Guest Editors' introduction: philosophical contributions to leadership ethics

This article introduces the first of two special issues on philosophical approaches to leadership ethics. In it, we show some of the ways that philosophy contributes to the study of leadership and leadership ethics. We begin with an overview of how philosophers have treated some of the ethical aspects and challenges of leadership. These include discussions of self interest, the problem of dirty hands, responsibility, moral luck, power, gender and diversity, and spirituality. The articles in this issue draw on philosophy to explore a variety of ethical questions related to leadership and the relationships that leaders have with followers and others

The Sexual health of pupils in years 4 to 6 of primary schools in rural Tanzania

Background/objectives: There is an urgent need for effective interventions to improve the sexual and\ud reproductive health of adolescents. Reliable data on the sexual health of adolescents are needed to guide\ud the development of such interventions. The aim was to describe the sexual health of pupils in years 4 to 6 of\ud 121 rural primary schools in north western Tanzania, before the implementation of an innovative sexual\ud health intervention in 58 of the schools.\ud Methods: A cross sectional survey of primary school pupils in rural Tanzania was carried out. The study\ud population comprised pupils registered in years 4 to 6 of 121 primary schools in 20 rural communities in\ud 1998. Basic demographic information was collected from all pupils seen. Those born before 1 January\ud 1985 (aged approximately 14 years and over) were invited to participate in the survey, and asked about\ud their knowledge and attitudes towards sexual health issues, and their sexual experience. A urine specimen\ud was requested and tested for HIV, Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and, for\ud females, pregnancy.\ud Results: 9283 pupils born before 1 January 1985 were enrolled and provided demographic information\ud and a urine sample. Male pupils were significantly older than females (mean age 15.5 years v 14.8 years,\ud p,0.001), but all other demographic characteristics were similar between the sexes. 14 (0.2%) of the\ud enrolled pupils (four male and 10 female) were HIV positive, 83 (0.9%) were positive for CT, and 12\ud (0.1%) for NG. 32 female pupils (0.8%) were positive by pregnancy test. Sexual experience was reported\ud by one fifth of primary school girls, and by almost half of boys. Only 45/114 (39%) girls with biological\ud markers of sexual activity reported having had sex.\ud Conclusions: HIV, CT, NG, and pregnancy were present though at relatively low levels among pupils in\ud years 4 to 6 of primary school. A high proportion of pupils with a biological marker of sexual activity\ud denied ever having had sex. Alternative ways of collecting sensitive data about the sexual behaviour of\ud school pupils should be explored

CADRE: the Central Aspergillus Data REpository 2012

The Central Aspergillus Data REpository (CADRE; http://www.cadre-genomes.org.uk) is a public resource for genomic data extracted from species of Aspergillus. It provides an array of online tools for searching and visualising features of this significant fungal genus. CADRE arose from a need within the medical community to understand the human pathogen Aspergillus fumigatus. Due to the paucity of Aspergillus genomic resources 10 years ago, the long-term goal of this project was to collate and maintain Aspergillus genomes as they became available. Since our first release in 2004, the resource has expanded to encompass annotated sequence for eight other Aspergilli and provides much needed support to the international Aspergillus research community. Recent developments, however, in sequencing technology are creating a vast amount of genomic data and, as a result, we shortly expect a tidal wave of Aspergillus data. In preparation for this, we have upgraded the database and software suite. This not only enables better management of more complex data sets, but also improves annotation by providing access to genome comparison data and the integration of high-throughput data

Rapid Syphilis Tests as Catalysts for Health Systems Strengthening: A Case Study from Peru.

OBJECTIVES: Untreated maternal syphilis leads to adverse pregnancy outcomes. The use of point of care tests (POCT) offers an opportunity to improve screening coverage for syphilis and other aspects of health systems. Our objective is to present the experience of the introduction of POCT for syphilis in Peru and describe how new technology can catalyze health system strengthening. METHODS: The study was implemented from September 2009-November 2010 to assess the feasibility of the use of a POCT for syphilis for screening pregnant women in Lima, Peru. Outcomes measured included access to syphilis screening, treatment coverage, partner treatment, effect on patient flow and service efficiency, acceptability among providers and patients, and sustainability. RESULTS: Before the introduction of POCT, a pregnant woman needed 6 visits to the health center in 27 days before she received her syphilis result. We trained 604 health providers and implemented the POCT for syphilis as the "two for one strategy", offering with one finger stick both syphilis and HIV testing. Implementation of the POCT resulted in testing and treatment on the first visit. Screening and treatment coverages for syphilis improved significantly compared with the previous year. Implementation of POCT has been scaled up nationally since the study ended, and coverages for screening, treatment and partner treatment have remained over 92%. CONCLUSIONS: Implementation of POCT for syphilis proved feasible and acceptable, and led to improvement in several aspects of health services. For the process to be effective we highlight the importance of: (1) engaging the authorities; (2) dissipating tensions between providers and identifying champions; (3) training according to the needs; (4) providing monitoring, supervision, support and recognition; (5) sharing results and discussing actions together; (6) consulting and obtaining feedback from users; and (7) integrating with other services such as with rapid HIV testing

