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Background: SCARF (Status, Certainty, Autonomy, Relatedness and Fairness) is a neuroscience model based on reward and threat that has been used in a number of areas, such as coaching and group facilitation including practice development, performance management and leadership development. Aim: The aim of this article is to understand readiness for transformation in the workplace by considering the impact of a new philosophy of care called ‘reablement’ on behaviour change in health services staff, using a modified SCARF questionnaire. Methods: The quantitative survey was nested in a larger health services project to introduce the philosophy of reablement to 166 staff members of a regional community care organisation. The data collection instrument was modified to combine the five SCARF domains into statements related to reablement. Data were collected from participants at six timepoints before and after project staff training. Results: The results show that for each SCARF domain, staff responses remain relatively stable. Results indicate a consistently positive response to the philosophy of reablement, reflecting a high level of comfort and engagement with the change-management process. Conclusion: Evaluating reflection and change over time using SCARF can support training and other methods of change management in the context of a community care organisation. Further development is needed with different groups, and different change-management projects within health services. Implications for practice: The SCARF model can be applied to organisational change in health and community care with benefits for clients, staff, stakeholders and the organisation as a whole This model has previously been used to improve organisational communication and collaboration but this article suggests it also has a positive impact on overall change management, with a particular focus on understanding the factors related to behaviour in health and community care

While research in recent years has investigated the influence of pornography consumption on sexually aggressive behavior, research on the relationship between pornography and experienced victimization is sparse. The current study sought to explore female sexual victimization and its relationship with pornography consumption and alcohol use at two universities ( N = 483). Binary logistic regression analyses indicate that both pornography and alcohol consumption were unique predictors of self-reported victimization for college females and that the combined effect of pornography and alcohol dramatically increases the odds of victimization. Results are discussed in the context of pornography’s impact on the minimization of sexually aggressive acts in real life and campus rape culture.

Aim: The aim of this scoping review is to explore the evidence by which community service providers have integrated reablement models of staff training and client assessment into practice. Background: The concept of reablement, which has emerged during the last two decades globally, has recently been defined by health experts from 11 countries through a Delphi study. Reablement is seen as a way to support integrated frameworks that achieve person-centred, long-term care and assistance across community settings. International research indicates there is some evidence of developing models of reablement that include staff training and individual components of client assessment. However, evidence of integrating reablement into interdisciplinary practice continues to be sparse. Methods: The review adopted the preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) approach. Inclusion criteria for the review related to community care, primary care, long-term care, and residential care. Populations of interest included service providers, interdisciplinary staff, trainers, and assessors. Results: A total of 11 papers were reviewed. The studies varied in their approach to reablement training and client assessment frameworks. Three studies included assessment of staff well-being. All included evidence-based, person-centred components that can be integrated across health care settings. Single disciplinary approaches were used in all studies and some included training evaluation. Conclusion: This review has identified that currently reablement models are not yet embedded as frameworks for practice by community service providers in primary health care settings. Different programmes of training and assessment are being designed based on single disciplinary approaches and the context in which they are delivered. Further developmental work is required to integrate the components of discipline-specific training programmes within interdisciplinary frameworks. This will achieve not only an integrated framework for delivery across settings but also further the success of ‘ageing in place’ policy.

To understand the experiences of vulnerable clients who used telehealth during the Coronavirus pandemic.The study employed a qualitative enquiry, utilising semi-structured interviews lasting 30-60 minutes with a thematic analysis approach to explore factors influencing client experience with telehealth.A wide range of locations across Tasmania, Australia.Twelve participants who were considered to be vulnerable on a number of domains, including: health and human wellbeing factors, social risk factors, functional limitations, and individual behavioural factors.The provision of telehealth consultations to vulnerable clients.Four global themes were discovered: i) Telehealth saves time, money and energy; ii) User friendly technology facilitates care; iii) Rapport and confidentiality helps clients to feel safe; and iv) Fit for purpose telehealth provides a quality service.The discovered themes entailed the major finding that most participants were satisfied with the overall quality of the telehealth service they received and the convenience of this service. Concerns were raised regarding the limitations around social interaction, physical examination, and access to fit-for-purpose telehealth devices.This research with vulnerable clients, from Tasmania, supports the evidence that the utilisation of telehealth allows more convenient access to care. To optimise the service, however, concerns regarding the desire for social interaction, appropriate physical examination, and access to fit-for-purpose telehealth devices will need to be addressed.

