Paradoxical Approach Research Articles

Indian experience with diethylstilbestrol in hormone-positive metastatic breast cancer after failure of standard hormone therapy.

e11502 Background: Blocking estrogen receptor or production is standard of care for hormone receptor positive advanced breast cancer patients. A paradoxical approach of using estrogens in such patients has been used for the last 5-6 decades. The mechanism of action of diethylstilbestrol (DES) focuses on induction of apoptosis. Methods: Fifteen cases of hormone receptor positive advanced breast cancer were treated with DES after failure of standard hormonal chemotherapy. Median age was 55 years. Median time before starting DES for metastatic disease was 2.5 years. Median lines of chemotherapy received before starting DES was two. All patients had received aromatase inhibitors, tamoxifen. Ten patients had also received fulvestrant. Nine patients had liver, nine had bone, six had lymph node, four had lung, and two had skin metastasis. Results: 5 mg BID dose of DES was started. After a period of median 6 month therapy, there were four partial responses, six patients had stable disease, and five had progressive disease. Reduction in serum markers CA15.3 and CEA was seen in eight patients. The therapy was well tolerated. There was mild elevation of liver enzymes – SGOT and SGPT in four cases. There were no other untoward toxicity. Conclusions: In post menopausal hormone receptor positive cases of advanced breast cancer, after failure of standard hormone therapy, DES offers safe, cheap, and effective palliative treatment. No significant financial relationships to disclose.

A Ghost in the Machine Age: The Westerwald Stoneware Industry and German Design Reform, 1900–1914

Between the Paris Exposition Universelle in 1900 and the Deutscher Werkbund's first major exhibition of mass-produced products in Cologne in 1914, German stoneware underwent a remarkable process of technical and aesthetic modernization. In collaboration with artists and cultural critics, the German region known as the Westerwald transformed its provincial, handcrafted vessels to rank among the exemplary mass-produced goods selected and deployed by the Werkbund to promote—at a domestic, grass-roots level—the development of a modern, national style. But this modern transformation was complicated by the legacy of the past: the Westerwald's heritage of indigenous craft affected its manufacture of modern products. This article traces the Westerwald's paradoxical approach to modern design as a reflection of Wilhelmine Germany's ambivalent modernism and employs “modern” stonewares in an interpretation of the Werkbund's vision for a technological future conflated with a vernacular past. Analysis of Westerwald vessels designed by influential modern artists and displayed, published and marketed by the Werkbund, helps to concretize the organization's notoriously elusive design theory, including its specialized use of the terms Qualität and Sachlichkeit. To a young German nation in search of an enduring, all-pervasive, national style, the Westerwald offered an “evolved” vernacular fit for modern consumption.

THE RADICAL CONSERVATISM OF FRANK H. KNIGHT

This article examines the most prominent interwar economist at the University of Chicago, Frank Knight, through the lens of a controversial 1932 lecture in which he exhorted his audience to vote Communist. The fact that he did so poses a historical problem: why did the premier American exponent of conservative economic principles appear to advocate a vote for radical change? This article argues that the speech is representative of Knight's deliberately paradoxical approach, in which he refused to praise markets without adding caveats about their substantial limitations, and expressed support for freedom of discussion alongside his skepticism of the public's capacity to exercise the privilege. In parsing these tensions, the article revises the conventional interpretation of Knight, illuminates the contested environment within which postwar free-market economics emerged, and reexamines a restrained defense of capitalism that has been largely forgotten in the subsequent years.

Musical Compost, Consorts and Collapsing Pyramids: On the Disintegration of Traditional Performance Practices to Raise a Sound Society

By introducing a consort of instrumentalists representing musical traditions from Iran to the Philippines, Zimbabwe, Japan, Korea and the Americas, the author presents a paradoxical compost approach of defining while disintegrating musical cultural elements, thus conveying the transformative nature of self and society. Improvisation informs the author's chromodal concept, illustrated in the article with a collapsing pyramid model, thereby illuminating co-existence as a shared creative source that ultimately expands human potential through the extinction of the formal.

