Direct reduction of hematite pellets with hydrogen (H2) was used to produce directly reduced iron (DRI) in a pilot scale reactor at a pellet feed rate of 21.4 kg/h. At a steady state, operational parameters of the pilot plant (gas recycling rate and inlet temperature) along with key reactor output parameters, the pellet metallization, and the internal temperature profile of the reactor were reported for two scenarios with high recycle and low recycle rate of H2. Scenario 1, with a high recycle rate of 400 L/min H2 along with external heating of 870 °C, gave an average metallization of 91.8%, while Scenario 2, with low recycle rate of 100 L/min H2 and external heating of 850 °C gave a metallization of 67.8% due to the higher moles of H2 available for reduction and the external energy required for the endothermic reduction reaction in Scenario 1 as compared with Scenario 2. Finite element analysis was used to build a model of the shaft reactor, which was validated against the metallization and internal temperature profile data. The average metallization values predicted by the model were very close to the metallization values obtained from the pilot plant samples, with 90.9% average metallization for Scenario 1 and 65.6% average metallization for Scenario 2. The internal temperature profiles in the lower region of the reactor obtained from the model were very close to these pilot plant data, with a maximum difference of 52.7 °C and 67.6 °C for Scenarios 1 and 2, respectively. The pilot plant reactor model was used extensively in the commissioning of the pilot plant and to predict the startup outcomes for a given set of operating parameters.

The extent to which languages share properties reflecting the non-linguistic constraints of the speakers who speak them is key to the debate regarding the relationship between language and cognition. A critical case is spatial communication, where it has been argued that semantic universals should exist, if anywhere. Here, using an experimental paradigm able to separate variation within a language from variation between languages, we tested the use of spatial demonstratives—the most fundamental and frequent spatial terms across languages. In n = 874 speakers across 29 languages, we show that speakers of all tested languages use spatial demonstratives as a function of being able to reach or act on an object being referred to. In some languages, the position of the addressee is also relevant in selecting between demonstrative forms. Commonalities and differences across languages in spatial communication can be understood in terms of universal constraints on action shaping spatial language and cognition.

Data on race-related differences in the clinical outcomes of Takotsubo syndrome are limited, particularly for Black patients. This study aimed to assess whether race and sex may have an additional impact on the inpatient mortality of patients with Takotsubo syndrome. A total of 4,628 patients from the United States' National Inpatient Sample from 2012 to 2016 were identified; propensity score analysis revealed a similar propensity score between Black patients (n = 2,314) and White patients (n = 2,314), which was used to balance observed covariates. Sex and age distributions were identical between the 2 groups. The groups were also similar in baseline characteristics, including cardiovascular risk factors. White patients were compared with Black patients on in-hospital outcomes and inpatient mortality. A logistic regression analysis was conducted to measure the difference in mortality based on race and sex. Compared with White patients, Black patients had a higher percentage of in-hospital complications, including cerebrovascular accidents (4.9% vs 2.5%, P ≤ .01), acute kidney injury (25% vs 19%, P ≤ .01); longer lengths of stay (8 vs 7 days, P ≤ .01); and higher inpatient mortality (6.1% vs 4.5%, P < .01). When analysis was conducted with race and sex combined, inpatient mortality was higher among Black men than among White women (odds ratio, 2.7 [95% CI, 1.80-3.95]; P ≤ .01). This study showed that Black patients with Takotsubo syndrome have higher in-hospital complications and inpatient mortality rates. When race and sex were combined, inpatient mortality was significantly higher among Black men than among either White men and women or Black women.

ABSTRACTAngel investor tax credits are used globally to spur high‐growth entrepreneurship. Exploiting their staggered implementation in 31 U.S. states, we find that they increase angel investment yet have no significant impact on entrepreneurial activity. Two mechanisms explain these results: crowding out of alternative financing and low sensitivity of professional investors to tax credits. With a large‐scale survey and a stylized model, we show that low responsiveness among professional angels may reflect the fat‐tailed return distributions that characterize high‐growth startups. The results contrast with evidence that direct subsidies to firms have positive effects, raising concerns about promoting entrepreneurship with investor subsidies.

