Paradoxical Relationship Research Articles

Right heart failure as a cause of pulmonary congestion in pulmonary arterial hypertension.

Recent studies have shown that lung ultrasound-assessed pulmonary congestion is worse in heart failure when pulmonary vascular resistance (PVR) is increased, suggesting a paradoxical relationship between right heart failure and increased lung water content. Accordingly, we wondered if lung ultrasound would reveal otherwise clinically silent pulmonary congestion in patients with pulmonary arterial hypertension (PAH). All patients referred for suspicion of PAH in a tertiary centre from January 2020 to December 2022 underwent a complete diagnostic work-up including echocardiography, lung ultrasound and right heart catheterization. Pulmonary congestion was identified by lung ultrasound B-lines using an 8-site scan. The study enrolled 102 patients with idiopathic PAH (mean age 53 ± 13 years; 71% female). World Health Organization functional classes I, II, and III were found in 2%, 52%, and 46% of them, respectively. N-terminal pro-brain natriuretic peptide (NT-proBNP) was 377 pg/ml (interquartile range [IQR] 218-906). B-lines were identified in 77 out of 102 patients (75%), with a median of 3 [IQR 1-5]. At univariable analysis, B-lines were positively correlated with male sex, age, NT-proBNP, systolic pulmonary artery pressure (sPAP), right atrial pressure (RAP), PVR, left ventricular end-diastolic volume and tricuspid annular plane systolic excursion (TAPSE), and negatively with cardiac output and stroke volume. At multivariable analysis, RAP (p < 0.001), TAPSE/sPAP (p = 0.001), and NT-proBNP (p = 0.04) were independent predictors of B-lines. Lung ultrasound commonly discloses pulmonary congestion in PAH. This finding is related to right ventricular to pulmonary artery uncoupling, and may tentatively be explained by increased central venous pressure impeding lymphatic outflow.

Michel Serres’s Le parasite: the noise of the world at work

ABSTRACT A universal irreversible movement, a single downward-pointing arrow gives rise to a second movement, parasitic upon the first but pointing in the opposite direction, towards an ever greater diversity and degree of organisation. This definition of the parasite is illustrated in the paradoxical relation between entropy and evolution. Starting from references scattered throughout the text, this article aims to elucidate and reconstruct the ‘fundamental thesis’ of Le parasite which grows out of Serres’s intimate knowledge of nineteenth-century science and in particular thermodynamics, which is the starting-point of his theory of ‘noise’ affecting all transfers of energy or meaning.

Digital technologies and corporate green innovation: opening the “black box” of resource orchestration mechanisms

PurposeDriven by the dual-carbon target and the widespread digital transformation, leveraging digital technology (DT) to facilitate sustainable, green and high-quality development in heavy-polluting industries has emerged as a pivotal and timely research focus. However, existing studies diverge in their perspectives on whether DT’s impact on green innovation is synergistic or leads to a crowding-out effect. In pursuit of optimizing the synergy between DT and green innovation, this paper aims to investigate the mechanisms that can be harnessed to render DT a more constructive force in advancing green innovation.Design/methodology/approachDrawing from the theoretical framework of resource orchestration, the authors offer a comprehensive elucidation of how DT intricately influences the green innovation efficiency of enterprises. Given the intricate interplay within the synergistic relationship between DT and green innovation, the authors use the fuzzy-set qualitative comparative analysis method to explore diverse configurations of antecedent conditions leading to optimal solutions. This approach transcends conventional linear thinking to provide a more nuanced understanding of the complex dynamics involved.FindingsThe findings reveal that antecedent configurations fostering high green innovation efficiency actually differ across various stages. First, there are three distinct configuration patterns that can enhance the green technology research and development (R&D) efficiency of enterprises, namely, digitally driven resource integration (RI), digitally driven resource synergy (RSy) and high resource orchestration capability. Then, the authors also identify three configuration patterns that can bolster the high green achievement transfer efficiency of enterprises, including a digitally optimized resource portfolio, digitally driven RSy and efficient RI. The findings not only contribute to advancing the resource orchestration theory in the digital ecosystem but also provide empirical evidence and practical insights to support the sustainable development of green innovation.Practical implicationsThe findings can offer valuable insights for enterprise managers, providing decision-making guidance on effectively harnessing the innovation-driven value of internal and external resources through resource restructuring, bundling and leveraging, whether with or without the support of DT.Social implicationsThe research findings contribute to heavy-polluting enterprises addressing the paradoxical tensions between digital transformation and resource constraints under environmental regulatory pressures. It aims to facilitate the simultaneous achievement of environmental and commercial success by enhancing their green innovation capabilities, ultimately leading to sustainability across profit and the environment.Originality/valueCompared with previous literature, this research introduces a distinctive theoretical perspective, the resource orchestration view, to shed light on the paradoxical relationship on resource-occupancy between DT application and green innovation. It unveils the “black box” of how digitalization impacts green innovation efficiency from a more dynamic resource-based perspective. While most studies regard green innovation activities as a whole, this study delves into the impact of digitalization on green innovation within the distinct realms of green technology R&D and green achievement transfer, taking into account a two-stage value chain perspective. Finally, in contrast to previous literature that predominantly analyzes influence mechanisms through linear impact, the authors use configuration analysis to intricately unravel the complex influences arising from various combinatorial relationships of digitalization and resource orchestration behaviors on green innovation efficiency.