Computed tomography pulmonary angiography (CTPA) has become the most widely used technique for diagnosis or exclusion of a pulmonary embolism (PE). It has been suggested that overuse of this imaging type may be prevalent, especially in emergency departments (EDs). The purpose of this literature review was to explore the use of CTPAs in EDs worldwide. A review following PRISMA guidelines was completed, with research published between September 2010 and August 2020 included. Five key topics emerged: use of CTPAs; explanations for overuse; use of D-dimer; variability in ordering practices between clinicians; and strategies to reduce overuse. This review found that CTPAs continue to be overused in EDs, leading to superfluous risks to patients. Published studies identify that while clinical practice guidelines (CPGs) have a strong effect on reducing unnecessary CTPAs with no significantly increased risk of missed diagnosis, the adoption of these tools by ED clinicians has remained low. This literature review highlights the need for further research into why CTPAs continue to be overused within EDs and why clinicians are hesitant to use CPGs in the clinical setting. Moreover, investigations into other potential strategies that may combat the overuse of this diagnostic tool are essential to reduce potential harm.

Non-tenure track (NTT) positions include faculty who teach full and part-time and are not on the tenure-track. These positions include full-time lecturers, fixed-term faculty, etc. Positions such as these are typically on one-year contracts, though some may be on 1 - 3 year contracts. While the title, pay and status, among other things, varies by institutions, it is undeniable that universities and colleges have been shifting in recent years to this kind of contingent labor force. These positions also include part-time adjuncts including professionals teaching a class here and there, and professional teachers who may teach at many institutions. Individuals who are not on the tenure-track often find themselves with little job security, an often inequitable distribution of labor (in terms of class preps, class size, etc.), and in positions that pay significantly less than their tenure-track counterparts’ salaries.

BACKGROUND Aphasia is an impairment of language, affecting the production or comprehension of speech and the ability to read or write. Aphasia is a frequent complication of stroke and is a major disability for patients and their families. The provision of services for stroke patients differs across health care providers and regions, and strategies directed at improving these services have benefited from the involvement of patients. However, patients with aphasia are often excluded from these co-design activities due to a diminished capacity to communicate verbally and a lack of health researcher experience in working with patients with aphasia. OBJECTIVE The primary aim of this paper is to identify approaches appropriate for working with patients with aphasia in an interview situation and, more generally, determine the importance of including people with aphasia in health service improvement research. The secondary aim is to describe the experiences of researchers involved in interviewing patients with aphasia. METHODS A total of 5 poststroke patients with aphasia participated in face-to-face interviews in their homes to gain insight into their in-hospital experience following their stroke. Interviews were audio-recorded, and thematic analysis was performed. The experiences of the researchers interviewing these patients were informally recorded postinterview, and themes were derived from these reflections. RESULTS The interview technique utilized in this study was unsuitable to gain rich, qualitative data from patients with aphasia. The experience of researchers performing these interviews suggests that preparation, emotion, and understanding were three of the main factors influencing their ability to gather useful experiential information from patients with aphasia. Patients with aphasia are valuable contributors to qualitative health services research, and researchers need to be flexible and adaptable in their methods of engagement. CONCLUSIONS Including patients with aphasia in health service redesign research requires the use of nontraditional interview techniques. Researchers intending to engage patients with aphasia must devise appropriate strategies and methods to maximize the contributions and valuable communications of these participants.

Like adults, young people want their voices to be heard. While most adults have spaces wherein they can express themselves (be that through affiliation with different group membership, voting in elections, or freely choosing their peer cohorts), most youth do not have such spaces. Youth are often limited by outside restraints – legal, social, familial – that constrict their ability to freely express themselves, or to have spaces to engage in conversations about issues such as gender and sexuality. Because youth often lack a voice in research, conducting research with, rather than on youth is an integral aspect of critical youth studies. Being able to design and carry out research that is youth-centered is not only necessary, but also critical in creating research projects that promote voice and agency for these young people. This article examines many of the hurdles faced when seeking to conduct youth-centered research. I unpack my experiences within the research project and advocate that youth se...

