Digital single-image smartphone assessment of total body fat and abdominal fat using machine learning

Background: Obesity is chronic health problem. Screening for the obesity phenotype is limited by the availability of practical methods. Methods: We determined the reproducibility and accuracy of an automated machine-learning method using smartphone camera-enabled capture and analysis of single, two-dimensional (2D) standing lateral digital images to estimate fat mass (FM) compared to dual X-ray absorptiometry (DXA) in females and males. We also report the first model to predict abdominal FM using 2D digital images. Results: Gender-specific 2D estimates of FM were significantly correlated (p 0.05). Reproducibility of FM estimates was very high (R2 = 0.99) with high concordance (R2 = 0.99) and low absolute pure error (0.114 to 0.116 kg) and percent error (1.3 and 3%). Bland–Altman plots revealed no proportional bias with limits of agreement of 4.9 to -4.3 kg and 3.9 to -4.9 kg for females and males, respectively. A novel 2D model to estimate abdominal (lumbar 2–5) FM produced high correlations (R2 = 0.99) and concordance (R2 = 0.99) compared to DXA abdominal FM values. Conclusions: A smartphone camera trained with machine learning and automated processing of 2D lateral standing digital images is an objective and valid method to estimate FM and, with proof of concept, to determine abdominal FM. It can facilitate practical identification of the obesity phenotype in adults.Peer ReviewedPostprint (published version

Fluid-dependent single-frequency bioelectrical impedance fat mass estimates compared to digital imaging and dual X-ray absorptiometry

The need for a practical method for routine determination of body fat has progressed from body mass index (BMI) to bioelectrical impedance analysis (BIA) and smartphone two-dimensional imaging. We determined agreement in fat mass (FM) estimated with 50 kHz BIA and smartphone single lateral standing digital image (SLSDI) compared to dual X-ray absorptiometry (DXA) in 188 healthy adults (69 females and 119 males). BIA underestimated (p 25 kg/m2, 54 male rugby players, compared to 40 male non-rugby players, had greater (p < 0.001) BMI and FFM but less (p < 0.001) FM and ECW/ICW. BIA underestimated (p < 0.001) FM in the non-rugby men, but SLSDI and DXA FM estimates were not different in both groups. This finding is consistent with the expansion of ECW in individuals with excess body fat due to increased adipose tissue mass and its water content. Unlike SLSDI, 50 kHz BIA predictions of FM are affected by an increased ECW/ICW associated with greater adipose tissue. These findings demonstrate the validity, practicality, and convenience of smartphone SLSDI to estimate FM, seemingly not influenced by variable hydration states, for healthcare providers in clinical and field settings.Peer ReviewedPostprint (published version

Coherence effects in the transition radiation spectrum and practical consequences

In the framework of the pseudophotons method and under the hypothesis of the far field approximation the formal evaluation of the transition radiation spectrum produced by a three-dimensional charged beam interacting with a metallic target is carried out. When spatial incoherent conditions are occurring, the transverse size of a three-dimensional beam affects the spectrum via a suitable dependence on the Fourier transform of the transverse distribution, while the temporal coherent enhance of the spectrum depends only on the longitudinal beam size via the longitudinal form factor in the same manner as in the case of a one-dimensional beam. Spatial incoherent effects, arising at short wave-length in the spectrum, on the one hand allow a better comprehension of some aspects of the transition radiation phenomelogy - e.g. an analytical formula for the total radiated energy - and on the other hand offer new perspectives in the practical application of the transition radiation as diagnostics method of the transverse beam size in a particle accelerator.Comment: 18 pages, 1 figures, Submitted to Nuclear Instruments and Methods in Physics Research Section

Covariant Formulation of the Transition Radiation Energy Spectrum of an Electron Beam at a Normal Angle of Incidence onto a Round Metallic Screen

