The Virtuousness of Ethical Networks: How to Foster Virtuous Practices in Nonprofit Organizations

Ethical networks are an emerging form of social alliance based on collaboration between organizations that share a common ethical commitment. Grounded in a theoretical framework of virtue-based business ethics and focusing on nonprofit alliances, this study investigates the virtuousness of ethical networks; that is, how they trigger virtuous practices in their member nonprofit organizations. Adopting a qualitative grounded theory approach, the study focuses on one of the largest Italian ethical networks of nonprofit organizations operating in the social care sector. The findings show that shared ethical values and religious beliefs are positively associated with ethical network building. Based on these findings, a circular model of virtuousness is proposed in which ethical networks foster virtuous practices among their members at four levels: (1) the strategic orientation level, (2) the institutional level, (3) the organizational level, and (4) the relational level. At each of these levels, ethical networks foster a habituation to virtues and the propagation of virtuous behaviors among their members. Theoretical, practical, and social implications of the research findings are discussed.

Drivers of social innovation in disability services for inclusion: a focus on social farming in nonprofit organizations

Purpose

This study investigates the drivers of social innovation in disability services with specific reference to the context of nonprofit organizations of social farming. In addition, it highlights the role of stakeholder networks in enhancing the social innovation process and the characteristics of stakeholders and networks driving and supporting social innovation.

Design/methodology/approach

Following a qualitative methodology, research was conducted through a case study survey with interviews to 13 nonprofit organizations of social farming for people with disability located in the northeast of Italy.

Findings

Insights gained from the interviews revealed that individual, organizational and contextual factors drive social innovation in disability nonprofits. In addition, networks play a key role in enhancing the three drivers of social innovation through the social innovation journey, from opportunity recognition to implementation of the innovation, to its consolidation phases. Characteristics of the networks and the stakeholders involved are also outlined.

Practical implications

Practical implications for social entrepreneurs include the need to establish cross-sectoral partnerships with diverse stakeholders, including private companies.

Social implications

Implications for policy makers stress the need for ongoing support for nonprofit disability organizations. Social implications are not limited to the inclusion of socially weaker groups; rather, the entire community benefits from the social innovation process.

Originality/value

Social farming represents a valuable solution to meet the needs of disadvantaged people. While much research has investigated the topic of social innovation in social entrepreneurship, only a few studies have addressed social innovation in the context of disability nonprofits involved in social farming.

Drawing up codes of ethics of higher education institutions: evidence from Italian universities

Purpose

Higher education institutions draw up codes of ethics, but in several countries there are no standards to follow. Most universities have autonomy and can freely draw up their codes of ethics in terms of structure and content. The purpose of this paper is to understand the main ethics issues that universities identify in their codes of ethics and what activities they implement to respond to these issues toward appropriate educational management of their institutions in ethical terms.

Design/methodology/approach

This study was performed through content analysis of codes of ethics of Italian public universities (64 codes), and may be considered a single in-depth case study. The main ethics issues and related activities were inductively codified in relation to the research purpose. The four constitutive aspects of business ethics (individual, managerial, organizational and societal ethics) proposed by Melé were chosen as the framework to investigate the main ethical needs and related activities implemented by universities to respond to these ethical issues.

Findings

This research has identified nine main ethical issues and related activities that contribute to guarantee the ethical compliance of universities under the four interrelated aspects different individual behaviors, managerial initiatives, organization strategies and responsibilities toward society. The analysis shows some relevant differences among Italian universities that have important implications in the ethical vision of academic communities and of managerial role in universities.

Practical implications

The research can help managers of higher education institutions to identify the main ethical issues to draw up codes of ethics and to formulate consistent development strategies that are able to improve the conditions of collaboration, work and productive participation in activities for all members of academic communities.

Originality/value

To the best of the authors’ knowledge, this is one of the first studies that connect codes of ethics and higher education. This research brings to light the main ethical issues and related activities that universities can consider to orient their strategic choices toward the public interest as well as educational management improvement.