Towards a safe and effective chlamydial vaccine: lessons from the eye.

As well as being the most common bacterial sexually transmitted infection, Chlamydia trachomatis (Ct) is the leading infectious cause of blindness. The pathogenesis of ocular chlamydial infection (trachoma) is similar to that of genital infection. In the 1960s the efficacy of Ct vaccines against ocular infection was evaluated in major field trials in Saudi Arabia, Taiwan, The Gambia, India and Ethiopia. These trials showed that it was possible to induce short term immunity to ocular infection, and to reduce the incidence of inflammatory trachoma, by parenteral immunisation with killed or live whole organism vaccines. In one study, it was also shown that the incidence of scarring sequelae was reduced in vaccinated children. Detailed studies in non-human primates conducted at this time suggested that vaccination could lead to more severe inflammatory disease on subsequent challenge. Since that time there have been many studies on the immunological correlates of protective immunity and immunopathology in ocular Ct infection in humans and non-human primates, and on host genetic polymorphisms associated with protection from adverse sequelae. These have provided important information to guide the development and evaluation of a human Ct vaccine

Long-term safety of ospemifene (52-week extension) in the treatment of vulvar and vaginal atrophy in hysterectomized postmenopausal women

Objective To examine the long-term safety of oral ospemifene, a non-estrogen tissue-selective estrogen agonist/antagonist, for the treatment of moderate to severe dyspareunia, a symptom of vulvar and vaginal atrophy (VVA) due to menopause. Study design This multicenter, long-term, open-label, safety extension study was conducted in women without a uterus aged 40–80 years (N = 301) who received oral ospemifene 60 mg/day for 52 weeks. Participants either continued their 60-mg/day ospemifene dose from the initial 12-week pivotal efficacy study or switched from blinded placebo or ospemifene 30 mg/day to open-label ospemifene 60 mg/day. The 52-week open-label extension period plus initial 12-week treatment period totaled up to 64 weeks of ospemifene exposure. A 4-week posttreatment follow-up ensued (68 weeks total). Main outcome measures Safety assessments included adverse events, laboratory studies, physical and gynecologic examination, vital signs, breast palpation, and mammography. Results Most treatment-emergent adverse events (TEAEs) during the extension study were mild or moderate in severity. The most common TEAE related to study drug was hot flushes (10%; leading to discontinuation for 2% of patients). One serious TEAE, a non-ST-elevation myocardial infarction in a patient with pre-existing cardiac disease, was considered possibly related to study medication. One mild breast-related TEAE, considered unrelated to study drug, was ongoing at study completion. There were no instances of pelvic organ prolapse, incontinence, venous thromboembolism, fractures, breast cancers or death. No clinically significant adverse changes were observed in other safety parameters. Conclusions Ospemifene is clinically safe and generally well tolerated in postmenopausal patients with dyspareunia, a symptom of VVA

Balancing employee needs, project requirements and organisational priorities in team deployment

The 'people and performance' model asserts that performance is a sum of employee ability, motivation and opportunity (AMO). Despite extensive evidence of this people-performance link within manufacturing and many service sectors, studies within the construction industry are limited. Thus, a recent research project set out to explore the team deployment strategies of a large construction company with the view of establishing how a balance could be achieved between organisational strategic priorities, operational project requirements and individual employee needs and preferences. The findings suggested that project priorities often took precedence over the delivery of the strategic intentions of the organisation in meeting employees' individual needs. This approach is not sustainable in the long term because of the negative implications that such a policy had in relation to employee stress and staff turnover. It is suggested that a resourcing structure that takes into account the multiple facets of AMO may provide a more effective approach for balancing organisational strategic priorities, operational project requirements and individual employee needs and preferences more appropriately in the future