Enhancing diagnostic precision for acute chest syndrome in sickle cell disease: insights from dual-energy CT lung perfusion mapping.

PURPOSE: Acute chest syndrome (ACS) is secondary to occlusion of the pulmonary vasculature and a potentially life-threatening complication of sickle cell disease (SCD). Dual-energy CT (DECT) iodine perfusion map reconstructions can provide a method to visualize and quantify the extent of pulmonary microthrombi. METHODS: A total of 102 patients with sickle cell disease who underwent DECT CTPA with perfusion were retrospectively identified. The presence or absence of airspace opacities, segmental perfusion defects, and acute or chronic pulmonary emboli was noted. The number of segmental perfusion defects between patients with and without acute chest syndrome was compared. Sub-analyses were performed to investigate robustness. RESULTS: Of the 102 patients, 68 were clinically determined to not have ACS and 34 were determined to have ACS by clinical criteria. Of the patients with ACS, 82.4% were found to have perfusion defects with a median of 2 perfusion defects per patient. The presence of any or new perfusion defects was significantly associated with the diagnosis of ACS (P = 0.005 and < 0.001, respectively). Excluding patients with pulmonary embolism, 79% of patients with ACS had old or new perfusion defects, and the specificity for new perfusion defects was 87%, higher than consolidation/ground glass opacities (80%). CONCLUSION: DECT iodine map has the capability to depict microthrombi as perfusion defects. The presence of segmental perfusion defects on dual-energy CT maps was found to be associated with ACS with potential for improved specificity and reclassification.

Optimisation of virtual monoenergetic reconstructions for the diagnosis of pulmonary embolism using photon-counting detector computed tomography angiography.

Purpose: Computed tomography (CT) pulmonary angiography is considered the gold standard for pulmonary embolism (PE) diagnosis, relying on the discrimination between contrast and embolus. Photon-counting detector CT (PCD-CT) generates monoenergetic reconstructions through energy-resolved detection. Virtual monoenergetic images (VMI) at low keV can be used to improve pulmonary artery opacification. While studies have assessed VMI for PE diagnosis on dual-energy CT (DECT), there is a lack of literature on optimal settings for PCD-CT-PE reconstructions, warranting further investigation. Material and methods: Twenty-five sequential patients who underwent PCD-CT pulmonary angiography for suspicion of acute PE were retrospectively included in this study. Quantitative metrics including signal-to-noise ratio (SNR) and contrast-to-noise (CNR) ratio were calculated for 4 VMI values (40, 60, 80, and 100 keV). Qualitative measures of diagnostic quality were obtained for proximal to distal pulmonary artery branches by 2 cardiothoracic radiologists using a 5-point modified Likert scale. Results: SNR and CNR were highest for the 40 keV VMI (49.3 ± 22.2 and 48.2 ± 22.1, respectively) and were inversely related to monoenergetic keV. Qualitatively, 40 and 60 keV both exhibited excellent diagnostic quality (mean main pulmonary artery: 5.0 ± 0 and 5.0 ± 0; subsegmental pulmonary arteries 4.9 ± 0.1 and 4.9 ± 0.1, respectively) while distal segments at high (80-100) keVs had worse quality. Conclusions: 40 keV was the best individual VMI for the detection of pulmonary embolism by quantitative metrics. Qualitatively, 40-60 keV reconstructions may be used without a significant decrease in subjective quality. VMIs at higher keV lead to reduced opacification of the distal pulmonary arteries, resulting in decreased image quality.

Non-contrast computed tomography findings for identification of chronically occluded coronary artery bypass grafts.