Objective: Overweight or obesity (OvOb) is a risk factor for the development of cardiometabolic complications. However, according to some investigators, OvOb developed without hypertension and insulin resistance may be considered as a benign phenotype. The aim of the present study was to investigate the prognostic significance of OvOb (BMI&gt; = 25 kg/m2) without concomitant metabolic abnormalities in young-to-middle-age subjects screened for stage 1 hypertension. Design and method: We examined 1208, 18-to-45-year-old participants from the HARVEST study. Mean age was 33.1 ± 8.6 years and BP 145.5 ± 10.6/93.5 ± 5.7 mmHg. Participants were classified into four groups according to whether they had OvOb or not (0/1) and had normal (group 0) or at least one abnormal (group 1) metabolic syndrome parameter (glucose, triglyceride, HDL-cholesterol, and average 24-hour BP). The predictive role of OvOb/metabolic group for incident hypertension and cardiovascular or renal events (MACE) was evaluated in Cox survival analyses, adjusting for other risk factors and several confounders. Results: ObOv was present in 51.1% of the participants and at least one metabolic abnormality was present in 74.5%. Among the subjects with OvOb, 20.2% had no metabolic abnormalities, 40.5% had one metabolic abnormality, and 39.3% had two or more metabolic abnormalities. During a median follow-up of 17.4 years, 80.6% of the participants developed hypertension requiring pharmacological treatment and 8.9% had a MACE. In adjusted Cox models, OvOb participants with at least one metabolic abnormality had an increased risk of incident hypertension (HR, 1.43; 95%CI,1.12 - 1.81, p = 0.003) and MACE (2.34,1.03 - 5.36, p = 0.043) compared to those with normal metabolic parameters. Among the participants with normal BMI, a similar metabolic-related increase in risk was found for the hypertension outcome (HR, 1.52;95%CI,1.21 - 1.92, p = 0.0003), but not for MACE (1.64,0.70 - 3.81, p = 0.25). In a Cox model in the whole population, when controlled for each other the metabolic group (0/1) was a predictor of hypertension (p &lt; 0.0001) and MACE (p = 0.028) whereas the ObOv group was not (p&gt;0.05). Conclusions: These data show that in young-to-middle-age people, an abnormal metabolic profile is an important predictor of future hypertension needing treatment and MACE. OvOb without metabolic abnormalities does not carry an increased risk of adverse outcomes.

Objective: The reproducibility and the prognostic value of white-coat hypertension (WCH) is still debated. The aim of the study was to investigate the reproducibility of WCH assessed twice within 3 months and its predictive capacity for development of hypertension needing antihypertensive treatment (HT) in young-to-middle-age subjects screened for stage 1 hypertension. Design and method: We investigated 1096, 18-to-45-year old subjects from the HARVEST. Office BP and 24hour BP were measured at baseline and after 3 months. On the basis of BPs measured after 3 months, 132 participants were classified as normotensive, 159 as WCH, 195 as masked hypertensive and 610 as sustained hypertensive. The reproducibility of WCH, office hypertension, and ambulatory hypertension was evaluated with Kappa statistics. The predictive capacity of WCH defined with a single assessment or with double assessment was tested in multivariate Cox models (N = 1054). Results: Baseline WCH was confirmed at 3-month assessment in only 33.3% of participants, whereas 31.6% became normotensive, 8.8% masked hypertensive and 26.3% sustained hypertensive. Reproducibility evaluated with weighted Kappa was fair (0.27, 95%CI 0.20 - 0.37) for WCH, poor (0.14, 95%CI 0.09 - 0.19) for office Hypertension (BP&gt; = 140/90 mmHg), and moderate (0.47, 95%CI 0.41 - 0.53) for ambulatory Hypertension (24hBP&gt; = 130/80 mmHg). During 17.4 years of follow-up, 80.5% of participants developed HT. WCH assessed either at baseline (p = 0.86) or after 3 months (p = 0.16) was not a significant predictor of future HT. However, participants who had WCH both at baseline and after 3 months (N = 76) had an increased risk of HT compared to the normotensives (Hazard ratio, 1.50, 95%CI 1.06 - 2.13, p = 0.022). HRs were 1.35 (95%CI 1.02 - 1.80, p = 0.037) in participants with masked hypertension and 1.52 (95%CI 1.19 - 1.95, p &lt; 0.001) in those with sustained hypertension. Conclusions: These results show that in young-to-middle-age individuals, WCH was confirmed in only one third of people at repeat assessment. This was mainly due to a poor reproducibility of office hypertension. WCH diagnosed with two but not with one BP assessment showed an increased risk of future HT. Our data indicate that people with WCH at first assessment should undergo a second set of ambulatory and office BP measurements before clinical decisions are made.

