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One class of models for the early history of the Earth requires the present-day inventory of siderophile elements in the mantle to have been established by equilibrium partitioning between core-forming metal and mantle minerals at high pressures and temperatures deep inside the Earth. We have accordingly carried out reconnaissance experiments on the partitioning of nickel between model lower mantle magnesiowustite (Mg[prime] = 85 and 1.3 wt% NiO) and a model core-forming alloy, [Fe.sub.94][Ni.sub.6] ([approximately]7 wt% Ni) at pressures between 1-40 GPa and temperatures ranging from 1200 [degrees] C to >2000 [degrees] C. Reversal experiments were also attempted. Our results highlight the difficulty of attaining equilibrium partitioning in this system and imply that partition coefficients derived from unreversed experiments should accordingly be viewed with reservation. Our data nevertheless imply that the concentration of NiO in lower mantle magnesiowustite in equilibrium with core-forming metal with [approximately] 7 wt% Ni would be extremely low, e.g., about 0.2 wt% NiO. Moreover, equilibrium seems to be fairly insensitive to the effects of either pressure or temperature, and so it is unlikely that magnesiowustite could acquire 1.3 wt% NiO simply by equilibrating with core-forming metal under special high P-T conditions early in Earth history. Alternative hypotheses for the present-day siderophile element inventory of the mantle are accordingly preferred.

Esther C Atukunda,1 Godfrey R Mugyenyi,1 Celestino Obua,1 Angella Musiimenta,2 Josephine N Najjuma,1 Edgar Agaba,1 Norma C Ware,3 Lynn T Matthews4,5 1Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; 2Faculty of Computing and Informatics, Mbarara University of Science and Technology, Mbarara, Uganda; 3Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; 4Division of Infectious Diseases and Center for Global Health, Massachusetts General Hospital, Boston, MA, USA; 5Division of Infectious Disease, University of Alabama at Birmingham, Birmingham, AL, USACorrespondence: Esther C Atukunda Email estheratukunda@gmail.comBackground: Uganda’s maternal mortality remains unacceptably high, with thousands of women and newborns still dying of preventable deaths from pregnancy and childbirth-related complications. Globally, Antenatal care (ANC) attendance has been associated with improved rates of skilled births. However, despite the fact that over 95% of women in Uganda attend at least one ANC, over 30% of women still deliver at home alone, or in the presence of an unskilled birth attendant, with many choosing to come to hospital after experiencing a complication. We explored barriers to women’s decisions to deliver in a health care facility among postpartum women in rural southwestern Uganda, to ultimately inform interventions aimed at improving skilled facility births.Methods: Between December 2018 and March 2019, we conducted in-depth qualitative face-to-face interviews with 30 post-partum women in rural southwestern Uganda. The purposeful sample was intended to represent women with differing experiences of pregnancy, delivery, and antenatal care. We included 15 adult women who had delivered from their homes and 15 who had delivered from a health facility in the previous 3 months. Women were recruited from 10 villages within 20 km of a regional referral hospital. Interviews were conducted and digitally recorded in a private setting by a trained native speaker to elicit experiences of pregnancy and birth. Translated transcripts were generated and coded. Coded data were iteratively reviewed and sorted to derive descriptive categories using an inductive content analytic approach.Results: Regardless of where they decided to give birth, women wished to deliver in a supportive, respectful, responsive and loving environment. The data revealed six key barriers to women’s decisions to deliver from a health care facility: 1) Fear of unresponsive care, fueling a fear of being neglected or abandoned while at the facility; 2) fear of embarrassment and mistreatment by health care providers; 3) low perception of risk associated with pregnancy and childbirth; 4) preferences for particular birthing positions and their outcome expectations; 5) perceived lack of privacy in public facilities; and 6) perceived poor clinical and interpersonal skills of health providers to adequately explain birthing procedures or support expectant or laboring women and their newborn.Conclusion: Anticipation of unsupportive, unresponsive, disrespectful treatment, and a perceived lack of tolerance for simple, non-harmful traditions prevent women from delivering at health facilities. Building better interpersonal relationships between patients and providers within health systems could reinforce trust, improve patient–provider interaction, and facilitate useful information transfer during ANC and delivery visits. These expectations are important considerations in developing supportive health care systems that provide acceptable patient-friendly care. These findings are indicative of the vital need for midwives and other health care providers to have additional training in the role of communication and dignity in delivery of quality health care.Keywords: childbirth, home delivery, facility delivery, health systems, barriers to care, Uganda