BACKGROUND: Detecting occlusions of coronary artery bypass grafts using non-contrast computed tomography (CT) series is understudied and underestimated. PURPOSE: To evaluate morphological findings for the diagnosis of chronic coronary artery bypass graft occlusion on non-contrast CT and investigate performance statistics for potential use cases. MATERIAL AND METHODS: Seventy-three patients with coronary artery bypass grafts who had CT angiography of the chest (non-contrast and arterial phases) were retrospectively included. Two readers applied pre-set morphologic findings to assess the patency of a bypass graft on non-contrast series. These findings included vessel shape (linear-band like), collapsed lumen and surgical graft marker without a visible vessel. Performance was tested using the simultaneously acquired arterial phase series as the ground truth. RESULTS: The per-patient diagnostic accuracy for occlusion was 0.890 (95% confidence interval = 0.795-0.951). Venous grafts overall had an 88% accuracy. None of the left internal mammary artery to left anterior descending artery arterial graft occlusions were detected. The negative likelihood ratio for an occluded graft that is truly patent was 0.121, demonstrating a true post-test probability of 97% for identifying a patent graft as truly patent given a prevalence of 20% occlusion at a median 8.4 years post-surgery. Neither years post-surgery, nor number of vessels was associated with a significant decrease in reader accuracy. CONCLUSION: Evaluation of coronary bypass grafts for chronic occlusion on non-contrast CT based off vessel morphology is feasible and accurate for venous grafts. Potential use cases include low-intermediate risk patients with chest pain or shortness of breath for whom non-contrast CT was ordered, or administration of iodine-based contrast is contraindicated.

Dual-energy CT iodine overlay improves efficiency of oral contrast leak assessment.

BACKGROUND: Evaluation for gastrointestinal leak is a frequent imaging indication, and dual-energy computed tomography (DECT) with oral or rectally administered contrast can be used to improve efficiency and diagnostic confidence. PURPOSE: To assess the value of the DECT iodine overlay (IO) reconstruction as a stand-alone image set compared to routine CT in assessing oral or rectal contrast leak from the gastrointestinal system. MATERIAL AND METHODS: A blinded, retrospective audit study was performed by three readers who each interpreted 50 studies performed for assessment of oral or rectal contrast leak that were acquired using DECT. Each reader independently assessed both the routine CT images and the images of the reconstructed IO for contrast leak in random order with a six-week "wash-out period" between readings. Clinical follow-up provided the reference standard. Readers recorded the presence/absence of a leak, diagnostic confidence, image quality score, and interpretation time for each image set. RESULTS: Pooled data for overall accuracy in identification of a leak increased from 0.81 (95% confidence interval [CI]=0.74-0.87) for routine CT to 0.91 (95% CI=0.85-0.95) with IO, and the area under the curve (AUC) was significantly higher for IO than routine CT (P = 0.015). Readers required significantly less time to interpret IO than routine CT (median improvement of 12.5 s per image using pooled data; P < 0.001) while maintaining diagnostic confidence and perceived image quality. CONCLUSION: Use of DECT IO reconstructions for identification of oral or rectal contrast leak requires less time to interpret than routine CT with improved accuracy and maintained diagnostic confidence and perceived image quality.

Sustainable maize intensification through site-specific nutrient management advice: Experimental evidence from Nigeria.

There is growing evidence on the impacts of site-specific nutrient management (SSNM) from Asia. The evidence for Sub-Saharan Africa (SSA), where SSNM developments are more recent and where conditions concerning soil fertility and fertilizer use differ importantly from those in Asia, is extremely scarce. We evaluate a SSNM advisory tool that allows extension agents to generate fertilizer recommendations tailored to the specific situation of an individual farmer's field, using a three-year randomized controlled trial with 792 smallholder farmers in the maize belt of northern Nigeria. Two treatment arms were implemented: T1 and T2 both provide SSNM information on nutrient use and management, but T2 provides additional information on maize price distributions and the associated variability of expected returns to fertilizer use. We estimate average and heterogenous intent-to-treat effects on agronomic, economic and environmental plot-level outcomes. We find that T1 and T2 lead to substantial increases (up to 116%) in the adoption of good fertilizer management practices and T2 leads to incremental increases (up to 18%) in nutrient application rates, yields and revenues. Both treatments improve low levels of nutrient use efficiency and reduce high levels of greenhouse gas emission intensity, after two years of treatment. Our findings underscore the possibility of a more gradual and sustainable intensification of smallholder agriculture in SSA, as compared with the Asian Green Revolution, through increased fertilizer use accompanied by improved fertilizer management.