Introduction People with co-occurring mental health and substance misuse problems are among the most excluded in society. A need to feel connected to others has been articulated in the occupational science literature although the concept of belonging itself has not been extensively explored within this paradigm. This paper reports findings from research that explored the meaning and experience of belonging for four people living with dual diagnosis in the United Kingdom. Method Researchers employed an interpretative phenomenological approach to the study. Four semistructured interviews were carried out. The interviews were guided by questions around the meaning of belonging, barriers to belonging and how belonging and not belonging impacted on participants’ lives. Data analysis facilitated the identification of themes across individual accounts and enabled comparisons. Findings Data analysis identified four themes – belonging in family, belonging in place, embodied understandings of belonging and barriers to belonging. Conclusion The findings add further insights into the mutable nature of belonging. A link between sense of belonging and attachment theory has been proposed, along with a way to understand the changeable and dependent nature of belonging through ‘dimensions of belonging’.

Mutations in fukutin-related protein (FKRP) are responsible for a common group of muscular dystrophies ranging from adult onset limb girdle muscular dystrophies to severe congenital forms with associated structural brain involvement. The defining feature of this group of disorders is the hypoglycosylation of α-dystroglycan and its inability to effectively bind extracellular matrix ligands such as laminin α2. However, α-dystroglycan has the potential to interact with a number of laminin isoforms many of which are basement membrane/tissue specific and developmentally regulated. To further investigate this we evaluated laminin α-chain expression in the cerebral cortex and eye of our FKRP knock-down mouse (FKRPKD). These mice showed a marked disturbance in the deposition of laminin α-chains including α1, α2, α4, and α5, although only laminin α1- and γ1-chain mRNA expression was significantly upregulated relative to controls. Moreover, there was a diffuse pattern of laminin deposition below the pial surface which correlated with an abrupt termination of many of the radial glial cells. This along with the pial basement membrane defects, contributed to the abnormal positioning of both early- and late-born neurons. Defects in the inner limiting membrane of the eye were associated with a reduction of laminin α1 demonstrating the involvement of the α-dystroglycan:laminin α1 axis in the disease process. These observations demonstrate for the first time that a reduction inFkrpinfluences the ability of tissue-specific forms of α-dystroglycan to direct the deposition of several laminin isoforms in the formation of different basement membranes.

This qualitative study explored older women's qualitative accounts regarding their strategies for maintaining or adapting their participation in visual art-making in the context of arthritis. Ten participants were interviewed, aged 62–81 years, all having lived with arthritis for at least 7 years. Interpretative phenomenological analysis identified four convergent themes. Participants described adapting their strategies of art-making in ways that maintained the aesthetic quality of their artwork while also accommodating their arthritis. They described devising more accessible creative spaces. Planning, design, and anticipating new creative activities enhanced choice and control during flares in symptoms. Positive attitudes toward self-managing illness informed the practical adaptations described.

This study explored the meanings, inspirations, and subjective significance of personal artwork created as a leisure activity by women living with cancer. A convenience sample of 12 women aged 23–74 years participated in semistructured interviews. Participants were living in various stages of the cancer trajectory, and engaged in several forms of visual art-making. They submitted examples of their artwork by photograph and explored the meanings of this work in semistructured interviews. The study found that body imagery was extremely rare in participants' array of artwork, unlike the images typically created in art therapy. Few pieces expressed fears about cancer in symbolic terms. Participants described their selected artwork as offering sensuous pleasures, and confirming their ongoing capability, personal continuity, and social connectedness. Participants acknowledged ongoing loss and difficulties related to cancer. However, each piece of art offered a tangible record of resistance against the psycholog...

This qualitative study invited Deaf adults with mental health difficulties to reflect on mental health, Deafness and the barriers to obtaining and retaining employment. The term Deaf with a capital ‘D’ denotes Deaf people as a cultural and linguistic minority group, who use sign language as their first language (British Deaf Association 2000). Eight people took part in three focus groups and one interview. The findings were analysed using interpretative phenomenological analysis. Six themes arose from the analysis: stigma, the benefits of employment, the support required, the differences and similarities between Deaf and hearing populations, communication and the challenges of mental health compared with those of Deafness. The strongest message was that Deaf people with mental health difficulties require somebody who speaks their language when obtaining employment. A list of recommendations is provided, which has relevance to occupational therapists.