La thérapie brève de Palo Alto : l'approche interactionnelle des situations dépressives

Cet article se propose de répondre à la question suivante: comment le modèle de thérapie brève, dû aux instigateurs du Mental Research Institute (MRI – Palo Alto) et à leurs disciples européens, voit et traite une des plaintes les plus communes en psychiatrie, celle du patient déprimé. Les prémisses théoriques (la non-séparation de l’observateur et de l’observé, du sujet et de son environnement) induisent une conception interactionnelle de la nature du problème et du changement. Au niveau clinique, les deux aspects, constructiviste et systémique, s’enchevêtrent pour donner contexte au processus des tentatives de solution (nature du problème) et à l’approche paradoxale (nature du changement).

Bariatric Surgery in Liver Transplant Patients: Weighing the Evidence

In developed nations, physicians must modify their practices in order to provide good medical care to an increasing number of patients who suffer from obesity [1]. Transplant surgeons have especially struggled to adapt their practices as an increasing number of obese patients compete for a scarce supply of donor organs [2]. Generally, patients are considered transplant candidates if they have a reasonable chance of surviving for 5 years following surgery. Patient selection is complicated when this principle is combined with the paradoxical approach of prioritizing patients with the greatest severity of liver disease [3]. Under these circumstances, the survival statistics for obese patients has been very disappointing [4, 5]. Far more obese patients suffer from early death and donor graft loss than other transplant recipients. Early deaths are clearly caused by complications due to obesity. The death rate due to cardiovascular and pulmonary disease and complications of insulin resistance mirrors the higher rate of medical problems in obese patients in general. Previously, many obese and virtually all morbidly obese patients were denied access to transplantation [6]. However, the solution is not that easy anymore. It has become increasingly difficult to dismiss a growing segment of the patient population. In addition to treating more patients with obesity, nonalcoholic fatty liver disease (NAFLD) caused by obesity-associated insulin resistance has recently emerged as the third most common cause of liver disease in the USA [7]. Epidemiologists project that it will be the most prevalent cause of liver failure requiring transplantation in this next decade. The transplant community now thinks about the obese candidates differently. The question is not if we should transplant obese patients but rather how do we improve their outcome. Behavioral weight loss programs are usually the first line of treatment for obesity [8]. While many healthy patients have problems with compliance, these programs are usually unrealistic in patients who are ill and often have insulin resistance as part of their disease process. The disappointing results of behavioral programs as a single intervention brought attention to bariatric surgery as an adjunct means to achieve long-term weight loss. If bariatric surgery is that effective, then why not use it in liver transplant candidates? In fact, a new report of bariatric surgery in a transplant recipient appeared in the August issue of this journal [9]. That case report which described adjustable gastric banding during liver transplantation raised a number of interesting and important questions. At the very foundation of weight loss intervention is the pervasive question: how much weight does the patient have to lose to improve outcome. The growing number of patients with NAFLD makes this an urgent problem to solve. The American Gastroenterological Association suggests that patients with NAFLD should reduce their weight by 10% [10]. However, no one actually knows if this goal will work equally well for all patients with NAFLD or if it will have any effect in other types of liver disease? OBES SURG (2008) 18:1515–1516 DOI 10.1007/s11695-008-9712-7

A note on reification in Hegel's logic

A note on reification in Hegel's logic

Les représentations des cancers liés au tabac chez les jeunes de l'île de La Réunion

An anthropological study was conducted on the island of Reunion between March and September 2004 within the framework of a project called "The non-smoking generation" carried out by the Regional Committee for Health Education. The primary objective was to provide field workers with a basis for reflection which they could incorporate into their tobacco prevention activities aimed at young people. The perceptions of youth on tobacco-use related cancer were explored using a sample population group of 37 young people aged between 14 and 25 years old (girls and boys, smokers and non-smokers, those who attend school and those who don't) from across the island. Interviews were conducted using an anthropological analysis grid and completed through observational sessions in their homes, schools and neighborhoods. The results, set within the context of time and the places where tobacco is consumed, demonstrate that their relationship to cigarettes symbolises some of the inherent characteristics of adolescence, namely, the difficulty in finding and establishing one's own limits, in integrating oneself into society and in envisioning one's potential future. An interesting observation was also made regarding their views on the one hand of a paradoxical approach relating the development of cancer and tobacco consumption behaviour, and the real, concrete physical and psychological impact of the disease on the other. The young people often expressed a certain fatality and a feeling of control ("I can quit whenever I want to!"). The team also found within their remarks a sense of being unfortunate as opposed to that of being in control, coupled with fear as opposed to feeling invincible ("cancer only happens to other people"). Finally, the study has allowed for reflections on youth tobacco prevention interventions to be nurtured with respect to how individual young people position the consequences of tobacco use and smoking, mainly with regard to their own personal responsibility.