In the transition radiation emission from a N electron bunch hitting at a normal angle of incidence a metallic screen, the transverse and the longitudinal spatial coordinates of the electron bunch play different roles in determining the N single electron radiation field amplitudes and their relative phases in relation to the different physical constraints which an electromagnetic radiative mechanism by a charged beam must meet: i.e., temporal causality and covariance. The distribution of the N electron longitudinal coordinates determines indeed the sequence of the N electron collisions onto the metallic screen and, on the basis of the temporal causality principle, it also determines the distribution function of the relative emission phases of the N single electron field amplitudes from the metallic surface. The distribution of the transverse coordinates of the N electrons contributes as well to determine the relative phase distribution of the N electron field amplitudes at the observation point - located on the longitudinal axis of the reference frame - providing a further phase information that accounts for the transverse displacement of the N electrons with respect to the beam axis. The distribution of the transverse coordinates of the N electrons is a relativistic invariant under a Lorentz transformation with respect to the direction of motion of the beam and, consequently, it is expected to leave a covariant mark on the N single electron amplitudes composing the radiation field. The covariant imprinting of the N electron transverse density on the radiation field affects both the temporal coherent and incoherent parts of the transition radiation energy spectrum. Such a dependence of the N single electron radiation field amplitudes on the electron density in the transverse plane manifests itself as....(abstract partially missed because of lack of space

The P3^3 Experiment: A Positron Source Demonstrator for Future Lepton Colliders

The PSI Positron Production (P$^3$ or P-cubed) experiment is a demonstrator for a e+ source and capture system with potential to improve the state-of-the-art e+ yield by an order of magnitude. The experiment is driven by the FCC-ee injector study and will be hosted in the SwissFEL facility at the Paul Scherrer Institute in Switzerland. This paper is an overview of the P$^3$ design at an advanced stage, with a particular emphasis on a novel e+ capture system and its associated beam dynamics. Additionally, a concept for the experiment diagnostics is presented, as well as the key points of the ongoing installation works

Efficacy of bendamustine and rituximab as first salvage treatment in chronic lymphocytic leukemia and indirect comparison with ibrutinib: A GIMEMA, ERIC and UK CLL FORUM study

We performed an observational study on the efficacy of bendamustine and rituximab (BR) as first salvage regimen in chronic lymphocytic leukemia (CLL). In an intention-to-treat analysis including 237 patients, the median progression-free survival (PFS) was 25 months. The presence of del (17p), unmutated IGHV and advanced stage were associated with a shorter PFS at multivariate analysis. The median time-to-next treatment was 31.3 months. Front-line treatment with a chemoimmunotherapy regimen was the only predictive factor for a shorter time to next treatment at multivariate analysis. The median overall survival (OS) was 74.5 months. Advanced disease stage (i.e. Rai stage III-IV or Binet stage C) and resistant disease were the only parameters significantly associated with a shorter OS. Grade 3-5 infections were recorded in 6.3% of patients. A matched-adjusted indirect comparison with ibrutinib given second-line within Named Patient Programs in the United Kingdom and in Italy was carried out with OS as objective end point. When restricting the analysis to patients with intact 17p who had received chemoimmunotherapy in first line, there was no difference in OS between patients treated with ibrutinib (63% alive at 36 months) and patients treated with BR (74.4% alive at 36 months). BR is an efficacious first salvage regimen in CLL in a real-life population, including the elderly and unfit patients. BR and ibrutinib may be equally effective in terms of OS when used as first salvage treatment in patients without 17p deletion. (Registered at clinicaltrials.gov identifier: 02491398)

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Antidiabetic Drug Prescription Pattern in Hospitalized Older Patients with Diabetes

Objective: To describe the prescription pattern of antidiabetic and cardiovascular drugs in a cohort of hospitalized older patients with diabetes. Methods: Patients with diabetes aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI—Società Italiana di Medicina Interna) registry from 2010 to 2019 and discharged alive were included. Results: Among 1703 patients with diabetes, 1433 (84.2%) were on treatment with at least one antidiabetic drug at hospital admission, mainly prescribed as monotherapy with insulin (28.3%) or metformin (19.2%). The proportion of treated patients decreased at discharge (N = 1309, 76.9%), with a significant reduction over time. Among those prescribed, the proportion of those with insulin alone increased over time (p = 0.0066), while the proportion of those prescribed sulfonylureas decreased (p &lt; 0.0001). Among patients receiving antidiabetic therapy at discharge, 1063 (81.2%) were also prescribed cardiovascular drugs, mainly with an antihypertensive drug alone or in combination (N = 777, 73.1%). Conclusion: The management of older patients with diabetes in a hospital setting is often sub-optimal, as shown by the increasing trend in insulin at discharge, even if an overall improvement has been highlighted by the prevalent decrease in sulfonylureas prescription