How do adults with cystic fibrosis cope following a diagnosis of diabetes?

The official published version of the article can be obtained from the link below.Aim. This paper is a report of a study examining the experience of adults with cystic fibrosis in adapting to the diagnosis of diabetes, a second chronic illness. Background. Diabetes is a common complication of cystic fibrosis; the onset signifies the development of a second chronic illness. Both cystic fibrosis and diabetes are complex conditions, which require daily treatment schedules as part of their management. However, it is unclear how people already living with cystic fibrosis respond to the diagnosis of diabetes. Method. A qualitative method was chosen to obtain an ‘insider’ experience of adjusting to a second chronic illness. Semi-structured interviews were conducted in 2004 with 22 adults with cystic fibrosis-related diabetes. The data were analysed using interpretative phenomenological analysis. Findings. Four recurring themes were identified: emotional response to diagnosis of diabetes, looking for an understanding, learning to live with diabetes, and limiting the impact of diagnosis. Having cystic fibrosis appeared helpful in limiting the impact of the diagnosis of diabetes. Juggling conflicting dietary demands of cystic fibrosis and diabetes coupled with the lack of practical professional advice available was seen as one of the biggest challenges in adapting to diabetes. Conclusion. Healthcare professionals need increased awareness of diabetes amongst adults with cystic fibrosis and provide adequate support and structured evidence-based education throughout the course of the illness, particularly in relation to diet. Nevertheless, patients’ familiarity with regular daily routines and problem-solving attitudes, already developed in the context of cystic fibrosis, may be drawn on to limit the impact of diabetes

The role of art-making in identity maintenance: Case studies of people living with cancer

The aim of this qualitative research was to understand why some people with cancer take up art as a leisure activity, and how visual art-making in daily life might support identity maintenance/ reconstruction. The study forms part of a larger project with people who view art-making as a resource for living with chronic illness. In order to provide a detailed, holistic analysis, the paper focuses on the accounts and artwork of three participants, two women (aged 47 and 59) each with breast cancer, and a man (aged 51) with stomach and lung cancer. The participants turned to art after a process of reflection but did not necessarily reject their pre-illness lifestyles or selves. Rather, art-making afforded many opportunities to retain familiar personal and social identities, and to resist being dominated by labels related to their illness. A practical implication is that people coping with cancer may need not only cognitive and emotional support, but opportunities to find meaningful activities. Such activities can be understood to have a powerful role in maintaining a familiar, positive identity in cancer, and providing a resource for coping

“Sticking jewels in your life”: Exploring women’s strategies for negotiating an acceptable quality of life with multiple sclerosis

This study explored women’s strategies for living with multiple sclerosis (MS). Twenty-seven women were interviewed, most of whom had lived with MS for more than five years. Analysis of the semi-structured interviews followed the interpretative phenomenological approach. The women portrayed living with MS as an ongoing process of negotiation, and described gaining quality of life through looking after their health; maintaining a familiar self-image, particularly through meaningful occupations, and adapting pre-illness skills and interests to their changing levels of physical functioning; actively valuing positive life experiences, including finding benefits in adversity; clarifying values, priorities and philosophy of life; and maintaining mutual, caring relationships. Some regarded MS as presenting opportunities for personal growth. Without minimizing the very substantial difficulties that MS presents, the findings suggest that well-being derives from both managing the illness and also embracing life’s wider experiences, including change and growth. Implications for rehabilitation and counseling professionals are considered

Sporadically Torqued Accretion Disks Around Black Holes

The assumption that black hole accretion disks possess an untorqued inner boundary, the so-called zero torque boundary condition, has been employed by models of black hole disks for many years. However, recent theoretical and observational work suggests that magnetic forces may appreciably torque the inner disk. This raises the question of the effect that a time-changing magnetic torque may have on the evolution of such a disk. In particular, we explore the suggestion that the ``Deep Minimum State'' of the Seyfert galaxy MCG--6-30-15 can be identified as a sporadic inner disk torquing event. This suggestion is motivated by detailed analyses of changes in the profile of the broad fluorescence iron line in XMM-Newton spectra. We find that the response of such a disk to a torquing event has two phases; an initial damming of the accretion flow together with a partial draining of the disk interior to the torque location, followed by a replenishment of the inner disk as the system achieves a new (torqued) steady-state. If the Deep Minimum State of MCG--6-30-15 is indeed due to a sporadic torquing event, we show that the fraction of the dissipated energy going into X-rays must be smaller in the torqued state. We propose one such scenario in which Compton cooling of the disk corona by ``returning radiation'' accompanying a central-torquing event suppresses the 0.5-10 keV X-ray flux coming from all but the innermost regions of the disk.Comment: 12 pages, 24 figures, ApJ accepte

Network Regulation Using an Agent

This paper introduces a new regulatory concept: the independent profit-maximising regulatory agent, as a possible model for regulating network industries where complex demand interdependencies, in particular demand complementarities, make traditional methods of regulation difficult. We derive a simple theoretical network model with differentiated demands and explore alternative competitive and regulatory strategies. We show that the employment of an independent profit-maximising agent may offer a partial solution to the problem of network regulation, yielding outcomes which involve all parties pursuing their own interests yet are relatively desirable to both firms and society

Iron line reverberation mapping with Constellation-X

The broad X-ray iron line seen in the spectra of many AGN is thought to originate from the inner regions of the putative black hole accretion disk, and hence provides a rare probe of that central region. In principle, future high throughput X-ray spectrometers should be able to examine the temporal response of this fluorescent line to flares in the X-ray continuum source (which energizes this emission line) - i.e. iron line reverberation mapping will be possible. It has been previously found that there are robust reverberation signatures of the black hole spin, mass and the X-ray flare location above the accretion disk. Here, we simulate observations of a bright Seyfert nucleus with the proposed NASA mission Constellation-X and demonstrate the feasibility of detecting these reverberation signatures with this mission. Hence, starting with XMM in 1999, and maturing with Constellation-X in c2010, iron line reverberation will open a new window on the innermost regions of AGN.Comment: 7 pages, 7 figures (some compressed postscript). Accepted for publication in Ap

Angle-resolved photoemission spectroscopy of band tails in lightly doped cuprates

We amend ab initio strongly-correlated band structures by taking into account the band-tailing phenomenon in doped charge-transfer Mott-Hubbard insulators. We show that the photoemission from band tails accounts for sharp "quasi-particle" peaks, rapid loss of their intensities in some directions of the Brillouin zone ("Fermi-arcs") and high-energy "waterfall" anomalies as a consequence of matrix-element effects of disorder-localised states in the charge-transfer gap of doped cuprates.Comment: 4 pages, 4 figure