Fostering green progress: The dual influence of natural resource rent and human capital on emerging economy energy transition

AbstractThe scale and complexity of the energy transition pose formidable challenges. For the fast‐track progress of energy transition, emerging economies must identify the barriers to a successful transition. This study aims to investigate the role of natural resource depletion and human capital in achieving clean energy affordability and climate action through successful energy transition in emerging economies from 1990 to 2021. The study used quantile regression to analyze and estimate the relationship between variables at different conditional quantiles. The outcomes of the analysis suggest that natural resource depilation, human capital, and economic growth significantly facilitate the energy transition in emerging economies at all quantiles (Q0.10 – Q0.90), while the study identifies a paradoxical inverse relationship between financial development and energy transition across all quantiles, which implies that it impedes the transformation from traditional fossil fuels to the green energy resources. The study's outcomes suggest policy implications for advancing the energy transition in the context of natural resources and human capital management for emerging economies.

Abstract TP123: Impact of Hospital Procedure Volume of Mechanical Thrombectomy on Outcomes in Patients With Acute Ischemic Stroke in the United States

Background: Hospitals with higher procedure volume are more likely to have lower rates of death or disability, with most neurovascular surgical and endovascular procedures. The volume of mechanical thrombectomy (MT) performed at hospitals is used as one of the criteria for advanced-level designation for stroke care. Objective: To determine the relationship between procedure volume for MT and in-hospital outcomes in acute ischemic stroke patients in the United States. Methods: We analyzed the nationally representative data from the Nationwide Inpatient Sample (NIS) from 2016 to 2020. The hospitals were grouped into quartiles based on the volume of MT procedures performed within the calendar year. We compared the rates of routine discharge/home health care (excluding those with palliative care), in-hospital mortality, and post-treatment intracranial hemorrhage (ICH) between the quartiles after adjusting for potential confounders. Results: In the logistic regression analysis, the odds of post-procedure ICH increased to 1.81 (p&lt;0.001), 1.84 (p&lt;0.001), and 1.98 (p&lt;0.001) among the quartiles from lowest to highest procedural volumes after adjusting for potential confounders including clinical severity makers. The odds of home discharge/self-care decreased to 0.66 (p&lt;0.001), 0.60 (p&lt;0.001), and 0.63 (p&lt;0.001) among the quartiles from lowest to highest procedural volumes. The odds of in-hospital mortality increased to 1.92 (p&lt;0.001), 1.99 (p&lt;0.001), and 1.84 (p&lt;0.001) among the quartiles from lowest to highest procedural volumes. Conclusions: We observed a paradoxical relationship between adverse outcomes and procedure volume of MT at the hospital, presumably due to the higher severity of acute ischemic stroke at high-volume hospitals.

Elucidating the paradox of sustainable art consumption: an interdisciplinary analysis

This study scrutinizes the paradoxical relationship between the burgeoning demand for sustainable materials and the persisting environmental impact of the global art market. Its interdisciplinary inquiry, methodologically informed by a survey and interviews with art gallery managers, seeks to elucidate the driving forces behind this phenomenon, comprehend the contribution of sustainable art consumption within an interdisciplinary framework, and identify potential strategies to foster a genuinely sustainable art market. The interdisciplinary analysis unveils a combination of several influential factors perpetuating the paradox of sustainable art consumption, such as socioeconomic forces, artistic motives and values, and regulatory and policy shortcomings. Implications for art market structures and rules, as well as policy and regulations, are discussed. Further, the article looks into the limitations in implementing the proposed framework, predominantly concerning resource constraints, the art market’s diversity and complexity, and the delicate balance between artistic freedom and sustainability. Additionally, it addresses challenges such as enforcement and compliance, measuring and monitoring impact, collaboration and coordination, and adaptation to a perpetually evolving market. The article provides a comprehensive argument for the pressing need to reconcile the art market’s ecological footprint with the rising demand for sustainability, offering potential avenues for achieving a truly sustainable global art market.