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 years) each with breast cancer, and a man (aged 51 years) 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.

This qualitative study invited women living with cancer who engaged in visual art-making to reflect on their experiences of the creative process. The study sought to explore whether the participants described experiences of flow during art-making and, if so, how such experiences helped them to cope with cancer. Ten women took part in semi-structured interviews. They described a range of difficulties associated with their illness. The interview data were analysed using a template approach, based on the theory of Csikszentmihalyi. The participants described a number of experiences that have been associated with flow in previous work. However, one aspect of flow, namely having clear goals, was not present clearly in the participants' accounts. The participants also described other facets of art-making that seemed part of the flow experience, including sensuous vitality, responsiveness to art materials and evolving imagery, and creative adventures. The flow experiences during art-making helped to banish intrusive thoughts about cancer, provided valued experiences of mastery and control and encouraged the participants to engage in positive journeys into the unknown, thereby alleviating some of the stress of cancer. The study offers a detailed analysis of the experience of creative occupation and has relevance to occupational therapists working with clients who have life-threatening illnesses.

Double-stranded RNA (dsRNA) is a common by-product of viral infections and a potent inducer of innate antiviral immune responses in vertebrates. In the marine shrimp Litopenaeus vannamei , innate antiviral immunity is also induced by dsRNA in a sequence-independent manner. In this study, the hypothesis that dsRNA can evoke not only innate antiviral immunity but also a sequence-specific antiviral response in shrimp was tested. It was found that viral sequence-specific dsRNA affords potent antiviral immunity in vivo, implying the involvement of RNA interference (RNAi)-like mechanisms in the antiviral response of the shrimp. Consistent with the activation of RNAi by virus-specific dsRNA, endogenous shrimp genes could be silenced in a systemic fashion by the administration of cognate long dsRNA. While innate antiviral immunity, sequence-dependent antiviral protection, and gene silencing could all be induced by injection of long dsRNA molecules, injection of short interfering RNAs failed to induce similar responses, suggesting a size requirement for extracellular dsRNA to engage antiviral mechanisms and gene silencing. We propose a model of antiviral immunity in shrimp by which viral dsRNA engages not only innate immune pathways but also an RNAi-like mechanism to induce potent antiviral responses in vivo.

In 1997, white spot syndrome virus (WSSV) was discovered in shrimp culture facilities in South Carolina, USA. This disease was known to cause devastating mortalities in cultured popula- tions in Southeast Asia and prompted concern for the health of wild populations in the USA. Our study surveyed wild shrimp populations for the presence of WSSV by utilizing molecular diagnostics and bioassay techniques. A total of 1150 individuals (586 Litopenaeus setiferus, 477 Farfantepenaeus aztecus and 87 F. dourarum) were examined for the presence of WSSV DNA by PCR. A total of 32 individuals tested positive and were used in a bioassay to examine the transmission of disease to healthy individuals of the culture species L. vannamei. DNA sequencing of PCR products from a pos- itive individual confirmed that the positive individuals carried WSSV DNA. Significant mortalities were seen in test shrimp injected with tissue extracts from heavily infected wild shrimp. These data confirm the existence of WSSV in wild shrimp stocks along the Atlantic Coast and that the virus can cause mortalities in cultured stocks.

The purpose of this phenomenological enquiry was to explore the meanings and functions of art for a group of women living with disabling chronic illness. Participants were recruited on the basis that they considered artwork as central to their current well-being.Thirty women were interviewed and five submitted written narratives. Interpretative phenomenological analysis was carried out.About half of the participants had taken up their preferred artistic occupation since the onset of illness. Participants described their artwork as contributing to their health and well-being in many diverse ways. Art filled occupational voids, distracted thoughts away from illness, promoted the experience of flow and spontaneity, enabled the expression of grief, maintained a positive identity, and extended social networks. Its value was conceptualised by one participant as a 'lifestyle coat-hanger' organising numerous further roles and activities that gave purpose to life. Art was more than cathartic. It offered a versatile means of overcoming the restrictions imposed by illness on self and lifestyle, in many cases creating a more enriched lifestyle than before.The findings may encourage professionals working in health and rehabilitation settings to assist clients in identifying meaningful, creative occupations that are feasible within the limits imposed by illness or injury.