The CSIRO laboratory-scale assimilation test is carried out by embedding ore particles into a fluxed matrix of known sinter blend composition. Samples are fired in a tube furnace under controlled conditions simulating the actual sintering process. The aim is to isolate and evaluate the nucleus behaviour of an individual blend component. Measured cross-sections of the resulting fired samples provide a semi-quantitative measure of reactivity, while accompanying photomicrographs allow a qualitative assessment of assimilation properties. Nucleus particles were selected from haematite, haematite-goethite and goethite ores and embedded in a simulated plant sinter matrix. Drilled core particles of two sizes were tested at fixed temperatures simulating low temperature (<1300°C) and high temperature (>1300°C) sintering conditions. The resulting assimilation properties are compared and discussed as a function of particle size, temperature and ore/sinter mineralogy. The implications for the contribution of each component in the prediction of blend sinter quality are also discussed. [ABSTRACT FROM PUBLISHER]

The physical properties of iron ore sinter are largely influenced by raw material properties, in particular the bulk ore composition and its associated mineralogy. The levels of Fe, SiO2, Al2O3, MgO and other elements, together with the nature of the minerals in the fine ore and associated sintering conditions play a major role in determining the abundance and type of high-temperature bonding phases that form during sintering. This study using natural ores combines in situ X-ray diffraction experiments in model sinter systems with laboratory-based compact sinter tests to examine the links between iron ore composition and sintering conditions and their effects on sinter strength. Results help to establish the critical compositional and thermal parameters that control the bonding phase chemistry, which in turn influences the strength, a key sinter quality parameter of the sinter matrix. [ABSTRACT FROM AUTHOR]

Background. Understanding HIV-infected patient experiences and perceptions of reproductive counseling in the health care context is critical to inform design of effective pharmaco-behavioral interventions that minimize periconception HIV risk and support HIV-affected couples to realize their fertility goals. Methods. We conducted semistructured, in-depth interviews with 30 HIVinfected women (with pregnancy in prior year) and 20 HIV-infected men, all reporting serodiscordant partners and accessing care in Durban, South Africa. We investigated patient-reported experiences with safer conception counseling from health care workers (HCWs). Interview transcripts were reviewed and coded using content analysis for conceptual categories and emergent themes. Results. The study findings indicate that HIV-infected patients recognize HCWs as a resource for periconception-related information and are receptive to speaking to a HCW prior to becoming pregnant, but seldom seek or receive conception advice in the clinic setting. HIV nondisclosure and unplanned pregnancy are important intervening factors. When advice is shared, patients reported receiving a range of information. Male participants showed particular interest in accessing safer conception information. Conclusions. HIV-infected men and women with serodiscordant partners are receptive to the idea of safer conception counseling. HCWs need to be supported to routinely initiate accurate safer conception counseling with HIV-infected patients of reproductive age. [ABSTRACT FROM AUTHOR]

Objective: This study sought to understand how case managers in one publicly funded health and social service system, community long-term care, understand and address depression among their clients.Methods: Four focus groups with a total of 18 case managers were conducted. Case managers were asked a series of questions about their perspectives on the recognition and treatment of depression, including subthreshold depression, in community long-term care.Results: Case managers perceived addressing depression as complex because of competing demands. Furthermore, case managers perceived conflict between their current role and what it would take to expand their role to include addressing depression.Conclusions: Case managers suggested that in order to successfully improve the detection and treatment of depression in community long-term care, systemic changes, such as increased support and training, may be necessary, along with a shift in the professional role of case managers. [ABSTRACT FROM AUTHOR]

BACKGROUND: One approach to improving quality of care is to encourage physicians to follow evidence-based practice guidelines. Examples of evidence-based guidelines are the PORT recommendations for the treatment of schizophrenia. However, few studies have examined the relationship between adherence to guidelines and patient outcomes in clinical settings. OBJECTIVE: The purpose of this article is to report the relationship between guideline adherence to antipsychotic medication dose and self-reported health status, side effects, and perceptions of care. RESEARCH DESIGN: This report is based on a subsample of patients from a larger prospective observational study of disabled Massachusetts Medicaid beneficiaries treated for schizophrenia. SUBJECTS: Participants were 329 acutely ill, vulnerable, high-risk Medicaid adult beneficiaries enrolled after visiting any 1 of 8 psychiatric emergency screening teams for hospital admission evaluation. MEASURES: Dose levels, symptoms, and functioning from medical records; self-reports as data collected from BASIS-32, SF-12, and CABHS; and paid health benefit claims for psychiatric treatment were measured. RESULTS: Approximately 40% of the patients in this study had daily antipsychotic doses well above the recommended range, but there was no evidence that their health status was better than those on doses below 1000 CPZ units recommended for acute episodes. High-dose levels had no relationship to baseline symptom profile or referral source. CONCLUSIONS: There was no evidence that health status was better on higher-than-recommended doses, but we cannot conclude that lower doses for some would have led to poorer outcomes. Physicians who believe that higher doses are more therapeutic for patients need to demand rigorous effectiveness research that tests whether there are benefits of higher doses and determine the ratio of those benefits to the clinical costs, including the risk of side effects. [ABSTRACT FROM AUTHOR]

