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Programs supporting the necessary combination of digital, organizational, and cultural transformational change, motivating and engaging the workforce, are scarce. This discussion paper reports on the initial experiences from a competency development program aiming at building capacity within the workforce, leaders, and organization in secondary healthcare to navigate and facilitate digitally transformative healthcare systems. The program aims to support employees and leaders who i) understand digitalization in and of practice, ii) reflect and approach digitalization in a critical and ethical way, iii) are curious and maintain a growth mind-set, iv) engage in development and implementation of digitalization, and v) can convey and communicate digitalization. The insights from the prototype can be useful in further promoting sustainable digitalization within healthcare and supporting leaders in their conduct and management of digital health initiatives.

Trans-3,4-dihydroxy-3,4-dihydrochrysene (chrysene-3,4-diol), a major metabolite of chrysene, is further metabolized by rat liver enzymes to products which effectively revert the his- Salmonella typhimurium strain TA98 to histidine prototrophy, but are only weakly mutagenic in strain TA100 and in Chinese hamster V79 cells (acquisition of resistance to 6-thioguanine). The liver enzyme mediated mutagenicity of chrysene-3,4-diol is substantially enhanced in the presence of 1,1,1-trichloropropene 2,3-oxide, an inhibitor of microsomal epoxide hydrolase. The predominant metabolites of chrysene-3,4-diol, namely the anti- and syn-isomers of its 1,2-oxide (termed reverse diol-epoxides), proved to be extraordinarily effective mutagens in S.typhimurium strain TA98, but were only moderately active in strains TA100 and TA104, and in the SOS induction in Escherichia coli PQ37. These genotoxicity spectra in bacteria are completely different from those observed with the bay-region diol-epoxides of chrysene and 3-hydroxychrysene. In V79 cells, the reverse diol-epoxides formed low levels of DNA adducts and were very weak inducers of gene mutations. In M2 mouse prostate cells, however, high numbers of transformed foci were induced by chrysene-3,4-diol and its diastereomeric 1,2-oxides. Chrysene-3,4-diol was somewhat more potent than chrysene-1,2-diol. The potency of both reverse diol-epoxides was similar to that of the syn-diastereomers of the bay-region diol-epoxides of chrysene and 3-hydroxychrysene, but lower than that of their anti-diastereomers. The reverse diol-epoxides of chrysene, unlike the bay-region diol-epoxides, were inactivated by purified microsomal epoxide hydrolase. Noteworthy findings were also made with regard to the chemical stability of the diol-epoxides in buffer, determined from the decline in mutagenicity after preincubation in the absence of the target cells. Despite its lower delta Edeloc/beta value for the formation of the benzylic carbocation, anti-chrysene-3,4-diol 1,2-oxide was shorter-lived (t1/2 = 46 min) than anti-chrysene-1,2-diol 3,4-oxide (t1/2 = 74 min). Unlike other investigated diastereomeric pairs of diol-epoxides, it was also shorter-lived than its syn-diastereomer (t1/2 = 340 min).

Valproic acid (VPA) and its analogues valpromide (VPM), valproyl-Coenzyme A (VP-CoA) and valproyl-ethylester (VPE) were examined as potential inhibitors of microsomal epoxide hydrolase (mEHb) using styrene-7,8-oxide (STO) and benzo(a)pyrene-4,5-oxide (BPO) as enzyme substrates. The effect of each potential inhibitor was examined using mEHb from rat liver, human livers (from a child, woman and man) and from human placenta. Of the compounds tested, only VPM (2 mM) expressed significant inhibition of mEHb activity with a maximum inhibition of 49%, 48%, 35% and 33% for liver microsomes from the child, woman, man and rat, respectively, using STO (2 mM) as substrate. Human placenta mEHb was inhibited 59% under the same conditions. The inhibition was found to be competitive, with closely related KI values of 0.11, 0.16, 0.28, 0.27 and 0.31 mM for mEHb obtained from rat liver, human placenta, child, female and male liver, respectively. VPA demonstrated only a slight inhibition (maximum 16%) of mEHb at high concentrations (10 mM), and VP-CoA was found to activate STO hydrolysis slightly at concentrations between 1 and 5 mM. VPE caused a moderate concentration-dependent activation of mEHb in all microsomal preparations examined. The inhibitory or activating properties of each compound were independent of the substrate and influenced slightly by the pH used in the incubation medium. The lack of inhibition of mEHb by VPA and its analogues other than VPM shows that neither masking of the carboxyl function of VPA nor the introduction of higher lipophilicity are sufficient to account for the inhibitory properties of VPM for mEHb. A molecular mechanism for the inhibition of mEHb by VPM is discussed.