‘You have a lot of mirrors’: structural and socioecological factors impacting adolescent pregnancy and reproductive health in the Amazon basin, Peru, a qualitative study

Loreto, in the Peruvian Amazon, has one of the highest adolescent pregnancy rates in the country. However, underlying causes of adolescent pregnancy are not fully understood as data are limited in Indigenous and remote Amazonian communities. This study investigated adolescent reproductive health within Loreto using an ecological systems framework. Forty-one semi-structured interviews were conducted in June 2022: community leaders (n = 12) and adolescent participants between 15 and 17 years of age (pregnant girls, n = 11; never pregnant girls, n = 9; and boys, n = 9). We also conducted focus group discussions with community health workers and educators in October 2022 (three focus groups, n = 15). Adolescent reproductive health is complex with multi-layered factors that put girls at higher risk of pregnancy. We found a paradoxical relationship between expected social and gender norms and individual desires. This research provides a contextual understanding of the lived experience of adolescents and young people in the Amazon region of Peru. Our findings suggest the need for greater exploration of the contradictory ideas surrounding adolescent pregnancy and female sexuality.

Vitamin D/Bone Mineral Density and Triglyceride Paradoxes Seen in African Americans: A Cross-Sectional Study and Review of the Literature.

Vitamin D is known to have a positive effect on bone health. Despite the greater frequency of vitamin D deficiency in African Americans (AA), they have a higher bone mineral density (BMD) compared to whites, demonstrating a disconnect between BMD and vitamin D levels in AA. Another intriguing relationship seen in AA is the triglyceride (TG) paradox, an unusual phenomenon in which a normal TG status is observed even when patients house conditions known to be characterized by high TG levels, such as Type II diabetes. To the best of our knowledge, no study has examined whether these two paradoxical relationships exist simultaneously in AA subjects with Type II diabetes. In this study, we compared levels of blood markers, including HbA1c, TG, and vitamin D, measured as serum 25-hydroxyvitamin D [25(OH)VD] µM/mL, [25(OH)VD]/TG, calcium, and BMD in AA (n = 56) and white (n = 26) subjects with Type II diabetes to see whether these relationships exist concurrently. We found that AA subjects had significantly lower TG and [25(OH)VD] levels and a significantly higher BMD status compared to white subjects, even when the ages, BMI, duration of diabetes, HbA1c, and calcium levels were similar between the two groups. This demonstrates that these two paradoxical relationships exist simultaneously in Type II diabetic AA subjects. In addition to these findings, we discuss the current hypotheses in the literature that attempt to explain why these two intriguing relationships exist. This review also discusses four novel hypotheses, such as altered circulating levels and the potential role of estrogen and hydrogen sulfide on BMD and HMG-CoA reductase as a possible contributor to the TG paradox in AA subjects. This manuscript demonstrates that there are still many unanswered questions regarding these two paradoxical relationships and further research is needed to determine why they exist and how they can be implemented to improve healthcare.

Abstract A028: Multiomic modelling of pancreatic IPMN stroma reveals distinct tertiary lymphoid structure distribution: Mapping the transcriptomic landscape via regional bulk, single-cell and subcellular approaches

