriole biogenesis. We find that in AK7-depleted embryos, cilia number, length, and beat frequency are all reduced, which in turn, significantly decreases the tissue-wide mucociliary flow. Additionally, we find a decrease in centriole number and an increase in sub-apical centrioles, implying that AK7 influences both centriole biogenesis and docking, which we propose underlie its defect in ciliogenesis. We propose that AK7 plays a role in PCD by impacting centriole biogenesis and apical docking, ultimately leading to ciliogenesis defects that impair mucociliary clearance.

Bidirectional multiciliated cell extrusion is controlled by Notch driven basal extrusion and Piezo 1 driven apical extrusion.

Xenopus embryos are covered with a complex epithelium containing numerous multiciliated cells (MCCs). During late stage development there is a dramatic remodeling of the epithelium that involves the complete loss of MCCs. Cell extrusion is a well-characterized process for driving cell loss while maintaining epithelial barrier function. Normal cell extrusion is typically unidirectional whereas bidirectional extrusion is often associated with disease (e.g. cancer). We describe two distinct mechanisms for MCC extrusion, a basal extrusion driven by Notch signaling and an apical extrusion driven by Piezo1. Early in the process there is a strong bias towards basal extrusion, but as development continues there is a shift towards apical extrusion. Importantly, receptivity to the Notch signal is age-dependent and governed by the maintenance of the MCC transcriptional program such that extension of this program is protective against cell loss. In contrast, later apical extrusion is regulated by Piezo 1 such that premature activation of Piezo 1 leads to early extrusion while blocking Piezo 1 leads to MCC maintenance. Distinct mechansms for MCC loss underlie the importance of their removal during epithelial remodeling. Summay Statement: Cell extrusion typically occurs unidirectionally. We have identified a single population of multiciliated cells that extrudes bidirectionally: Notch-driven basal extrusion and Piezo 1-mediated apical extrusion.

Blockchain in Healthcare: 2023 Predictions From Around the Globe.

Over the past 50 years, although categorized as the "Information Age" or "Digital Age," the vast amounts of digitized data have been sorely underutilized. Only recently, in response to the COVID-19 pandemic, efforts have accelerated to harness these data using blockchain technology as it pertains to healthcare. Today, through the blockchain infrastructure and its tokenization applications, we are able to leverage healthcare data effectively into more efficient business processes. In addition, we can secure better patient engagement and outcomes, while generating new revenue streams for an array of healthcare stakeholders. It is in the application of blockchain technology to compile these stockpiled data into new, compliant business models that we can reap the full potential of the blockchain. Here are predictions by members of the BHTY editorial board members on how we might further advance the role of blockchain in healthcare in 2023.

Migrants' living conditions, perceived health needs and implications for the use of antibiotics and antimicrobial resistance in the United Kingdom: A qualitative study.

Background and Aims: Antimicrobial resistance (AMR) is among the top public health concerns around the globe. Migrants, especially forced migrants, could be at higher risk of acquiring and transmitting AMR during their journeys or in host countries. There is limited understanding regarding migrants' living conditions and the wider factors contributing to their risk of acquiring infections, and behaviors around antimicrobial use, and AMR development. In this study, we aimed to explore transit experiences, living conditions, and antibiotic use of migrants living in the United Kingdom. Methods: We conducted semistructured qualitative interviews with 27 participants and identified five themes regarding migrants' journey and their living conditions during transit and after arriving in the United Kingdom, their access to water, sanitation and hygiene (WASH), and their use of antibiotics. Results: Migrants, particularly forced migrants, experienced unfavorable living conditions, poor access to WASH, and challenges in accessing healthcare, which further contributed to health conditions like urinary and skin problems. Isolation and difficulty in accessing healthcare played significant roles in migrants' perceived need for storing and using antibiotics as a safety net. Conclusion: The findings highlight the need for coordinated and multilevel interventions to address these challenges and contribute toward tackling AMR and improving the health of this population group.

Unlocking the eHealth professionals' career pathways: A case of Gulf Cooperation Council countries.

