The additional value of patient-reported health status in predicting 1-year mortality after invasive coronary procedures: A report from the Euro Heart Survey on Coronary Revascularisation

Objective: Self-perceived health status may be helpful in identifying patients at high risk for adverse outcomes. The Euro Heart Survey on Coronary Revascularization (EHS-CR) provided an opportunity to explore whether impaired health status was a predictor of 1-year mortality in patients with coronary artery disease (CAD) undergoing angiographic procedures. Methods: Data from the EHS-CR that included 5619 patients from 31 member countries of the European Society of Cardiology were used. Inclusion criteria for the current study were completion of a self-report measure of health status, the EuroQol Questionnaire (EQ-5D) at discharge and information on 1-year follow-up, resulting in a study population of 3786 patients. Results: The 1-year mortality was 3.2% (n = 120). Survivors reported fewer problems on the five dimensions of the EQ-5D as compared with non-survivors. A broad range of potential confounders were adjusted for, which reached a p<0.10 in the unadjusted analyses. In the adjusted analyses, problems with self-care (OR 3.45; 95% CI 2.14 to 5.59) and a low rating (≤ 60) on health status (OR 2.41; 95% CI 1.47 to 3.94) were the most powerful independent predictors of mortality, among the 22 clinical variables included in the analysis. Furthermore, patients who reported no problems on all five dimensions had significantly lower 1-year mortality rates (OR 0.47; 95% CI 0.28 to 0.81). Conclusions: This analysis shows that impaired health status is associated with a 2-3-fold increased risk of all-cause mortality in patients with CAD, independent of other conventional risk factors. These results highlight the importance of including patients' subjective experience of their own health status in the evaluation strategy to optimise risk stratification and management in clinical practice

A case study of a mantled gneiss antiform, the Hospitalet massif, Pyrenees (Andorra, France)

The Hospitalet mantled gneiss antiform consists of monzo-granitic orthogneisses, which are overlain by a predominantly pelitic, at least 2.5 km thick succession of Cambro-Ordovician metasediments. During the Hercynian orogeny the rocks were polyphase deformed and plurifacially metamorphosed. Three stages in its tectonic evolution can be distinguished. Pre-antiform episode NE-SW trending (Dl) folds were formed and overprinted by upright EW trending (D2) folds and foliations, defining the suprastructure around the massif. Deformation occurred at low grade conditions and NS shortening is indicated, probably accompanied by thickening of the metasedimentary pile. Gneiss antiform formation Within the massif the D2 structures are overprinted by flat lying to gently inclined (D3) folds and foliations, defining the infrastructure. The geometry of S3 relative to the gneiss-cover contact limits antiform formation to vertical tectonics at the scale of the massif, accommodated by horizontal extension at the same scale. Subsequently, a low piT ratio metamorphism (650 C/km) took place in the infrastructure, associated with extensive, zonal growth of biotite, andalusite, cordierite, staurolite and sillimanite in highest grade. Structural and tectono-metamorphic considerations suggest that extension was largely accommodated by an extensional shear zone or shear zones of which the infrastructure represents the upper part. Post-antiform episode During isobaric cooling in lower amphibolite facies conditions the infrastructure has been deformed in (1) a 1 km wide zone of mylonitic strain at the gneiss-cover contacts, (2) a 1.5 km wide zone of (D4/5) refolding SW of the gneisses, (3a) a km scale recumbent fold in the eastern hinge zone of the gneiss antiform and (3b) small-scale recumbent (D6) folds throughout the massif. The antiformal gneiss core acted as a relatively rigid body and the metasediments and mineral zones were draped around it, first in NNE-SSW stretching, afterwards in WNW-ESE stretching, causing (a) seemingly high thermal gradients and (b) the antiformal pattern of the isograds. The three stages in the evolution of the Hospitalet mantled gneiss antiform are considered to represent early (Westphalian), middle (Westphalian- Stephanian) and late (Stephanian-early Permian) Hercynian tectonics. The structures mentioned have been cut by high angle faults, shear zones and folds, which are accompanied by low greenschist facies metamorphic conditions and which probably reflect Alpine movements

