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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

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]