Failure to scale in digital agronomy: An analysis of site-specific nutrient management decision-support tools in developing countries.

While many have extolled the potential impacts of digital advisory services for smallholder agriculture, the evidence for sustained uptake of such tools remains limited. This paper utilizes a survey of tool developers and researchers, as well as a systematic meta-analysis of prior studies, to assess the extent and challenges of scaling decision support tools for site-specific soil nutrient management (SSNM-DST) across smallholder farming systems, where "scaling" is defined as a significant increase in tool usage beyond pilot levels. Our evaluation draws on relevant literature, expert opinion and apps available in different repositories. Despite their acclaimed yield benefits, we find that SSNM-DST have struggled to reach scale over the last few decades and, with strong heterogeneity in adoption among intended stakeholders and tools. For example, the log odds of a SSNM-DST reaching 5-10 % of the target farmers compared with reaching none, decreases by âˆ¼200% when a technical problem is stated as a reason for the tools' failure to be used at scale. We find a similar decrease in odds ratios when technical, socioeconomic, policy, and R&D constraints were identified as barriers to scaling by national extension and private systems. Meta-regression analysis indicates that the response ratio of using SSNM-DST over Farmer Fertilizer Practice (FFP) varies by non-tool related covariates, such as initial crop yield potential under FFP, current and past crop types, acidity class of the soil, temperature and rainfall regimes, and the amount of input under FFP. In general, the SSNM-DST have moved one step forward compared with the traditional 'blanket' fertilizer recommendation by accounting for in-field heterogeneities in soil and crop characteristics, while remaining undifferentiated in terms of demographic and socioeconomic heterogeneities among users, which potentially constrains adoption at scale. The SSNM-DSTs possess reasonable applicability and can be labeled 'ready' from purely scientific viewpoints, although their readiness for system-level uptake at scale remains limited, especially where socio-technical and institutional constraints are prevalent.

Left atrial calcification on chest CT: atrial ablation replaces rheumatic heart disease as the most identified etiology.

Purpose: Left atrial calcification (LAC), a primarily radiologic diagnosis, has been associated with rheumatic heart disease (RHD) and rheumatic fever (RF). However, left atrial calcification continues to be observed despite a significant decrease in the prevalence of rheumatic heart disease. The purpose of this study was to investigate other possible etiologies of left atrial calcification. Material and methods: This retrospective, observational single-center study included patients from 2017 to 2022 identified as having left atrial calcification as well as age- and sex-matched controls. The prevalence of rheumatic heart disease, atrial ablation, and mitral valve disease was compared, and odds ratios were calculated for each independent variable. Results: Sixty-two patients with left atrial calcifications were included and compared with 62 controls. 87.1% of patients in the left atrial calcifications cohort had a history of atrial fibrillation compared with 21% in the control cohort (p < 0.001). 16.1% of patients in the calcifications cohort presented a history of rheumatic fever compared with zero in the control cohort (p = 0.004). 66.1% of the left atrial calcifications cohort had a history of atrial ablation compared with 6.5% of the control group (p < 0.001). The odds ratio for left atrial calcification was 19.0 vs. 4.8 for rheumatic fever (comparative odds = 4.0 for atrial ablation vs. rheumatic fever). Multivariable log model found atrial ablation to explain 79.8% of left atrial calcifications identified. Conclusions: Our study found a 4-fold higher association between history of atrial ablation and left atrial calcification compared with rheumatic heart disease, suggesting a potential shift in etiology.

Diagnostic accuracy and performance of artificial intelligence in measuring left atrial volumes and function on multiphasic CT in patients with atrial fibrillation.

