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ProblemThere is a lack of leadership training in health care despite it being an essential competency for providers to deliver accessible, high quality healthcare and navigate a continually changing system. The barriers to adding leadership development to the various stages of medical training are numerous. A specific barrier is the lack of access to resources for this training. This group aimed to tackle this barrier within post-graduate medical education and training through their e- Leadership Academy.ApproachThe e-Leadership Academy was developed as a partnership between the Harvard Medical School Center for Primary Care and Clinical Directors Network, Inc. (CDN). The result of the collaboration was a virtual leadership academy, offered over a 10-month period that covered the fundamental concepts and skills for leading within a clinical practice. The audience for this program were clinicians and staff of community health centers and health departments in the United States.OutcomesFor the results of this article, primary outcome analysis was of participant responses to both formative and summative evaluations that took place throughout and at the end of the course. Results were used to assess course quality, participant satisfaction, participant engagement, and provide data about future offerings that would be useful to the target audience.Next StepsThe group proposes future training programs could measure the changes in the behavior of teams and clinical outcomes utilizing expanded evaluations. Proposed plans for expansion of the e- Leadership Academy include developing additional modules and the potential integration of an in- person component.

Background: Forty years after Alma Ata, there is renewed commitment to strengthen primary health care as a foundation for achieving universal health coverage, but there is limited consensus on how to build strong primary health care systems to achieve these goals. Methods: We convened a diverse group of global stakeholders for a high-level dialogue on how to create an enabling ecosystem for disruptive primary care innovation. We focused our discussion on four themes: workforce innovation and strengthening; impactful use of data and technology; private sector engagement; and innovative financing mechanisms. Findings: Here, we present a summary of our convening’s proceedings, with specific recommendations for strengthening primary health care systems within each of these four domains. Conclusions: In the wake of the Astana Declaration, there is global consensus that high-quality primary health care must be the foundation for universal health coverage. Significant disruptive innovation will be required to realize this goal. We offer our recommendations to the global community to catalyze further discourse and inform policy-making and program development on the path to Health for All by 2030.

Fetal aortic stenosis (AS) imposes pressure load on the developing left ventricle (LV) and leads to derangements in myocardial structure and function via mechanisms that are not well characterized.We compared amniotic fluid NT-BNP and troponin levels in fetuses with AS prior to fetal valvuloplasty and controls. We estimated correlations between NT-BNP and fetal echo parameters and identify NT-BNP cutoff associated with biventricular outcome RESULTS: Median NT-BNP level was higher in fetal AS than controls (3858 vs 1737 pg/mL, P 0.012). By contrast, troponin levels were lower in fetal AS, with troponindetectable in 0/25 (0%) AS cases compared with 22/85 (26%) controls (P = 0.03). Of 25 fetal AS cases, 12 (48%) had biventricular outcome. Fetuses with NT-BNP 910 pg/mL were more likely to have biventricular (OR =10) compared with those ≥910 pg/mL (P = 0.045). Higher NT-BNP correlated with earlier gestational age and measures of larger left heart size.NT-BNP is elevated in fetal AS, suggesting that LV pressure load and increased wall stress lead to maladaptive stretch-related myocardial remodeling. Troponin is normal in mid-gestation fetal AS, suggesting that ischemia is not the primary factor in fetal response to LV pressure load.