A pretest-posttest control-group design (N = 20) was used to assess the effects of transformational leadership training, with 9 and 11 managers assigned randomly to training and control groups, respectively. Training consisted of a 1-day group session and 4 individual booster sessions thereafter on a monthly basis. Multivariate analyses of covariance, with pretest scores as the covariate, showed that the training resulted in significant effects on subordinates' perceptions of leaders' transformational leadership, subordinates' own organizational commitment, and 2 aspects of branch-level financial performance.One significant development in understanding leadership in the past decade has been the emergence of theories of charismatic and transformational leadership (e.g., Bass, 1985;Conger & Kanungo, 1987;House, 1977;Locke et al., 1991). Although the terms charisma and transformational leadership are often used synonymously, Bass (1985Bass ( , 1990 separates them, with charisma forming a part of transformational leadership. Within Bass's approach, transformational leadership includes charisma (providing a vision and a sense of mission, and raising followers' self-expectations), intellectual stimulation (helping employees emphasize rational solutions and challenge old assumptions), and individualized consideration (developing employees and coaching); transformational leadership also goes beyond transactional leadership (or contingent reward, i.e., the exchange of rewards for efforts) in elevating leaders and helping followers achieve higher levels of organizational functioning. In addition, the relationship between transJulian Barling and Tom Weber, School of Business, Queen's University, Kingston, Ontario, Canada; E. Kevin Kelloway, Department of Psychology, University of Guelph, Guelph, Ontario, Canada.This research was part of a management research project submitted by Tom Weber in partial fulfillment of the requirements for an executive master's of business administration degree. We express our appreciation to Bruce J. Avolio for constructive assistance in the earlier phases of this research.

Objective To test the postulated preventive effects of dietary n-3 fatty acids on pre-term delivery, intrauterine growth retardation, and pregnancy induced hypertension.Design In six multicentre trials, women with high risk pregnancies were randomly assigned to receive fish oil (Pikasol) or olive oil in identically-looking capsules from around 20 weeks (prophylactic trials) or 33 weeks (therapeutic trials) until delivery. Setting Nineteen hospitals in Europe.Samples Four prophylactic trials enrolled 232,280, and 386 women who had experienced previous preterm delivery, intrauterine growth retardation, or pregnancy induced hypertension respectively, and 579 with twin pregnancies. Two therapeutic trials enrolled 79 women with threatening pre-eclampsia and 63 with suspected intrauterine growth retardation.Interventions The fish oil provided 2.7 g and 6.1 g n-3 fatty aciddday in the prophylactic and therapeutic trials, respectively. Main outcome measures Preterm delivery, intrauterine growth retardation, pregnancy induced hypertension.Results Fish oil reduced recurrence risk of pre-term delivery from 33% to 21% (odds ratio 0.54 (95% CI 0.30 to 0.98)) but did not affect recurrence risks for the other outcomes (OR 1.26; 0.74 to 2.12 and 0.98; 0.63 to 1.53, respectively). In twin pregnancies, the risks for all three outcomes were similar in the two intervention arms (95% CI for the three odds ratios were 0-73 to 1.40,0-90 to 1.52, and 0.83 to 2.32, respectively). The therapeutic trials detected no significant effects on pre-defined outcomes. In the combined trials, fish oil delayed spontaneous delivery (proportional hazards ratio 1.22; 1.07 to 1.39, P = 0-002).Conclusions Fish oil supplementation reduced the recurrence risk of pre-term delivery, but had no effect on pre-term delivery in twin pregnancies. Fish oil had no effect on intrauterine growth retardation and pregnancy induced hypertension, affecting neither recurrence risk nor risk in twin pregnancies.

Objectives To evaluate the implementation of four high evidence practices for the care of very preterm infants to assess their use and impact in routine clinical practice and whether they constitute a driver for reducing mortality and neonatal morbidity.Design Prospective multinational population based observational study.Setting 19 regions from 11 European countries covering 850 000 annual births participating in the EPICE (Effective Perinatal Intensive Care in Europe for very preterm births) project.Participants 7336 infants born between 24+0 and 31+6 weeks’ gestation in 2011/12 without serious congenital anomalies and surviving to neonatal admission.Main outcome measures Combined use of four evidence based practices for infants born before 28 weeks’ gestation using an “all or none” approach: delivery in a maternity unit with appropriate level of neonatal care; administration of antenatal corticosteroids; prevention of hypothermia (temperature on admission to neonatal unit ≥36°C); surfactant used within two hours of birth or early nasal continuous positive airway pressure. Infant outcomes were in-hospital mortality, severe neonatal morbidity at discharge, and a composite measure of death or severe morbidity, or both. We modelled associations using risk ratios, with propensity score weighting to account for potential confounding bias. Analyses were adjusted for clustering within delivery hospital.Results Only 58.3% (n=4275) of infants received all evidence based practices for which they were eligible. Infants with low gestational age, growth restriction, low Apgar scores, and who were born on the day of maternal admission to hospital were less likely to receive evidence based care. After adjustment, evidence based care was associated with lower in-hospital mortality (risk ratio 0.72, 95% confidence interval 0.60 to 0.87) and in-hospital mortality or severe morbidity, or both (0.82, 0.73 to 0.92), corresponding to an estimated 18% decrease in all deaths without an increase in severe morbidity if these interventions had been provided to all infants.Conclusions More comprehensive use of evidence based practices in perinatal medicine could result in considerable gains for very preterm infants, in terms of increased survival without severe morbidity.

Objective: To investigate the variation in the survival rate and the mortality rates for very preterm infants across Europe. Design: A prospective birth cohort of very preterm infants for 10 geographically defined European regions during 2003, followed to discharge home from hospital. Participants: All deliveries from 22 + 0 to 31 + 6 weeks' gestation. Main outcome measure: All outcomes of pregnancy by gestational age group, including termination of pregnancy for congenital anomalies and other reasons, antepartum stillbirth, intrapartum stillbirth, labour ward death, death after admission to a neonatal intensive care unit (NICU) and survival to discharge. Results: Overall the proportion of this very preterm cohort who survived to discharge from neonatal care was 89.5%, varying from 93.2% to 74.8% across the regions. Less than 2% of infants ,24 weeks' gestation and approximately half of the infants from 24 to 27 weeks' gestation survived to discharge home from the NICU. However large variations were seen in the timing of the deaths by region. Among all fetuses alive at onset of labour of 24-27 weeks' gestation, between 84.0% and 98.9% were born alive and between 64.6% and 97.8% were admitted to the NICU. For babies ,24 weeks' gestation, between 0% and 79.6% of babies alive at onset of labour were admitted to neonatal intensive care. Conclusions: There are wide variations in the survival rates to discharge from neonatal intensive care for very preterm deliveries and in the timing of death across the MOSAIC regions. In order to directly compare international statistics for mortality in very preterm infants, data collection needs to be standardised. We believe that the standard point of comparison should be using all those infants alive at the onset of labour as the denominator for comparisons of mortality rates for very preterm infants analysing the cohort by gestational age band.Although the validity of direct comparisons of perinatal and neonatal mortality rates and their contributions to overall survival has been questioned, these figures are still routinely produced and attract often sensational media headlines. The problems associated with the collection of these data in terms of differences in definitions, registration and delivery policies (which may reflect differences in ethical attitude), have been highlighted in many publications.