Objective: The risk of adverse CV outcomes in young patients with isolated systolic hypertension (ISH) or isolated diastolic hypertension (IDH) is still debated and whether these hypertension subtypes should undergo pharmacological treatment is unclear. Aim of the present the study was to investigate the vascular characteristics and the risk of progression to sisto-diastolic hypertension (SDH) associated with these hypertension subtypes from the HARVEST study. Design and method: We examined 1231 young-to middle age subjects (mean age 33.1 ± 8.6 years, 72.3% males). ISH (11.9%) IDH (22.8%) NT (6.6%) and SDH (58.7%) were defined using the office 140/90 mmHg cutoffs. Vascular stiffness was assessed by radial-carotid pulse wave velocity (PWV) and vascular compliance by radial tonometry among 371 participants. Risk of future hypertension needing antihypertensive treatment was assessed with Cox analysis adjusting for several clinical confounders. Results: Metabolic parameters did not differ significantly among subgroups. Peripheral resistance was 1297.1 ± 326 among NT, 1371.3 ± 281 among ISH, 1502.5 ± 261 among IDH and 1531.6 ± 308 dynesxsecxcm-5 among SDH (p = 0.048 IDH vs NT and &lt;0.001 SDH vs NT), while did not differ significantly between ISH and NT. Large artery compliance was 15.0 ± 4.2, 15.5 ± 4.9, 15.1 ± 4.9 and 14.0 ± 4.3 ml/minx10 respectively, again with similar values between NT and ISH and a significant difference between IDH and SDH p = 0.016. PWV and AIx did not differ significantly among groups, while central SBP was similar among NT, ISH, IDH (122.2 ± 12.0, 122.6 ± 12.4 mmHg respectively, p = n.s.) and higher among SDH (p &lt; 0.001 SHD vs IDH). Progression to sustained HT was 59.2%, 66.4%, 77.9% and 87.5%, in NT, ISH, IDH and SDH respectively, p &lt; 0.001. At cox analysis, considering SDH as reference, ISH presented a lower risk of progression to unfavourable outcome (H.R. 0.70, 95%CI 0.58 - 0.88; p = 0.0023). Conclusions: Young-to-middle age hypertensives have different endothelial function according to different hypertensive subtypes and this may contribute to the future development of hypertension needing treatment. The assessment of vascular function may help to identify those patients who should be treated earlier.

Exercise prescription based on fixed heart rate (HR) values is not associated with a specific work rate (WR) during prolonged exercise. This phenomenon has never been evaluated in cardiac patients, and might be associated with a slow component of HR kinetics and -adrenergic activity. The aim was to quantify, in cardiac patients, the work rate decrease at a fixed HR, and to test if it would be attenuated by β-blockers. 17 patients with coronary artery disease in stable conditions (69 ± 9 yr) were divided into two groups according to the presence (BB) or absence (no-BB) of a therapy with β-blockers, and performed on a cycle ergometer: an incremental exercise (INCR); a 15-min "HRCLAMPED" exercise, in which WR was continuously adjusted to maintain a constant HR, corresponding to the gas exchange threshold (GET) +15%. HR was determined by the ECG signal, and pulmonary gas exchange was assessed breath-by-breath. During INCR HRpeak was lower in BB vs. no-BB (p < 0.05), whereas no differences were observed for other variables. During HRCLAMPED the decrease in WR needed to maintain HR constant was less pronounced in BB vs. no-BB (-16 ± 10% vs. -27 ± 10, p = 0.04), and was accompanied by a decreased O2 only in no-BB (-13 ± 6%, p < 0.001). The decrease in WR during 15-min exercise at a fixed HR (slightly higher than that at GET) was attenuated in BB, suggesting a potential role by β-adrenergic stimulation. The phenomenon may represent, also in this population, a sign of impaired exercise tolerance, and interferes with aerobic exercise prescription.

Three-dimensional electroanatomical mapping (EAM) has the potential to identify the pathological substrate underlying ventricular arrhythmias (VAs) in different clinical settings by detecting myocardial areas with abnormally low voltages, which reflect the presence of different cardiomyopathic substrates. In athletes, the added value of EAM may be to enhance the efficacy of third-level diagnostic tests and cardiac magnetic resonance (CMR) in detecting concealed arrhythmogenic cardiomyopathies. Additional benefits of EAM in the athlete include the potential impact on disease risk stratification and the consequent implications for eligibility to competitive sports. This opinion paper of the Italian Society of Sports Cardiology aims to guide general sports medicine physicians and cardiologists on the clinical decision when to eventually perform an EAM study in the athlete, highlighting strengths and weaknesses for each cardiovascular disease at risk of sudden cardiac death during sport. The importance of early (preclinical) diagnosis to prevent the negative effects of exercise on phenotypic expression, disease progression, and worsening of the arrhythmogenic substrate is also addressed.