Wetlands - A Development Paradox: The Dilemma of South Chennai, India

The present study aims to bring to light the damage being wrecked to the wetlands in the south of the Metropolis of Chennai, India. It tries to raise the plea for the Ecologically sensitive and beneficial wetlands. The setting of the study includes the burgeoning real estate haven of Velachery. These Wetlands are being eaten up by the rampant urban sprawl and unscientific solid waste disposal. The relative callousness coupled with the paradoxical approach of the authorities to development is baffling. Sparring some protests from concerned NGOs and People, there has been very little constructive work for the wetlands and their salvation. The study has used Remote Sensing and Geographic information systems to analyse the extent of damage caused to the ecologically sensitive and essential wetlands. Specie Identification, Water quality analysis and Socio-economic surveys were carried out. It also suggests a Management Plan and hopes that this work would go a long way in the reclamation of this bountiful resource base. The authors of paper hope that this would be a valid step in the path to attain a much-needed salve for the wetlands that can at best remain mute witness to their own doom.

Mystical Contemplation and the Limits of the Mind: The Case of Sheqel ha-Qodesh

As was the case with medieval Jewish philosophy, the kabbalah of 13th-century Spain was profoundly concerned with the status of the human mind in its quest to comprehend and experience divine reality. Building on the legacy of Maimonides, the kabbalists were caught between the desire to achieve full theosophical gnosis and the conflicting assumption that God is utterly unknowable. This article studies the problem of epistemology in the thought of Rabbi Moses de Leon, one of the greatest Jewish mystics of the Middle Ages. My central conclusion is that de Leon advocated a paradoxical approach to theological knowledge-one which sought to dialectically balance the contemplative ideal with a radically negative mode of apophasis. In agreement with the general scholarly consensus that experiential elements underlie the metaphysical discourse of kabbalah, this study seeks to further demonstrate the manner in which epistemological concerns shape ontological discussions in medieval kabbalistic literature.

Nutritional treatment for gastrointestinal illnesses: future directions

Throughout the world, departments of gastroenterology often include a division or section for nutritional care. This is a logical inclusion because of the inextricable nature of gastrointestinal illnesses and impaired nutrient utilization. Despite this intuitive rationale, patients are frequently prescribed the most avant-garde medications, such as the newest cholesterol-lowering drug, without explicit dietary recommendations regarding limiting the intake of cholesterol. This paradoxical approach to treatment is partly due to the lack of formal nutritional training among most physicians caring for patients with gastrointestinal illnesses. In addition, most nutritional scientists are unfamiliar with the pathophysiological effects of gastrointestinal illnesses that impair nutrient utilization. Advances in research are uniting pharmacological and nutritional therapies into a new treatment, termed ‘nutritional pharmacotherapy’. Evidence-based confirmation of this important therapy is included in this issue of Current Opinion in Clinical Nutrition and Metabolic Care. Nutritional pharmacotherapy is defined as the use of nutrients that function more like drugs, sometimes used in combination with drugs to enhance nutrient utilization. Historically, clinical nutritionists have been deeply imbued in the ‘more is better’ ideology. This therapeutic approach led to futile attempts to correct nutrient deficits during the catabolic phases of gastrointestinal illnesses. Controlled clinical trials have shown that it is impossible to reverse gastrointestinal-induced catabolism with the prescription of large amounts of nutrients; moreover, this approach may be harmful, often resulting in liver dysfunction. An improved understanding of the mechanisms of catabolism in gastrointestinal illnesses has shown that increased production of counter-regulatory hormones and upregulation of pro-inflammatory cytokines create a metabolic milieu which in turn inhibits the utilization of large (repletion) amounts of nutrients. Because of their unique properties, nutrients with pharmacological effects (pharmaconutrients) are prescribed in small amounts, and are metabolized efficiently in the patient with altered gut function. Examples of pharmaconutrients include the anti-oxidative effects of micronutrients such as vitamins A, C, and E, selenium and zinc; enterotrophic responses of glutamine in the small intestine and butyrate in the colon; stimulation of the immune response with the omega-3 fatty acids; vasodilatory effects of arginine; and amelioration of components of the stress response with the administration of growth factors such as growth hormone and insulin-like growth factor-1. Escalating costs and precipitous changes in the demographics of healthcare delivery will mandate the prescription of pharmaconutrients in the home setting. This will perhaps be most evident in patients in need of elective gastrointestinal endotherapeutic procedures and surgery. Future preoperative preparations will probably include combinations of enterotrophic nutrients, anti-oxidants and immune stimulants before elective surgery such as total proctocolectomy and ileal-anal pouch for refractory ulcerative colitis. ln summary, pharmaconutrients provide exciting new treatments for patients with gastrointestinal disorders. These nutrients may directly affect the gut or may enhance the response to medications. Alternatively, pharmacological agents may improve the absorption of nutrients. Preliminary work suggests that pharmaconutrients may be useful as singular agents or, more likely, in combination with other nutrients or drugs. Pharmaconutrients will be prescribed in the home setting, and may provide prophylactic benefits for depleted patients in need of major gastrointestinal procedures and surgery. These intriguing nutrient-pharmacological agents may revolutionize the nutritional treatment of selected patients with disorders of the gut. Further investigations are warranted in well-controlled clinical trials.

