Innovative approach to medical leadership and management development: clinician secondment to a management consulting firm.

BACKGROUND AND AIM: Opportunities to participate in leadership and management with protected time can be limited for clinical trainees. The aim of this fellowship was to gain experience of gold standard healthcare management by becoming part of multidisciplinary teams working to deliver transformational change in the National Health Service (NHS). METHODS: A 6-month pilot fellowship, structured as an Out of Programme Experience was created for two registrars to be seconded to the healthcare division of Deloitte, a leading professional services firm. Competitive selection was jointly administered by the Director of Medical Education at St Bartholomew's Hospital and Deloitte. RESULTS: The successful candidates worked on service-led and digital transformation projects, interfacing with senior NHS executives and directors. Trainees gained direct experience and understanding of high-level decision making in the NHS, tackling complex service delivery problems and the practical realities of delivering change within a constrained budget. One impact of this pilot has been completion of a business case to scale up the fellowship into an established programme that can allow other trainees to apply. CONCLUSION: This innovative fellowship has allowed interested trainees an opportunity to broaden the relevant skills and experience in leadership and management required in specialty training curriculum with real-life application in the NHS.

Low-level seaweed supplementation improves iodine status in iodine-insufficient women.

Iodine insufficiency is now a prominent issue in the UK and other European countries due to low intakes of dairy products and seafood (especially where iodine fortification is not in place). In the present study, we tested a commercially available encapsulated edible seaweed (Napiers Hebridean Seagreens® Ascophyllum nodosum species) for its acceptability to consumers and iodine bioavailability and investigated the impact of a 2-week daily seaweed supplementation on iodine concentrations and thyroid function. Healthy non-pregnant women of childbearing age, self-reporting low dairy product and seafood consumption, with no history of thyroid or gastrointestinal disease were recruited. Seaweed iodine (712 µg, in 1 g seaweed) was modestly bioavailable at 33 (interquartile range (IQR) 28-46) % of the ingested iodine dose compared with 59 (IQR 46-74) % of iodine from the KI supplement (n 22). After supplement ingestion (2 weeks, 0·5 g seaweed daily, n 42), urinary iodine excretion increased from 78 (IQR 39-114) to 140 (IQR 103-195) µg/l (P< 0·001). The concentrations of thyroid-stimulating hormone increased from 1·5 (IQR 1·2-2·2) to 2·1 (IQR 1·3-2·9) mIU/l (P< 0·001), with two participants having concentrations exceeding the normal range after supplement ingestion (but normal free thyroxine concentrations). There was no change in the concentrations of other thyroid hormones after supplement ingestion. The seaweed was palatable and acceptable to consumers as a whole food or as a food ingredient and effective as a source of iodine in an iodine-insufficient population. In conclusion, seaweed inclusion in staple foods would serve as an alternative to fortification of salt or other foods with KI.

Endothelial activation and cell adhesion molecule concentrations in pregnant women living at high altitude.

OBJECTIVES: Maternal physiology at high altitude could be considered to resemble an intermediate state between preeclampsia and normal pregnancy. The objective of the current study was to determine if cell adhesion molecules, known to be increased in preeclampsia, are increased with chronic maternal and placental hypoxia (due to high-altitude residence) in the absence of preeclampsia. METHODS: Serum was collected from women residing at 3100 m or 1600 m in the three trimesters of pregnancy and postpartum. Vascular cell adhesion molecule-1 (VCAM-1), E-selectin, and intercellular adhesion molecule-1 (ICAM-1) were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: General linear model (GLM) repeated measures analysis of VCAM-1, E-selectin, and ICAM-1 data showed there were no statistically significant effects of gestation within either the high- or moderate-altitude groups or between the different altitudes. CONCLUSION: The increase in cell adhesion molecules reported in preeclampsia is not present in pregnant women at high altitude, suggesting that maternal systemic hypoxia is not responsible for this pathway of endothelial cell activation in preeclampsia.

Villous explant culture: characterization and evaluation of a model to study trophoblast invasion.

The mechanisms that control invasion of cytotrophoblast (CTB) cells into the maternal decidua and myometrium with transformation of the maternal spiral arteries are not fully understood, but oxygen is thought to be a key factor. We carried out a semiquantitative evaluation of an explant culture model for use in the study of trophoblast proliferation and invasion. Explants of human villous tissue (6-9 weeks of gestation) cultured on Matrigel in both standard culture conditions (18% O2) and in a low oxygen environment (2% O2) produced regions of outgrowth, of cytotrophoblast cells from villous tips and migration of cells into the Matrigel. The number of sites of outgrowth and migration, area of outgrowth, and extent of migration of cells into the Matrigel tended to increase throughout the culture period (144 h) but varied between explants from the same placenta and those from different placentas. There were no significant differences in the number of sites of outgrowth or migration scores in explants cultured in a low oxygen environment compared to those cultured in standard conditions. This study highlights the importance of careful validation, design and interpretation of experiments using in vitro culture systems, particularly those investigating the regulatory role of oxygen.

Expression of Gsalpha, connexin-43, connexin-26, and EP1, 3, and 4 receptors in myometrium of prelabor singleton versus multiple gestations and the effects of mechanical stretch and steroids on Gsalpha.

OBJECTIVE: We tested the hypothesis that multiple pregnancies would be associated with altered expression of the following three groups of proteins that are key regulators of myometrial function: (i) Gsalpha, (ii) connexins-43 and 26, and (iii) prostanoid EP1, EP3, and EP4 receptors. METHODS: An in vitro model was used to determine the effects of mechanical stretch on myometrial cell Gsalpha expression. Then the effects of the steroid hormones beta-estradiol and progesterone were tested on Gsalpha expression in vitro. All in vitro studies were performed using myometrium from nonlaboring women. RESULTS: There were no differences in the expression of Gsalpha, prostaglandin E2 receptors, or gap junction proteins in myometrium of singleton versus multiple pregnancies. Mechanical stretch did not alter Gsalpha expression in vitro, and Gsalpha expression was unaffected by steroid hormones. CONCLUSION: These results suggest that the methods whereby stretch can promote myometrial contraction are complex or require additional factors than those tested here. Alternatively, cases of multiple gestation that do not result in preterm labor perhaps compensate for the increased stretch by preventing aberrant expression of the proteins investigated in this study.