Abstract Background Intraductal Papillary Mucinous Neoplasms (IPMN) remain the largest subtype of cystic pancreatic cancer precursors. Cancer risk has been observed to vary between histological grades and histological subtypes. Spatial characterisation has revealed variation in immune cell distribution disease subtypes. Methods A cohort of 14 surgically resected IPMN tumors across a range of histological grades (Low-grade LG, high-grade HG and invasive IPMN cancers IPMN-PDAC) and subtypes (gastric, intestinal, pancreaticobiliary) underwent multimodal spatial interrogation. After expert histopathological annotation; tissue sections underwent regional whole transcriptome analysis with TempO-seq and 10x Visium. Extensive region analysis with NanoString GeoMx employing segmentation using staining for epithelium (PanCK) fibroblast stroma (aSMA) was performed. A tissue microarray was then constructed, and representative cores underwent single-cell and subcellular spatial transcriptomic analysis with NanoString CosMx. Raw count data and digital images were exported and analysed using Seurat, Giotto, SPATA2 and custom R pipelines. Region deconvolution, Harmony integration, Leiden Clustering, Gene Set Enrichment Analysis, Trajectory Mapping, and Moran’s I Analysis were performed. Results TempO-seq revealed up-regulation of canonical oncogene expression in all IPMN-PDAC cases as compared to LG and HG IPMN. There were no statistically significant differences in expression comparing LG and HG IPMN lesions. Visium differential gene expression and clustering models identified cancer epithelium, stroma and lymphatic components that correlated with histopathological annotations. Immune cell rich spots were identified via gene ontology of top 50 marker genes. The spatial trajectory of B-cell expression signatures in IPMN-PDAC showed greater concentration and less variability than HG tumors, Moran’s I -0.34 vs 0.12 (P = 0.021). B-cells in HG IPMN were showed greater concentration and less variability than LG IPMN, Moran’s I -0.15 vs 0.02 (P=0.05). Much of this concentration was in identified lymphoid aggregates or tertiary lymphoid structures. The spatial trajectory of T-cell expression. The spatial trajectory of macrophage expression showed greater concentration and less variability than in LG and HG tumors. GeoMx analysis of stromal regions identified up regulation of B cell signatures in IPMN PDAC and HG IPMN when compared to LG IPMN. Markers associated with TLS formation were found to be significantly upregulated including CXCL13, CXCR5 and LAMP3. Pancreaticobiliary subtypes were found to have the least concentrated B-cell distribution across subtypes. Conclusions Immune cell composition was found to vary across histological grades and subtypes of IPMN. A paradoxical relationship was observed between T-cell infiltrates and B-cell and macrophage populations. The greater proportion of tertiary lymphoid structures, and high levels of TLS specific gene expression, may indicate a propensity for b-cell activation in IPMN tumors which progress to malignancy. Citation Format: Andrew J. Cameron, Assya Legrini, Colin S. Wood, Craig Nourse, Yoana Doncheva, Claire Kennedy Dietrich, Colin Nixon, Jennifer Hay, Fraser Duthie, Pawel Herzyk, Jennifer Morton, Nigel B. Jamieson. Multiomic modelling of pancreatic IPMN stroma reveals distinct tertiary lymphoid structure distribution: Mapping the transcriptomic landscape via regional bulk, single-cell and subcellular approaches [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Pancreatic Cancer; 2023 Sep 27-30; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(2 Suppl):Abstract nr A028.

Lipoprotein-associated phospholipase A2 predicts cardiovascular death in patients on maintenance hemodialysis: a 7-year prospective cohort study

BackgroundCardiovascular diseases (CVD) is the leading cause of death among maintenance hemodialysis patients, with dyslipidemia being a prevalent complication. The paradoxical relationship between cardiovascular outcomes and established lipid risk markers, such as low-density lipoprotein cholesterol (LDL-C), complicates lipid management in this population. This study investigated Lipoprotein-associated phospholipase A2 (Lp-PLA2), an emerging biomarker known for its proinflammatory and proatherogenic properties, as a potential cardiovascular prognostic marker in this cohort. In this context, the association between Lp-PLA2 levels and cardiovascular outcomes was evaluated, with the aim to facilitate more accurate stratification and identification of high-risk individuals.MethodsFrom August 2013 to January 2014, 361 hemodialysis patients were prospectively enrolled. Lp-PLA2 activity and laboratory measures at baseline were quantified. Comorbidities and medications were recorded. All patients were followed until the end of April, 2022. The individual and combined effects of Lp-PLA2 activity and LDL-C on patient outcomes were examined. The association between Lp-PLA2 activity and all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events (MACEs) was analyzed.ResultsThe median Lp-PLA2 activity was 481.2 U/L. In subjects with Lp-PLA2 activity over 481.2 U/L, significantly higher total cholesterol (4.89 vs. 3.98 mmol/L; P < 0.001), LDL-C (3.06 vs. 2.22 mmol/L; P < 0.001), and apolipoprotein B (0.95 vs. 0.75 mmol/L; P < 0.001) were observed. Over a median follow-up of 78.1 months, 182 patients died, with 77 cases identified as cardiovascular death, 88 MACEs happened. Cardiovascular mortality and MACEs, but not all-cause mortality, were significantly increased in the high Lp-PLA2 group. Cox regression analyses showed that high Lp-PLA2 activity was associated with cardiovascular mortality and MACE occurrence. After comprehensive adjustment, high Lp-PLA2 activity was independently associated with cardiovascular mortality(as a dichotomous variable: HR:2.57, 95%CI:1.58,4.18, P < 0.001; as a continuous variable: HR:1.25, 95%CI:1.10,1.41, P = 0.001) and MACEs(as a dichotomous variable: HR:2.17, 95%CI:1.39,3.40, P = 0.001; as a continuous variable: HR:1.20, 95%CI:1.07,1.36, P = 0.002). When participants were grouped by median Lp-PLA2 activity and LDL-C values, those with high Lp-PLA2 and low LDL-C had the highest CV mortality. The addition of Lp-PLA2 significantly improved reclassification (as a dichotomous variable NRI = 42.51%, 95%CI: 5.0%,61.33%; as a continuous variable, NRI = 33.32%, 95% CI: 7.47%,56.21%).ConclusionsHigh Lp-PLA2 activity is an independent risk factor for cardiovascular mortality and MACEs occurrence in patients on hemodialysis. The combined measures of Lp-PLA2 and LDL-C help to identify individuals with a higher risk of cardiovascular death.