A retrospective study of ketamine administration and the development of acute or post-traumatic stress disorder in 274 war-wounded soldiers

The objective of this study was to explore whether ketamine prevents or exacerbates acute or post-traumatic stress disorders in military trauma patients. We conducted a retrospective study of a database from the French Military Health Service, including all soldiers surviving a war injury in Afghanistan (2010-2012). The diagnosis of post-traumatic stress disorder was made by a psychiatrist and patients were analysed according to the presence or absence of this condition. Analysis included the following covariables: age; sex; acute stress disorder; blast injury; associated fatality; brain injury; traumatic amputation; Glasgow coma scale; injury severity score; administered drugs; number of surgical procedures; physical, neurosensory or aesthetic sequelae; and the development chronic pain. Covariables related to post-traumatic and acute stress disorders with a p ≤ 0.10 were included in a multivariable logistic regression model. The data from 450 soldiers were identified; 399 survived, of which 274 were analysed. Among these, 98 (36%) suffered from post-traumatic stress disorder and 89 (32%) had received ketamine. Fifty-four patients (55%) in the post-traumatic stress disorder group received ketamine vs. 35 (20%) in the no PTSD group (p < 0.001). The 89 injured soldiers who received ketamine had a median (IQR [range]) injury severity score of 5 (3-13 [1-26]) vs. 3 (2-4 [1-6] in the 185 patients who did not (p < 0.001). At multivariable analysis, only acute stress disorder and total number of surgical procedures were independently associated with the development of post-traumatic stress disorder. In this retrospective study, ketamine administration was not a risk factor for the development of post-traumatic stress disorder in the military trauma setting.

Efficacy and safety of oral ketamine for the relief of intractable chronic pain: A retrospective 5-year study of 51 patients

BACKGROUND

This work summarizes the efficiency, failures and adverse effects of oral administration of ketamine at home for intractable pain.

METHODS

This 5-year retrospective study involved testing ketamine by intravenous in-hospital administration, then a conversion to an oral route, or oral treatment directly administered at home. The daily intravenous dose was increased by steps of 0.5 mg/kg to attain an effective daily dose of 1.5-3.0 mg/kg. Pain was evaluated on a numeric scale from 0 to 10, and evidence of adverse effects was collected every day. The effective daily dose was delivered orally (three to four intakes). If effective, ketamine was continued for 3 months. Short infusions or direct oral treatment began with a 0.5-mg/kg dose, then the daily ketamine dose was increased in 15- to 20-mg increments.

RESULTS

Among 55 cases (51 patients, neuropathic pain 60%), the mean effective oral dose was 2 mg/kg. Ketamine was effective in 24 patients (44%, mean pain reduction 67 ± 17%), partially effective in 20% (mean pain reduction 30 ± 11%), with a mean opioid sparing of 63 ± 32%, and failure in 22%. Half of the patients experienced adverse effects, but only eight had to stop treatment. For patients with opioid therapy, failure of ketamine was less frequent (7% vs. 36%; p < 0.02), with fewer adverse effects (33% vs. 68%; p < 0.01).

CONCLUSIONS

Pain was reduced or abolished in two-thirds of patients under ketamine therapy; ketamine was effective for patients taking opioids and resulted in few adverse effects.

[Which antivenom for Cerastes envenoming?]

During Echis viper envenoming, the administration of a single FAV-Afrique(®) antivenin vial generally corrects hemostasis disorders in less than twelve hours. The correction of hemostasis after 36 hours by 4 vials of FAV-Afrique(®) is thus not in favor of the usefulness of this antivenin for Cerastes envenoming . Mortality due to viper envenoming in Africa is high, but more than 90 % of poisoned patients survive despite the absence of appropriate antivenom. The severity of poisoning depends on several factors: age and condition of the patient, location of the bite, composition and amount of injected venom, management delay, and therefore, survival is not necessarily synonymous of effectiveness of antivenom treatment. Cerastes venoms contain many enzymes that disrupt various stages of hemostasis. It remains to prove that FAV-Afrique(®), a polyvalent antivenom adapted to venom of the main species responsible for envenoming in sub-Saharan Africa, (Bitis, Echis, Naja and Dendroaspis), is able to neutralize these specific proteins. The most logical approach of Cerastes envenoming is the administration of an antivenin adapted to species found in North Africa: Favirept(®) (Sanofi Pasteur) is a polyvalent antivenom adapted to the venoms of C. cerastes, Bitis arietans, Echis leucogaster, Macrovipera deserti, Naja haje and Naja nigricollis.

[Pulmonary embolism in the context of severe envenomation by a Moroccan viper]

Heparin, which was widely used thirty years ago for the treatment of viper envenomations, is now contra-indicated during the acute phase, which is at risk for hemorrhage and death. We report a case of pulmonary embolism, a rare situation in the context of viper envenomation. By means of this case report, we want to discuss the pathophysiological links between envenomation and thromboembolic disease, and on the other hand, the potential heparin usefulness, not during the acute, hemorrhagic phase, but as a prophylactic treatment when hemorrhagic risk has been replaced by an inflammatory syndrome, with increased fibrinogen and platelets which are then prothrombotic factors.