Towards a Geocentric Framework of Organizational Form: A Holistic, Dynamic and Paradoxical Approach

Despite its increasing importance to the research and practice of organizational management, there is no consensus on how to describe, explain and prescribe network as an organizational form. Based upon the evidence of the Chinese network form within its institutional and cultural contexts, this paper seeks to make three contributions. First, it describes network as a unique form, different from other organizational forms and thus needing a new perspective. Second, it explains network form from a holistic, dynamic and paradoxical perspective by synthesizing economic, social and psychological rationalities. Third, it prescribes the ideal-typical network form by offering a geocentric framework of organizational form which is neither culture-blind (under-embedded) nor culture-bounded (over-embedded).

The workers’ compensation patient: A paradoxical cognitive-behavioral approach to rehabilitation

The literature indicates that whereas a wealth of interacting factors is involved, psychosocial issues are generally more important than are physical factors in predicting who will report an industrial injury and successfully return to work. However, patients have a strong tendency to maintain a focus on their physical symptoms.This somatizing tendency is fostered by the social stigma surrounding mental health needs, clinician bias against patients exhibiting emotional distress, and an adversarial industrial compensation system that challenges the integrity of patients and provides a lack of alternatives to disability. A paradoxical cognitive-behavioral treatment approach is presented that enables one to eventually address psychosocial issues by initially focusing on patient concerns about their physical condition. Five specific issues that need to be addressed for successful rehabilitation to occur are presented.The need for a consensus group to develop standardized assessment tools, treatment protocols, and outcome measures for multicenter studies is emphasized.

Development of clinical approaches to psychological study of family

This article reviewed the development of clinical approaches to psychological study of family. Five relevant issues were discussed: Viewpoints, paradoxical approach, family system, school system and prevention. First, epistemological bases for clinical family psychology were discussed. Then, some of paradoxical approaches in psychotherapy and family therapy were reviewed. An innovative approach to family system was introduced to exemplify the collaboration of clinical practitioners and basic researchers. Also, clinical approaches to school-system reform were reviewed in the context of systemic intervention. Finally, the future direction of clinical approaches in prevention research was suggested. It was also argued that complementary development of clinical and basic research in psychological study should attract much more attention of psychologists in every field.

