Mesozoic Alpine facies deposition as a result of past latitudinal plate motion

The fragmentation of Pangaea as a consequence of the opening of the Atlantic Ocean is documented in the Alpine-Mediterranean region by the onset of widespread pelagic sedimentation1. Shallow-water sediments were replaced by mainly pelagic limestones in the Early Jurassic period, radiolarian cherts in the Middle-Late Jurassic period, and again pelagic limestones in the Late Jurassic-Cretaceous period. During initial extension, basin subsidence below the carbonate compensation depth (CCD) is thought to have triggered the transition from Early Jurassic limestones to Middle-Late Jurassic radiolarites. It has been proposed that the transition from radiolarites to limestones in the Late Jurassic period was due to an increase in calcareous nannoplankton abundance when the CCD was depressed below the ocean floor. But in modern oceans, sediments below the CCD are not necessarily radiolaritic. Here we present palaeomagnetic samples from the Jurassic-Cretaceous pelagic succession exposed in the Lombardian basin, Italy. On the basis of an analysis of our palaeolatitudinal data in a broader palaeogeographic context, we propose an alternative explanation for the above facies tripartition. We suggest that the Lombardian basin drifted initially towards, and subsequently away from, a near-equatorial upwelling zone of high biosiliceous productivity. Our tectonic model for the genesis of radiolarites adds an essential horizontal plate motion component to explanations involving only vertical variations of CCD relative to the ocean floor. It may explain the deposition of radiolarites throughout the Mediterranean and Middle Eastern region during the Jurassic period

Differences between immigrant and non-immigrant groups in the use of primary medical care; a systematic review

Background. Studies on differences between immigrant and non-immigrant groups in health care utilization vary with respect to the extent and direction of differences in use. Therefore, our study aimed to provide a systematic overview of the existing research on differences in primary care utilization between immigrant groups and the majority population. Methods. For this review PubMed, PsycInfo, Cinahl, Sociofile, Web of Science and Current Contents were consulted. Study selection and quality assessment was performed using a predefined protocol by 2 reviewers independently of each other. Only original, quantitative, peer-reviewed papers were taken into account. To account for this hierarchical structure, logistic multilevel analyses were performed to examine the extent to which differences are found across countries and immigrant groups. Differences in primary care use were related to study characteristics, strength of the primary care system and methodological quality. Results. A total of 37 studies from 7 countries met all inclusion criteria. Remarkably, studies performed within the US more often reported a significant lower use among immigrant groups as compared to the majority population than the other countries. As studies scored higher on methodological quality, the likelihood of reporting significant differences increased. Adjustment for health status and use of culture-/language-adjusted procedures during the data

The Consumer Quality Index Hip Knee Questionnaire measuring patients' experiences with quality of care after a total hip or knee arthroplasty

<p>Abstract</p> <p>Background</p> <p>The Dutch Consumer Quality Index Hip Knee Questionnaire (CQI Hip Knee) was used to assess patients' experiences with and evaluations of quality of care after a total hip (THA) or total knee arthroplasty (TKA). The aim of this study is to evaluate the construct validity and internal consistency reliability of this new instrument and to assess its ability to measure differences in quality of care between hospitals.</p> <p>Methods</p> <p>Survey data of 1,675 subjects who underwent a THA or TKA were used to evaluate the psychometric properties. Exploratory factor analyses were performed and item-total correlations and inter-factor correlations were calculated to assess the construct validity of the instrument. Reliability analyses included tests of internal consistency (Cronbach's alpha coefficients). Finally, multilevel analyses were performed to assess the ability of the instrument to discriminate between hospitals in quality of care.</p> <p>Results</p> <p>Exploratory factor analyses indicated that the survey consisted of 21 items measuring five aspects of care (i.e. communication with nurses, communication with doctors, communication with general practitioner, communication about new medication, and pain control). Cronbach's alpha coefficients ranged from 0.76 to 0.90 indicating good internal consistency. The survey's ability to discriminate between hospitals was partly supported by multilevel analysis. Two scales (i.e. communication with nurses and communication with doctors) were able to measure differences between hospitals with respect to patients' experiences with quality of care. Logistic multilevel analyses indicated that hospitals explained part of the variation between patients in receiving information.</p> <p>Conclusion</p> <p>These findings suggest that the CQI Hip Knee is reliable and valid for use in Dutch health care. Health care providers or health plans can use this survey to measure patients' experiences with hospital care and to identify variations in care between hospitals.</p