[Adder bites in France]

Snake bites are a major public health problem in the tropics but they have a low incidence in Europe and are responsible for few deaths each year. The incidence is higher in children than in adults but no difference in severity seems to be observed between children and adults. In France, snake envenomations are due mainly to Vipera aspis and Vipera berus. The clinical presentation is usually limited to a local syndrome with pain and local inflammatory edema, but systemic signs occur in 17% of cases. Clinical grading published by the Institut Pasteur in Paris helps to assess the severity of envenomation and to decide the use of antivenom. Every bitten patient must be transferred in a hospital for medical assessment. Specific treatment is based on antivenom immunotherapy. However, other medical and surgical treatments have limited value.

[Ischaemic stroke secondary to viper envenomation in Morocco in the absence of adequate antivenom]

An ischaemic stroke is a rare complication of viper envenomation that is due to multifactorial pathophysiological mechanisms. The authors describe the case of a 55-year-old patient bitten by the viper Cerastes cerastes. The patient was admitted to the intensive care unit with multiple organ failure, disseminated intravascular coagulopathy, rhabdomyolysis, anuria and elevated troponin level. The persistent disturbance of consciousness has motivated a brain scan which has revealed a bifocal ischemic stroke. The complex venom of the species C. cerastes may induce hypotension, tissue necrosis, acute renal failure, bleeding disorders or DIC. With the cessation of a non-indicated heparintherapy and haemodialysis, the patient recovered in a few weeks despite the initial infusion of an unsuitable antivenom due to the late identification of the reptile. The preventive treatment of the complications of this envenomation is based on the infusion of the polyvalent antivenom Favirept(®).

[The damage control resuscitation concept]

OBJECTIVE

Damage control is a strategy of care for bleeding trauma patients, involving minimal rescue surgery associated to perioperative resuscitation. The purpose of this review is to draw up a statement on current knowledge available on damage control.

DATA SOURCES

References were obtained from recent review articles, personal files, and Medline database research of English and French publications. All categories of articles on this topic have been selected.

DATA SYNTHESIS

Historical damage control surgery, that consist of abbreviated laparotomy with second-look after resuscitation, is now included in a wider concept called "damage control resuscitation", addressing the lethal triad (coagulopathy, hypothermia and acidosis) at an early phase. Care is focused on coagulopathy prevention. Early resuscitation, or damage control ground zero, has been improved: aggressive management of hypothermia, bleeding control techniques, permissive hypotension concept and early use of vasopressors. Transfusion practices also have evolved: early platelets and coagulation factors administration, use of hemostatic agents like recombinant FVIIa, whole blood transfusion, denote the damage control hematology. Progress in surgical practices and development of arteriographic techniques lead to wider indications of damage control strategy.

[Acute respiratory distress syndrome caused by tropical eosinophilic lung disease: a case in Gabon]

The purpose of this report is to describe the case of a 28-year-old woman in whom acute respiratory distress syndrome (ARDS) following cholecystectomy led to the discovery of eosinophilic lung disease. Outcome was favorable after oxygenotherapy and medical treatment using ivermectin and corticosteroids. The case shows that hypereosinophilic syndrome can be the underlying cause of ARDS.

[Ketamine: drug facts, uses in anesthesia, and new applications for analgesia]

Ketamine is an anesthetic drug of choice in tropical zones. In addition to excellent pharmocologic properties and low cost, it offers the possibility of using a variety of administration routes and of performing invasive procedures with spontaneous ventilation. Adverse psychodysleptic effects can be prevented by association with midazolam or propofol. Hypersalivation can be prevented with atropine. Recent experience has shown that thanks to its antihyperalgesic effects ketamine can be used for postoperative analgesia at doses ten times lower than for anesthesia.

[Action of venoms on blood coagulation: diagnosis of hemorrhagic syndromes]

Venoms from Viperidae, Crotalidae, some Australian Elapidae and few Colubridae are a mixture of enzymes which impact on blood coagulation in several ways. These proteins can be classified as haemorragins which induce disorders of the capillary permeability, disintegrins and related proteins which disturb the clotting time while acting on plate adhesion, and proteases which cleave peptides. Venoms contain molecules directed against several targets of the coagulation system. The same molecule may present different activities. Components of snake venoms are used in diagnostic coagulation tests, fundamental research and as drugs against infectious agents, cancer or haematological disorders. The structural differences between proteins from snake venoms and natural coagulation factors and the target diversity of the venom components explain why it remains illusory to treat bleedings when acting just at symptom level. Conversely, antivenom, whose components are directed against the venom proteins, is the only aetiological therapy effective against snake envenomations.