Retrospective, narrative accounts of illness experience in chronic fatigue syndrome provide the empirical basis for a preliminary conceptual model of social course in chronic illness. Qualities of distress interact with culturally specific expectations for social life and personal conduct to trigger microsocial processes of marginalization: role constriction, delegitimation, impoverishment, and social isolation. Marginalizing processes are opposed by acts of resistance initiated by ill individuals and directed toward integration in social worlds. Social distance from the perceived centers of CFS sufferers' interpersonal worlds expands and contracts with the changing predominance of marginalizing and resisting influences over time. Social course thus consists of successive, bi-directional movements along a 'continuum of marginality' by persons living lives with chronic illness. [ABSTRACT FROM AUTHOR]

Objective: This study examines social processes that construct the course of chronic illness. Specifically, it identifies and describes mechanisms that constitute the process of role constriction in employment for individuals with chronic illness.Method: Sixty-six persons meeting the Centers for Disease Control case definition of chronic fatigue syndrome (CFS) participated in a longitudinal study involving three waves of data collection over 3 years. Qualitative and quantitative methods were combined in the research, which included face-to-face semistructured interviews, telephone interviews, and self-report questionnaires. Materials presented in this study are drawn principally from the Year 1 face-to-face and telephone interviews.Results: When patterns of symptoms and of the illness course in CFS intersect with work requirements, they impede performance and place ill individuals at risk for job loss. Persons with CFS devise and implement specific strategies to resist role constriction and remain in the work force.Conclusions: Role constriction is a social process of marginalization in chronic illness. Opposing forces of marginalization and resistance define the social course in chronic illness and suggest that chronicity can be thought of as a marginalized position in social space. [ABSTRACT FROM AUTHOR]

Summary: We report a case of foreign body induced endobronchial actinomycosis secondary to a shirt button aspirated 30 years previously. Radiological and bronchoscopic appearances mimicked that of lung cancer. However pathology revealed gram-positive anaerobic infection with actinomycosis, which was successfully treated with antibiotics. Previously reported incidences of this rare presentation have been due to organic material, usually food matter. This case illustrates the importance of evaluating episodes of foreign body aspiration and also considering actinomycosis in the differential diagnosis of endobronchial mass. Repeating bronchoscopy after treatment and clinical improvement revealed a reduction in the size of the endoluminal mass and is therefore essential to exclude a foreign body or tumour not seen on initial assessment. [Copyright &y& Elsevier]

Abstract Background Patient-provider communication is a major challenge in resource-limited settings with large catchment areas. Though mobile phone usership increased 20-fold in Africa over the past decade, little is known about acceptability of, perceptions about disclosure and confidentiality, and preferences for cell phone communication of health information in the region. Methods We performed structured interviews of fifty patients at the Immune Suppression Syndrome clinic in Mbarara, Uganda to assess four domains of health-related communication: a) cell phone use practices and literacy, b) preferences for laboratory results communication, c) privacy and confidentiality, and d) acceptability of and preferences for text messaging to notify patients of abnormal test results. Results Participants had a median of 38 years, were 56% female, and were residents of a large catchment area throughout southwestern Uganda. All participants expressed interest in a service to receive information about laboratory results by cell phone text message, stating benefits of increased awareness of their health and decreased transportation costs. Ninety percent reported that they would not be concerned for unintended disclosure. A minority additionally expressed concerns about difficulty interpreting messages, discouragement upon learning bad news, and technical issues. Though all respondents expressed interest in password protection of messages, there was also a strong desire for direct messages to limit misinterpretation of information. Conclusions Cell phone text messaging for communication of abnormal laboratory results is highly acceptable in this cohort of HIV-infected patients in rural Uganda. The feasibility of text messaging, including an optimal balance between privacy and comprehension, should be further studied.