Cobalt-induced bronchial asthma in diamond polishers

Three diamond workers had occupational asthma attributed to the inhalation of cobalt powder. The exposure originated from high speed polishing disks with an abrasive consisting of microdiamonds cemented in extra fine cobalt not alloyed to tungsten carbide. The bronchoconstriction progressed towards the end of working-days; it was especially pronounced in the absence of an adequate exhaust ventilation; and it could be accompanied by rhinitis and chest tightness. Cobalt inhalation challenge tests were positive in all three patients, and exposure to cobalt temporarily increased nonspecific hyperreactivity

Uplift history of a Betic fold nappe inferred from Neogene-Quaternary sedimentation and tectonics (in the Sierra Alhamilla and Almeria, Sorbas and Tabernas Basins of the Betic Cordilleras, SE Spain)

Structural, stratigraphical and sedimentological studies of the Alhamilla region show that the Sierra Alhamilla was elevated relative to the surrounding basins by open folding towards the end of the Tortonian period (about 7 Ma ago) and before the onset of Messinian sedimentation. The main arguments are: (1) the dominant current direction in the Neogene cover changes from southward to southeast- and southwestward during the Late Tortonian, (2) Late Tortonian seismites suggest contemporaneous major tectonic activity which is contrasted by low tectonic activity during the Messinian, (3) Messinian reefs colonise Nevado-Filabride basement exposed (near Polopos) in the eroded hinge of the Alhamilla Anticlinorium, (4) the Northern Boundary Fault which is interpreted to be cogenetic with the formation of the Alhamilla Anticlinorium transects Tortonian sediments but is covered (near Cantona) by unfaulted Messinian reefs, and (5) the base of an almost non-tectonised Messinian succession (in the Sorbas Basin) unconformably overlies an erosion surface of folded Tortonian sediments, Neogene uplift of the Alhamilla region is interpreted here to be due to isostatic recovery after the emplacement of the Alboran Diapir between 20 and 25 Ma ago. Estimates of the average uplift rates vary between 0.7 to 0.5 mm a-' for the Miocene and 0.15 to 0.1 mm a-t for the Pliocene and Quaternary. Pliocene and Quaternary uplift rates are almost identical to the sedimentation rates of 0.23 to 0.2 mm a-' estimated previously for the Alboran Basin

Uplift history of a Betic fold nappe inferred from Neogene-Quaternary sedimentation and tectonics (in the Sierra Alhamilla and Almeria, Sorbas and Tabernas Basins of the Betic Cordilleras, SE Spain)

Structural, stratigraphical and sedimentological studies of the Alhamilla region show that the Sierra Alhamilla was elevated relative to the surrounding basins by open folding towards the end of the Tortonian period (about 7 Ma ago) and before the onset of Messinian sedimentation. The main arguments are: (1) the dominant current direction in the Neogene cover changes from southward to southeast- and southwestward during the Late Tortonian, (2) Late Tortonian seismites suggest contemporaneous major tectonic activity which is contrasted by low tectonic activity during the Messinian, (3) Messinian reefs colonise Nevado-Filabride basement exposed (near Polopos) in the eroded hinge of the Alhamilla Anticlinorium, (4) the Northern Boundary Fault which is interpreted to be cogenetic with the formation of the Alhamilla Anticlinorium transects Tortonian sediments but is covered (near Cantona) by unfaulted Messinian reefs, and (5) the base of an almost non-tectonised Messinian succession (in the Sorbas Basin) unconformably overlies an erosion surface of folded Tortonian sediments, Neogene uplift of the Alhamilla region is interpreted here to be due to isostatic recovery after the emplacement of the Alboran Diapir between 20 and 25 Ma ago. Estimates of the average uplift rates vary between 0.7 to 0.5 mm a-' for the Miocene and 0.15 to 0.1 mm a-t for the Pliocene and Quaternary. Pliocene and Quaternary uplift rates are almost identical to the sedimentation rates of 0.23 to 0.2 mm a-' estimated previously for the Alboran Basin