[Clinical and biological surveillance of envenomed patients]

Faced with an envenomation, the problem is to take sufficiently rapidly the decision to administer the only effective treatment--immunotherapy--, to know which antivenom to choose and how long to administrate it. If the snake is not identified, symptoms and initial development give information on the type of venom. It is convenient to classify the symptoms according to four clinical types: i) the cobra syndrome with a potentially fatal evolution within two to ten hours and which resembles an Elapid bite, ii) the viper syndrome associating bleeding and inflammation, which can be due either to a viper, pit viper or, in Australia, to Elapids, iii) disturbance of blood circulating functions and iv) disturbance of other live functions. Between the third to the half of snakebite victims present no envenomation. Severe envenomations must be monitored in an intensive care unit, with experience in emergency management and monitoring of patients with major life-threatening conditions. Throughout the world, snakebites induce more than 100,000 deaths every year. Schematically, the emergency may be considered in terms of seconds for blood circulation disorders, minutes for respiratory paralysis, and hours for the coagulopathy.

Round table and synthesis of the meeting

Our knowledge of the epidemiology of scorpion stings and snakebites remains fragmentary but sufficient, nevertheless, to be able to confirm that envenomations constitute a real public health problem throughout Africa. In order for the health authorities to be able to improve management of this problem, data collection must be enhanced. The objective should be to determine what kinds of intervention are necessary (quantity of antivenom serum and drugs, in particular) and where they should be applied. Specialists must come to a rapid consensus for a simple therapeutic protocol to be used in peripheral health centres where means are often scarce. Training for health personnel is also insufficient. Appropriate courses must be organised for medical doctors and nurses within both their basic and on-going training. These courses must necessarily involve health personnel from rural zones must affected by envenomations. The availability of antivenom serum--the only specific, efficacious drug--must be improved as soon as possible. If quantitative and geographic needs can be determined by epidemiological studies, then distribution must be developed by original means (grouping orders at national level, direct orders) and diversified financial support (purchase on the open market, local authority grants, community participation). The symposium attendees agreed to meet again within two years' time to evaluate progress in the area.

Tachycardia and convulsions induced by accidental intravascular ropivacaine injection during sciatic block

Ropivacaine, a recently introduced local anesthetic of the amide family (1), seems to show less toxicity than bupivacaine (2-4). Nevertheless, both neurologic and cardiovascular toxicities are possible. Six cases of ropivacaine-induced convulsions have previously been reported (5-10), of which three cases also showed cardiovascular toxicity. In three cases, total plasma concentrations were measured (Table 1).

[Hypertensive effects of qat]

Chewing of Qat leaves which contain amphetamine alkaloids is a traditional drug practice in the horn of Africa. Cathine and cathinone are responsible for the desired psychogenic (suppression of hunger, mind stimulation, euphoria) and sympathicomimetic effects. In this study, we monitored seven volunteers during a traditional qat ritual. An increase in systolic and diastolic pressure was observed in three patients including one presenting predisposing chronic arterial hypertension. Peak pressure was observed approximately seven hours after beginning the ritual. The three patients presenting pressure changes were not significantly different from the four unaffected patients with regard to age or duration of qat use. These findings suggest that qat use by untreated hypertensive patients who react strongly to vasoconstrictive effects can lead to hypertension and resulting cardiovascular complications.

[Epidemiologic study of qat use in the National Army of Djibouti]

Chewing of qat leaves is a traditional practice in the horn of Africa. Amphetamine-like alkaloids contained in the leaves account for the psychostimulating (anorexia, exhiliaration, euphoria) and sympathomimetic effects. The results of this prospective study based on interviews of 100 servicemen seeking medical advice showed that the prevalence of qat use in the National Army of Djibouti was 84%. Mean consumption of qat by users was 400 +/- 50 grams per chew requiring a monthly expenditure of approximately 500 FF. Heart rate and blood pressure in users were not significantly different from non-users. No correlation was found between blood pressure and either age or quantity of qat ingested per chew. A greenish discoloration of the tongue was observed in 65% of qat users but this sign was not specific (60%). qat use was correlated with poor dental health. The findings of this study indicate that qat use is widespread among young males in Djibouti but that its cardiovascular effects are limited in this age group.