OBJECTIVES: To evaluate the effectiveness of a novel artificial intelligence (AI) algorithm for fully automated measurement of left atrial (LA) volumes and function using cardiac CT in patients with atrial fibrillation. METHODS: We included 79 patients (mean age 63 ± 12 years; 35 with atrial fibrillation (AF) and 44 controls) between 2017 and 2020 in this retrospective study. Images were analyzed by a trained AI algorithm and an expert radiologist. Left atrial volumes were obtained at cardiac end-systole, end-diastole, and pre-atrial contraction, which were then used to obtain LA function indices. Intraclass correlation coefficient (ICC) analysis of the LA volumes and function parameters was performed and receiver operating characteristic (ROC) curve analysis was used to compare the ability to detect AF patients. RESULTS: The AI was significantly faster than manual measurement of LA volumes (4 s vs 10.8 min, respectively). Agreement between the manual and automated methods was good to excellent overall, and there was stronger agreement in AF patients (all ICCs ≥ 0.877; p < 0.001) than controls (all ICCs ≥ 0.799; p < 0.001). The AI comparably estimated LA volumes in AF patients (all within 1.3 mL of the manual measurement), but overestimated volumes by clinically negligible amounts in controls (all by ≤ 4.2 mL). The AI's ability to distinguish AF patients from controls using the LA volume index was similar to the expert's (AUC 0.81 vs 0.82, respectively; p = 0.62). CONCLUSION: The novel AI algorithm efficiently performed fully automated multiphasic CT-based quantification of left atrial volume and function with similar accuracy as compared to manual quantification. Novel CT-based AI algorithm efficiently quantifies left atrial volumes and function with similar accuracy as manual quantification in controls and atrial fibrillation patients. KEY POINTS: • There was good-to-excellent agreement between manual and automated methods for left atrial volume quantification. • The AI comparably estimated LA volumes in AF patients, but overestimated volumes by clinically negligible amounts in controls. • The AI's ability to distinguish AF patients from controls was similar to the manual methods.

Automated diagnosis and prognosis of COVID-19 pneumonia from initial ER chest X-rays using deep learning.

BACKGROUND: Airspace disease as seen on chest X-rays is an important point in triage for patients initially presenting to the emergency department with suspected COVID-19 infection. The purpose of this study is to evaluate a previously trained interpretable deep learning algorithm for the diagnosis and prognosis of COVID-19 pneumonia from chest X-rays obtained in the ED. METHODS: This retrospective study included 2456 (50% RT-PCR positive for COVID-19) adult patients who received both a chest X-ray and SARS-CoV-2 RT-PCR test from January 2020 to March of 2021 in the emergency department at a single U.S. INSTITUTION: A total of 2000 patients were included as an additional training cohort and 456 patients in the randomized internal holdout testing cohort for a previously trained Siemens AI-Radiology Companion deep learning convolutional neural network algorithm. Three cardiothoracic fellowship-trained radiologists systematically evaluated each chest X-ray and generated an airspace disease area-based severity score which was compared against the same score produced by artificial intelligence. The interobserver agreement, diagnostic accuracy, and predictive capability for inpatient outcomes were assessed. Principal statistical tests used in this study include both univariate and multivariate logistic regression. RESULTS: Overall ICC was 0.820 (95% CI 0.790-0.840). The diagnostic AUC for SARS-CoV-2 RT-PCR positivity was 0.890 (95% CI 0.861-0.920) for the neural network and 0.936 (95% CI 0.918-0.960) for radiologists. Airspace opacities score by AI alone predicted ICU admission (AUC = 0.870) and mortality (0.829) in all patients. Addition of age and BMI into a multivariate log model improved mortality prediction (AUC = 0.906). CONCLUSION: The deep learning algorithm provides an accurate and interpretable assessment of the disease burden in COVID-19 pneumonia on chest radiographs. The reported severity scores correlate with expert assessment and accurately predicts important clinical outcomes. The algorithm contributes additional prognostic information not currently incorporated into patient management.

Site-specific agronomic information and technology adoption: A field experiment from Ethiopia.