Resisting Simulation: Heiner Muller's Paradoxical Approach to Theater and Audiovisual Media since the 1970s

Heiner Maller's writing and theater productions, at least since the late 1970s, seemed to tie-in with and thus buttress the very socio-cultural realities and type of cultural performances they, at the same time, were expected to resist vehemently. It even appears as if they simply reversed or at least contradicted what the author/director was expounding time and again. Two examples: His articles and interviews emphasized that their was no end to history or, more precisely, that history was, finally, open-ended. Maller wrote in 1979 that, Foucault's question as to what revolution is worth which price is a privileged question. He added, when Victor Shklovsky describes Eisenstein's film October as the end of the world of commodities made visual, he knows that the masses experience this end, for the time being, as restriction of commodity production.' The same year MUiller rather coolly commented on postmodernist discourses as a typical phenomenon of privileged intellectuals in the First World. Referring to the murals [Wandbilder] of the minorities and the proletarian art of the subway in New York that occupy a territory beyond the market, he hinted at the underprivileged masses' desire for fundamental societal transformation and at his own view that history was as an open-ended project.2 In 1980 he did his first-ever theater production, premiering The Task in

Feminist Discourse and Literary Representation in Turn-of-the-Century Greece: Kallirrhoe Siganou-Parren's "The Books of Dawn"

The second half of the nineteenth century was an era of reconstruction for the modern Greek state. The new nation struggled to redefine its ethnicity by means of a two-directional, ostensibly paradoxical approach: by modernizing its society, Westernizing it, and at the same time by rediscovering its fundamental Greekness in local customs and mores. The "woman question," which raised feminist awareness in Greek society toward the end of the nineteenth century, influenced the nation's cultural evolution. Literature began reflecting the new role women were expected to play in this evolution. Kallirrhoë Siganou-Parren, the leader of the feminist movement at the turn of the century, exploited the needs of society in the nascent Greek nation in order to advance her own feminist agenda. Toward this end, she wrote The Books of Dawn, a trilogy of novels that promote a new model of women, educated and independent but also maternal-capable of raising citizens willing to sacrifice everything for their nation's security and social progress. In addition, Parren's novels present a new gender relationship within marriage and a new, more liberal way of child-rearing.

A Paradoxical Approach to Teaching Group Dynamics: First Thoughts, First Findings

This article reports on an attempt to create an experiential group learning structure based on the paradoxical principles described in Smith and Berg's 1987 work, Paradoxes of Group Life. This learning structure departs from the group-on-group design described by Gillette and McCollom in their 1990 work, Groups in Context, in the role prescribed for the facilitator. In this structure, the facilitator is active in providing directions for each of the first five experiential sessions, directions that are intended to prompt members to explore together the influence on group life of (a) contradiction, (b) group membership, (c) opposition, and (d) negotiation with authority. The article includes case material from a single course in which this method was used and includes the authors' reflections on the opportunities and risks they observed in their initial attempt to put this approach into practice.

The effece of the Paradoxical Approach in the correctional counselling

The effece of the Paradoxical Approach in the correctional counselling

Paradoxical approach to the management of faecal incontinence in normal children.

Three children with faecal incontinence, in whom conventional treatment had failed, were managed with a regimen that focuses on the symptoms and present behaviour. It is short term and uses a paradoxical approach.

Client cooperative interview behavior and outcome in paradoxical and behavioral brief treatment approaches.

In this study, we investigated the differential implications of client cooperation for improvement in behavioral versus paradoxical brief treatment approaches. The subjects included 16 clients who completed a brief course of counseling, 9 in a paradoxical condition and 7 in a behavioral condition. Client cooperation versus resistance was assessed on the basis of behavior during intake interviews in terms of the coordinating style construct (Westerman, Tanaka, Frankei, & Kahn, 1986), which assesses how well the client coordinates contributions to the interaction with the interviewer's contributions and the client's own contributions at other points in time. As hypothesized, there was a stronger negative relation between noncoordinating style and improvement in the behavioral condition as compared with the paradoxical condition. The findings provide preliminary empirical support for the widely held position that a paradoxical approach is especially well suited for resistant clients, whereas behavioral approaches are appropriate for cooperative clients. There is now considerable interest in determining how to most effectively match clients and counseling approaches. One claim about matching has been put forward quite widely. According to this position, a paradoxical approach is the treatment of choice for difficult, resistant clients, whereas behavioral approaches are well suited for cooperative clients. This view has been advanced by proponents of both treatment approaches. In recent years, behavior therapists have recognized that client resistance plays a significant negative role in the outcome of behavioral treatment approaches (Goldfried, 1982; Patterson, 1984). They have argued that it is necessary to use special techniques when clients do not engage in the treatment process in an active, cooperative manner. The suggestion that paradoxical interventions may