The effectiveness of a 6-week anxiety management course at a mental health day hospital was researched. The author was motivated to research these sessions due to her own observations of the clients' progress in the groups. There was also an increasing demand for anxiety management groups with many clients being referred by general practitioners. The subjects were 37 clients. The diagnosis of the clients varied but anxiety must have been identified as a problem. Four of the 6-week courses were run over a period of 10 months. The course was evaluated using three questionnaires: the Hospital Anxiety and Depression (HAD) Scale, the Spielberger Questionnaire (state and trait) and the Fear Questionnaire. The clients completed the questionnaires four times: pre-treatment, at the beginning and at the end of the course, and at 2 months post-treatment. A control group was used. The data collected from the questionnaires were analysed using paired t-tests. The results showed that the anxiety management course was effective, with a statistically significant reduction in symptoms by the end of the course. The control group did not show significant change. It was the HAD Scale that showed the statistically significant positive change. The state section of the Spielberger Questionnaire followed the same pattern as the HAD Scale and showed a reduction in symptoms, although it was not statistically significant. The results of the Fear Questionnaire suggested that the clients' phobias were not treated by the anxiety management course. A client satisfaction questionnaire was used and participants made positive comments about the value of the course.

Moral panics about youth sexuality have heavily influenced the construction and curriculum of sexual health education, as the long and complicated history of sex ed in United States schools continues to plague political campaigns, school boards, parents, and health advo- cates (Irvine 2004; Moran 2002; Di Mauro and Joffe 2009). Since the early responses to the moral panics about venereal diseases that began in the early twentieth century, there has been a significant narrowing of the opportunities for young people to receive any type of compre- hensive sexual education. Truly, sex education has been shrouded in debate that is characterized by panic, fueled by misinformation, and cloaked in the language of morality. This chapter explores a brief his- tory of sex education in the United States, focusing specifically on the rise of Abstinence-Only Sexual Education (AOSE) as a moral panic about youth sexuality, followed by an analysis of media representations about adolescent sexual experiences presented in the popular television show Glee. This chapter examines the discontinuity between the formal curriculum young people receive through AOSE programs and the informal education they receive from popular culture references, linking those sites as relevant to the politics of how moral panics are both created and sustained. Using Glee, this chapter shows how moral panics about youth sexuality are still heavily problematic in American culture and demonstrates how popular television has the ability to both challenge and duplicate dangerous stereotypes about young people and sex.

The need for better control of infectious diseases in shrimp aquaculture and the ecological importance of crustacea in marine ecosystems have prompted interest in the study of crustacean immune systems, particularly those of shrimp. As shrimp and other crustacea are poorly understood from the immunological point of view, functional genomic and proteomic approaches have been applied as a means of quickly obtaining molecular information regarding immune responses in these organisms. In this article, a series of results derived from transcriptomic and proteomic studies in shrimp (Litopenaeus vannamei) are discussed. Expressed Sequence Tag analysis, differential expression cloning through Suppression Subtractive Hybridization, expression profiling using microarrays, and proteomic studies using mass spectrometry, have provided a wealth of useful data and opportunities for new avenues of research. Examples of new research directions arising from these studies in shrimp include the molecular diversity of antimicrobial effectors, the role of double stranded RNA as an inducer of antiviral immunity, and the possible overlap between antibacterial and antiviral responses in the shrimp.

This paper explores the narratives of three women aged 65-72 years. They reflected on an episode of therapeutic art-making in midlife, which addressed depression associated with marital crisis and breakdown. The narrative analysis focused upon on the ways in which participants narrated the events leading up to their participation in therapeutic art-making; the aspects of therapeutic art-making that continued to be given significance; the characters given primacy in the stories they told about their journey through therapy and marital breakdown; meanings, symbolic and otherwise, that participants ascribed to their artwork made during this turning point in their lives; and aspects of the narratives that conveyed present-day identities and artistic endeavors. The narratives revealed the complexity of the journey through marital breakdown and depression into health, and showed that therapeutic art-making could best be understood, not as a stand-alone experience, but as given meaning within the context of wider personal and social resources. Participants looked back on therapeutic art-making that occurred two decades earlier and still described this as a significant turning point in their personal development. Art as an adjunct to counselling/therapy was not only symbolically self-expressive but provided opportunity for decision-making, agency and a reformulated self-image.