Abstract B013: A quest for deeper understanding of BRCA2 Variants of Uncertain Significance (VUS)

Abstract Deleterious mutations in homology-directed repair pathway genes impact both future cancer risk and therapeutic intervention options for cancer diagnosis and prognosis. Homology-directed repair pathway is a high-fidelity DNA repair pathway for resolving double-strand breaks (DSBs) throughout the human genome. BRCA2, as a homology-directed repair factor, is essential to ensure genome integrity through an error-free process. Deleterious BRCA2 mutations increase the lifetime risk of breast, ovarian, melanoma, prostate, and pancreatic cancers. Deleterious BRCA2 mutations cover only 25% of the total BRCA2 mutations identified in the population by genetic testing whereas 60% are mutations with unknown connection to the disease called Variants of Uncertain Significance (VUS). The majority of BRCA2 VUS are missense mutations with one point mutation which could potentially alter BRCA2 cellular localization and/or nuclear functions. Thus, evaluating BRCA2 cellular localization and function in BRCA2 missense carriers and tumors is urgently needed to provide clinical guidance regarding cancer risk and treatment options. We have identified a paradoxical relationship between BRCA2 nuclear import and treatment. Deleterious missense mutations in the DNA binding domain of BRCA2 direct the protein to the cytosol which increase sensitivity to PARP inhibitors (PARPi) and platinum drugs. Therefore, although BRCA2 mislocalization might be a cause of cancer, keeping it out of the nucleus allows for much better treatment outcomes. Here, we present how BRCA2 cancer-driver missense mutations lead to cytosolic mislocalization and how BRCA2 localization can be used as a diagnostic tool to stratify patients. Our robust multi-step molecular approach will guide future clinical decision rules surrounding BRCA2 VUS. By providing reliable and accurate functional assays to correctly evaluate the pathogenicity of BRCA2 VUS, our goal is to improve personalized medicine by providing actionable information to patients and their physicians. Citation Format: Cole Niedmann, Judit Jimenez Sainz. A quest for deeper understanding of BRCA2 Variants of Uncertain Significance (VUS) [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: DNA Damage Repair: From Basic Science to Future Clinical Application; 2024 Jan 9-11; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2024;84(1 Suppl):Abstract nr B013.

Obesity and the obesity paradox in abdominal aortic aneurysm.

Obesity, characterized by its complexity and heterogeneity, has emerged as a significant public health concern. Its association with increased incidence and mortality of cardiovascular diseases stems not only from its complications and comorbidities but also from the endocrine effects of adipose tissue. Abdominal aortic aneurysm (AAA), a chronic inflammatory condition, has been closely linked to obesity. Intriguingly, mild obesity appears to confer a protective effect against AAA mortality, whereas severe obesity and being underweight do not, giving rise to the concept of the "obesity paradox". This review aims to provide an overview of obesity and its paradoxical relationship with AAA, elucidate its underlying mechanisms, and discuss the importance of preoperative weight loss in severely obese patients with AAA.