Smallholder farmers in Africa typically only have access to blanket fertilizer recommendations which are defined over very broad areas and may not be optimal for local production conditions. The response to such recommendations has generally been poor. Using a randomized control trial in Ethiopia, we explore whether targeted extension advice leads farmers to align fertilizer usage to the recommended levels and whether this impacts productivity. We also consider whether coupling the targeted information with agricultural insurance encourages fertilizer investment. Results show that targeted recommendations closed the gap between the amount of fertilizer used and the recommended amounts and this in turn increased productivity and profits. We found no differential effect of the targeted recommendation when coupled with agricultural insurance, suggesting that the risk of crop failure is not a binding constraint to fertilizer adoption in this context, or that farmers do not consider agricultural insurance a useful risk-mitigating mechanism.

Automated detection of lung nodules and coronary artery calcium using artificial intelligence on low-dose CT scans for lung cancer screening: accuracy and prognostic value.

BACKGROUND: Artificial intelligence (AI) in diagnostic radiology is undergoing rapid development. Its potential utility to improve diagnostic performance for cardiopulmonary events is widely recognized, but the accuracy and precision have yet to be demonstrated in the context of current screening modalities. Here, we present findings on the performance of an AI convolutional neural network (CNN) prototype (AI-RAD Companion, Siemens Healthineers) that automatically detects pulmonary nodules and quantifies coronary artery calcium volume (CACV) on low-dose chest CT (LDCT), and compare results to expert radiologists. We also correlate AI findings with adverse cardiopulmonary outcomes in a retrospective cohort of 117 patients who underwent LDCT. METHODS: A total of 117 patients were enrolled in this study. Two CNNs were used to identify lung nodules and CACV on LDCT scans. All subjects were used for lung nodule analysis, and 96 subjects met the criteria for coronary artery calcium volume analysis. Interobserver concordance was measured using ICC and Cohen's kappa. Multivariate logistic regression and partial least squares regression were used for outcomes analysis. RESULTS: Agreement of the AI findings with experts was excellent (CACV ICC = 0.904, lung nodules Cohen's kappa = 0.846) with high sensitivity and specificity (CACV: sensitivity = .929, specificity = .960; lung nodules: sensitivity = 1, specificity = 0.708). The AI findings improved the prediction of major cardiopulmonary outcomes at 1-year follow-up including major adverse cardiac events and lung cancer (AUCMACE = 0.911, AUCLung Cancer = 0.942). CONCLUSION: We conclude the AI prototype rapidly and accurately identifies significant risk factors for cardiopulmonary disease on standard screening low-dose chest CT. This information can be used to improve diagnostic ability, facilitate intervention, improve morbidity and mortality, and decrease healthcare costs. There is also potential application in countries with limited numbers of cardiothoracic radiologists.

Implications of intra-plot heterogeneity for yield estimation accuracy: Evidence from smallholder maize systems in Ethiopia.

Intra-plot heterogeneity in yield is often observed in smallholder farming systems, although its implications for yield measurement remain under-investigated. Using a unique dataset on smallholder maize production in Ethiopia, we quantify the magnitude of inter- and intra-plot heterogeneity, describe the relationship between intra-plot heterogeneity and maize productivity, and document the implications of intra-field heterogeneity on the accuracy of alternative yield estimation protocols. Our data include five common yield estimation protocols, as well as full plot harvests of 230 smallholder maize fields. We surveyed agronomic decisions, biophysical variables, and accessibility characteristics of the surveyed fields. We quantify intra-plot heterogeneity using the coefficient of variation (CV) of stand density, cob weight, and maize grain yield. A generalized linear mixed model is used to explore the relationship between these variables and the method- and heterogeneity-dependence of yield estimation accuracy. We find inter-plot CV values ranging from 32 to 56 %, 22 to 73 % and 39 to 49 % in population density, cob weight and grain yield, respectively. Intra-plot heterogeneity constituted most of this variation, with across-method mean CV values of 41 %, 82 % and 63 %, respectively, of the total variability in population density, cob weight and grain yield. A rise in intra-plot heterogeneity of 0.5 % to 0.8 % is associated with a significant increase in yield estimation error under alternative yield estimation protocols. Regression analysis shows that interactions in agronomic decisions, input intensity and plot accessibility factors dictate intra-plot heterogeneity and method accuracy in smallholder systems. Intra-plot heterogeneity is larger than inter-plot heterogeneity in the current study area. Our analysis shows that the effect of intra-plot heterogeneity on yield estimation accuracies is method-dependent and yield estimation methods that fail to capture true intra-plot heterogeneity are more error-prone. Results of such estimations should be considered with caution when used as the basis of decision-making.