This is the author's accepted manuscript. The final published article is available from the link below. Copyright © 2008 Informa Plc. Purpose. To understand the meanings of art-making among a group of women living with the occupational constraints and stigma of CFS/ME. The study explored their initial motives for art-making, and then examined how art-making had subsequently influenced their subjective well-being. Method. Ten women with CFS/ME were interviewed; three provided lengthy written accounts to the interview questions. Findings. Illness had resulted in devastating occupational and role loss. Participants took many years to make positive lifestyle changes. Art-making was typically discovered once participants had accepted the long-term nature of CFS/ME, accommodated to illness, and reprioritized occupations. Several factors then attracted participants specifically to art-making. It was perceived as manageable within the constraints of ill-health. Participants also tended to be familiar with craft skills; had family members interested in arts and crafts, and some desired a means to express grief and loss. Once established as a leisure activity, art-making increased subjective well-being mainly through providing increased satisfaction in daily life, positive self-image, hope, and contact with the outside world. Participants recommended provision of occupational/recreational counselling earlier in the illness trajectory. Conclusions. Creative art-making occurred as part of a broader acceptance and adjustment process to CFS/ME, and allowed some psychological escape from a circumscribed lifeworld.

White Spot Syndrome Virus (WSSV) is a highly pathogenic and prevalent virus affecting crustacea. A number of WSSV envelope proteins, including vp28, have been proposed to be involved in viral infectivity based on the ability of specific antibodies to attenuate WSSV-induced mortality in vivo. In the present study, a series of monoclonal and polyclonal antibodies targeting vp28 were tested for their ability to neutralize WSSV infectivity, with the purpose of identifying epitopes potentially involved in vp28-mediated infection of shrimp. Surprisingly, when used as protein A-purified immunoglobulin, none of the antibodies tested were capable of inhibiting WSSV infectivity. This included one polyclonal preparation that has been previously shown to inactivate WSSV, when used as whole rabbit serum. Moreover, strong inactivation of WSSV by some rabbit sera was observed, in a manner independent of anti-vp28 antibodies. These results underscore the problems associated with using heterogeneous reagents (e.g. whole rabbit antiserum) in viral neutralization experiments aimed at defining proteins involved in infection by WSSV. In light of this, the potential of anti-vp28 antibodies to specifically neutralize WSSV should be reconsidered.

Vertebrates mount a strong innate immune response against viruses, largely by activating the interferon system. Double-stranded RNA (dsRNA), a common intermediate formed during the life cycle of many viruses, is a potent trigger of this response. In contrast, no general inducible antiviral defense mechanism has been reported in any invertebrate. Here we show that dsRNA induces antiviral protection in the marine crustacean Litopenaeus vannamei . When treated with dsRNA, shrimp showed increased resistance to infection by two unrelated viruses, white spot syndrome virus and Taura syndrome virus. Induction of this antiviral state is independent of the sequence of the dsRNA used and therefore distinct from the sequence-specific dsRNA-mediated genetic interference phenomenon. This demonstrates for the first time that an invertebrate immune system, like its vertebrate counterparts, can recognize dsRNA as a virus-associated molecular pattern, resulting in the activation of an innate antiviral response.

The authors explored women's strategies for achieving quality of life with multiple sclerosis (MS) through interviews with 27 women, most of whom had lived with MS for more than 5 years. Analysis of the semistructured 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 health; maintaining meaningful occupations and roles; establishing mutual relationships; clarifying beliefs, aspirations, and philosophy of life; activism on disability issues; consciously valuing positive life experiences; and finding benefits in adversity. Despite recounting resourceful strategies, many acknowledged ongoing difficulties. Some narratives suggested a mesh or tapes-try of coexisting positive and negative experiences. Others portrayed an adversarial relationship, with the positive and negative forces in their lives constantly battling for supremacy. A wide array of flexible, evolving strategies was required to achieve an acceptable quality of life with MS.