Materialistic Ambitions: A Critical Exploration of Wealth, Identity, and Cultural Reflection in Daniel Defoe's Robinson Crusoe

This research paper critically examines the materialist issues embedded in Daniel Defoe's seminal novel, Robinson Crusoe. It provides a comprehensive analysis of how material goods are depicted, their significance, and their impact on characters and their environment. The study explores the influence of material wealth on identity formation, examining Crusoe’s transformation through his accumulation of goods and the construction of his fortification as a manifestation of materialism and power. Additionally, it investigates the paradoxical relationship between materialism and isolation, considering how Crusoe’s material possessions offer both comfort and contribute to his sense of seclusion. The character of Friday is analyzed to critique materialism, highlighting the contrasts between Crusoe’s European materialism and Friday’s indigenous perspective. The paper also explores the link between materialism and colonialism, demonstrating how Crusoe’s actions reflect broader colonial attitudes and power dynamics. Employing a qualitative methodology, the research integrates close textual analysis with insights from prominent literary critics. Excerpts from the novel, supported by precise citations, substantiate the arguments presented. The findings illuminate the multifaceted nature of materialism in the novel, showing how material goods shape the protagonists' identities, provide solace, and inflict suffering. The study underscores the degrading effects of materialism and its implications for power and colonialism. This paper contributes to the scholarly discourse on Robinson Crusoe by offering a nuanced understanding of its materialist themes and their broader social and cultural implications, reaffirming the novel's relevance and significance in contemporary literary studies.

Unpacking the paradoxical impact of ethical leadership on employees' pro-social rule-breaking behavior: The interplay of employees' psychological capital and moral identity.

This study delves into the complex dynamics of ethical leadership's influence on employees' pro-social rule-breaking behavior, taking into account the mediating role of psychological capital and the moderating effect of moral identity. Using data collected from nursing staff in Pakistani hospitals and analyzed through PLS SEM, the study yielded unexpected results. Contrary to the initial hypotheses, the findings reveal a positive relationship between ethical leadership and employees' pro-social rule-breaking behavior within organizational settings. Furthermore, the study identifies psychological capital as a key mediator in this relationship, while moral identity emerges as a crucial moderator. These results challenge the conventional perception of ethical leadership as an exclusively positive form of leadership and underscore its unintended consequences. Moreover, they underscore the significance of employees' psychological processes and individual differences in unraveling this paradoxical relationship. These results have the potential to reshape how organizations view ethical leadership and consider the unintended outcomes it may generate. Future research can build upon these findings to explore the boundaries and contextual factors that influence the effects of ethical leadership, ultimately contributing to a more comprehensive understanding of leadership dynamics in diverse organizational settings.

How the Nineteenth-century Evangelical Revival Strengthened Faith and Undermined Christendom

This article deals with the paradoxical relationship between the nineteenth-century Evangelical Revival and secularization. It is argued here that the revival and its worldview played a role in increasing pluralism and choice in the nineteenth century – a process often related to secularization. The Evangelical movement both attempted to oppose modernity and rationalism and emphasized religious freedom, voluntarism, and individualism. It therefore induced and popularized self-reflection, doubt, and deconversion. It also favoured religious democracy in opposition to a state-imposed religious monopoly (at least in northern Europe). Furthermore, by dividing people into believers and nonbelievers, it emphasized religious polarization. This contributed to an undermining of established religious structures, fragmenting and pluralizing the religious landscape and giving people the option to abstain completely from religious commitment. The Swedish confessional (inner mission) revivalist denomination Evangeliska Fosterlands-Stiftelsen (EFS – approx. the Swedish Evangelical Mission Society), founded in 1856, is used as a case. The popular literature they published and distributed manifested an evangelical worldview. In this article four themes, based on the popular literature, are used to study empirically the changing role of religion in relation to nineteenth-century revivalism: ‘the dualistic worldview’; ‘conversion’; ‘activism’; and ‘self-reflection’.