BACKGROUND: During the past two decades, various sectors and industries have undergone digital transformation. Healthcare is poised to make a full transformation in the near future. Although steps have been taken toward creating an infrastructure for digital health in the Middle East, as it stands, digital health is still an emerging field here. The current global health care crisis has underscoredthe need for digitization of the healthcare sector to provide high-value, high-quality care and knowledge generation. With the advent of digital transformation in countries around the globe, there is a rising demand for investment and innovation in health information technology. With the demand for health informatics (HI) graduates in different disciplines (e.g., healthcare professions, information technology, etc.), there is an urgent need to determine and regulate clear career pathways and the core competencies necessary for digital health professional to practice effectively and to allow technology to add value to the healthcare systems. Given the changing landscape of the profession, the Kingdom of Saudi Arabia (KSA) and the Gulf Cooperation Council (GCC) countries are experiencing a rising demand to produce digital health professionals who can meet the needs of all the stakeholders involved, including patients, healthcare professionals, managers, and policymakers. However, despite the number of region-wide initiatives in the form of training programs, there remains a knowledge-practice gap and unclear job roles within the HI community. In recent years, regional digital health workforce initiatives have been put forward, such as the GCC Taskforce on Workforce Development in Digital Healthcare. The taskforce initiated a survey and several workshops to identify and classify HI disciplines according to the needs of the job market and through comparisons with similar efforts developed across the globe, such as the TIGER project and the EU*US eHealth Work project. Digital health implementation has been flourishing in the Middle East for the past 15 years. During this period, while digital health professions have been thriving in the industry to deliver tools and technologies, academic institutions have offered some amount of training and education in digital health; however, the career pathway for digital health professionals is not clear due to mismatch about the qualifications, skills, competencies and experience needed by the healthcare industry. OBJECTIVES: Due to this discrepancy between the academic curriculum and the skills needed in the healthcare industry, the objectives of this study are to define the career pathway for eHealth professions and identify the challenges experienced by academic institutions and the industry in describing digital health professionals. METHODS: We elicited qualitative data by conducting six focus groups with individuals from different professional backgrounds, including healthcare workers, information managers, computer sciences professionals, and workers in the revenue cycle who participated in a workshop on November 2-3, 2019, in Dubai. All focus group sessions were audio-recorded and transcribed, and participants were de-identified before analysis. An exploratory method was used to identify themes and subthemes. Saturation was reached when similar responses were found during the analysis. In this study, we found that respondents clearly defined eHealth career pathways based on criteria that included qualifications, experience, job scope, and competency. We also explored the challenges that the respondents encountered, including differences in the required skill sets and training and the need to standardize the academic curriculum across the GCC region, to recognize the various career pathways, and to develop local training programs. Additionally, country-specific projects have been initiated, such as the competency-based Digital Health framework, which was developed by the Saudi Commission of Healthcare Specialties (SCFHS) in 2018. Competency-based digital health frameworks generally include relevant job definitions, roles, and recommended competencies. Both the GCC taskforce and the Saudi studies capitalized on previous efforts by professional organizations, including Canada's Digital Health formerly known as (COACH), the U.S. Office of the National Coordinator for Health Information Technology (ONC), the American Medical Informatics Association (AMIA), and the Health Information and Management Systems Society (HIMSS). RESULTS: In this study, we found that respondents defined eHealth career pathways based on different criteria such as: qualifications; various background of health and IT in the HI field; work experiences; job scope and competency. We also further explore the challenges that the respondents encountered which delineates four key aspects such as need of hybrid skills to manage the digital transformation, need of standardization of academic curriculum across GCC, recognition of the career pathways by the industry in order to open up career opportunity and career advancement, and availability of local training programs for up-skilling the current health workforce. CONCLUSION: We believe that successful health digital transformation is not limited to technology advancement but requires an adaptive change in: the related competency-based frameworks, the organisation of work and career paths for eHealth professionals, and the development of educational programmes and joint degrees to equip clinicians with understanding of technology, and informaticians with understanding of healthcare. We anticipate that this work will be expanded and adopted by relevant professional and scientific bodies in the GCC region.

Exploring Healthy Retinal Aging with Deep Learning.

Purpose: To study the individual course of retinal changes caused by healthy aging using deep learning. Design: Retrospective analysis of a large data set of retinal OCT images. Participants: A total of 85 709 adults between the age of 40 and 75 years of whom OCT images were acquired in the scope of the UK Biobank population study. Methods: We created a counterfactual generative adversarial network (GAN), a type of neural network that learns from cross-sectional, retrospective data. It then synthesizes high-resolution counterfactual OCT images and longitudinal time series. These counterfactuals allow visualization and analysis of hypothetical scenarios in which certain characteristics of the imaged subject, such as age or sex, are altered, whereas other attributes, crucially the subject's identity and image acquisition settings, remain fixed. Main Outcome Measures: Using our counterfactual GAN, we investigated subject-specific changes in the retinal layer structure as a function of age and sex. In particular, we measured changes in the retinal nerve fiber layer (RNFL), combined ganglion cell layer plus inner plexiform layer (GCIPL), inner nuclear layer to the inner boundary of the retinal pigment epithelium (INL-RPE), and retinal pigment epithelium (RPE). Results: Our counterfactual GAN is able to smoothly visualize the individual course of retinal aging. Across all counterfactual images, the RNFL, GCIPL, INL-RPE, and RPE changed by -0.1 µm ± 0.1 µm, -0.5 µm ± 0.2 µm, -0.2 µm ± 0.1 µm, and 0.1 µm ± 0.1 µm, respectively, per decade of age. These results agree well with previous studies based on the same cohort from the UK Biobank population study. Beyond population-wide average measures, our counterfactual GAN allows us to explore whether the retinal layers of a given eye will increase in thickness, decrease in thickness, or stagnate as a subject ages. Conclusion: This study demonstrates how counterfactual GANs can aid research into retinal aging by generating high-resolution, high-fidelity OCT images, and longitudinal time series. Ultimately, we envision that they will enable clinical experts to derive and explore hypotheses for potential imaging biomarkers for healthy and pathologic aging that can be refined and tested in prospective clinical trials. Financial Disclosures: Proprietary or commercial disclosure may be found after the references.