A Christian Engagement and Interpretation of Ga Rites of Passage and the Kpelelogical Theological Method

The paper studies the dialogical relationship between the gospel and Ga rites of passage. There is a paradox in this relationship which only becomes meaningful only by considering its mediation through the person and works of Jesus Christ. This view allows a mutual critical approach which resolves the paradox of the initial rejection of Ga rites of passage by the gospel and their later acceptance after they have been transformed and preserved by the mystery of Christ. In this way, Ga rites of passage become useful in the light of the death and resurrection of Jesus Christ, while the gospel adds on to itself the contextual elements of Ga holistic existence. The paper looks at how this paradoxical relationship between Ga rites and the Christian gospel underlies the processes transforming the liturgy of the Presbyterian Church of Ghana and helping to preserve important Ga traditions and culture in Christianity for of church and of society.

The Paradox of Choice in Healthcare: Treating Decision Paralysis

It is widely accepted that having more choices is inherently positive. When there are more available options from which to choose, an individual is more likely to be able to select the particular option that is the best fit and most likely to satisfy them. Hence, choice is typically thought to be related to personal freedom and enhanced well-being. Therefore, for most individuals the ultimate goal is to constantly maximize their choices in life to increase their overall satisfaction and well-being. The decision-making process, however, is a complex cognitive task that does not always lead to positive outcomes. In this article we discuss the decision-making process under the paradox of choice model. We shed light on the paradoxical relationship that increased choice has in the medical practice: instead of giving individuals the freedom to choose the best course of action to improve their overall satisfaction and well-being, overwhelming individuals with too much choice is actually found to be associated with decision paralysis, dissatisfaction, and diminished well-being. The purpose of this article is to draw attention to the consequences of choice overload in healthcare, and to help both practitioners and patients to avoid decision paralysis.

Retailers view on customer loyalty – a social resource theory perspective

ABSTRACT This study elaborates on the concept of loyalty. Strategic work to increase loyalty such as loyalty programs is increasingly being questioned. Using a relational perspective, viewing loyalty as an ongoing process of social exchanges, the paradoxical relationship between loyalty strategies and customer loyalty is underlined. The empirical data comprised qualitative interviews with eight key managers in Swedish retail companies. The result shows that loyalty programs foster rational shopping behaviours, misinterpreted by the retailers as loyalty. Thus, the concrete nature of loyalty programs make the customers less loyal only returning the concrete resources given. Particular resources will not be given by customers if none are offered by retailers. From the perspective of social exchanges, a shift from tangible rewards to forming meaningful emotional bonds is needed in order to achieve customer loyalty.

An integrated analysis of transcriptome and metabolome reveals three BCAAs relieve lipid accumulation by inhibiting lipid synthesis and promoting lipid oxidation in the liver of largemouth bass (Micropterus salmoides)

The intricate and paradoxical relationship between branched-chain amino acids (BCAAs) and lipid metabolism has been focused on the field of nutrition. However, the molecular mechanism mediated by BCAAs in the lipid metabolism of fish is poorly understood. To address this knowledge gap, we characterized the transcriptome and metabolome in the liver of largemouth bass (Micropterus salmoides), an extensively cultivated fish with high commercial value. Dietary BCAA supplementation significantly enhanced growth performance, combined with the elevation of essential amino acid levels and the improvement of liver health. Moreover, enzymatic detection and RT–qPCR results showed that BCAAs decreased lipid deposition in the liver. Integrated transcriptomics and metabolomics analysis revealed that the inhibition of lipid synthesis and enhancement of fatty acid degradation may explain the mechanism by which BCAAs relieved lipid accumulation in the liver. The metabolic enzymes acaca, acaa2, cpt2, acat, and aldh9a1, which were regulated by all three BCAAs, are key targets linking BCAA metabolism and lipid metabolism. Considering that farmed fish suffer from abnormal lipid accumulation in the liver, appropriate BCAA supplementation is an effective nutritional strategy to improve lipid metabolism disorders in aquaculture.

Transitioning to a Circular Economy: Paradoxical Tensions of the Circular Business Model

The circular economy is seen as a way to replace the dominant linear business models, which are based solely on increasing economic value. However, organisations transitioning to a circular business model usually face multiple tensions arising from the paradoxical relationship between achieving circularity and creating economic value. Therefore, we combine the literature on circular business models and paradox theory to systematise knowledge on paradoxical tensions that occur while transitioning to circular business model. Following an abductive approach, the research methodology employs semi-structured interviews and observation in the cross-sectorial manufacturing context. The research results allow us to identify novel insights into organisational-level tensions, namely, goal setting, performance orientation, compliance, in-network collaboration, and innovation adoption. In addition, we define the concept of a strategic paradox in the circular economy, which acknowledges the tension between true circular products and products as usual.