How accurate are yield estimates from crop cuts? Evidence from smallholder maize farms in Ethiopia.

Agricultural statistics and applied analyses have benefitted from moving from farmer estimates of yield to crop cut based estimates, now regarded as a gold standard. However, in practice, crop cuts and other sample-based protocols vary widely in the details of their implementations and little empirical work has documented how alternative yield estimation methods perform. Here, we undertake a well-measured experiment of multiple yield estimation methods on 237 smallholder maize plots in Amhara region, Ethiopia. We compare yield from a full plot harvest with farmer assessments and with estimates from a variety of field sampling protocols: W-walk, transect, random quadrant, random octant, center quadrant, and 3 diagonal quadrants. We find that protocol choices are important: alternative protocols vary considerably in their accuracy relative to the whole plot, with absolute mean errors ranging from 23 (farmer estimates) to 10.6 (random octant). Furthermore, while most methods approximate the sample mean reasonably well, the divergence of individual measures from true plot-level values can be considerable. We find that randomly positioned quadrants outperform systematic sampling schemes: the random octant had the best accuracy and was the most cost-effective. The nature of bias is non-classical: bias is correlated with plot size as well as with plot management characteristics. In summary, our results advocate that even "gold standard" crop cut measures should be interpreted cautiously, and more empirical work should be carried out to validate and extend our conclusions.

COVID-19 and food security: Panel data evidence from Nigeria.

This paper combines pre-pandemic face-to-face survey data with follow up phone surveys collected in April-May 2020 to examine the implication of the COVID-19 pandemic on household food security and labor market participation outcomes in Nigeria. To examine these relationships and implications, we exploit spatial variation in exposure to COVID-19 related infections and lockdown measures, along with temporal differences in our outcomes of interest, using a difference-in-difference approach. We find that households exposed to higher COVID-19 case rates or mobility lockdowns experience a significant increase in measures of food insecurity. Examining possible transmission channels for this effect, we find that the spread of the pandemic is associated with significant reductions in labor market participation. For instance, lockdown measures are associated with 6-15 percentage points increase in households' experience of food insecurity. Similarly, lockdown measures are associated with 12 percentage points reduction in the probability of participation in non-farm business activities. These lockdown measures have limited implications on wage-related activities and farming activities. In terms of food security, households relying on non-farm businesses, poorer households, and those living in remote and conflicted-affected zones have experienced relatively larger deteriorations in food security. These findings can help inform immediate and medium-term policy responses, including social protection policies aiming at ameliorating the impacts of the pandemic.

The role of active soil carbon in influencing the profitability of fertilizer use: Empirical evidence from smallholder maize plots in Tanzania.

We use recent plot-level panel data from Tanzanian smallholder farmers to investigate maize yield responses to inorganic fertilizer under variable soil carbon conditions. Unlike many prior studies which consider total carbon measurements, we focus on active soil carbon, which is a component strongly related to key soil functions, such as nutrient cycling and availability. Active soil carbon is found to be a strong predictor of maize yield response to nitrogen fertilizer. These results highlight important sources of variation in the returns to fertilizer investments across plots and smallholder farmers in the region. When farmgate prices for maize and fertilizer are incorporated into calculations of economic returns, we find that the profitability of fertilizer use is strongly dependent upon farmgate price ratio assumptions: under our most optimistic agronomic response estimates, 39% of farmer plots have an average value-cost ratio greater than 1.5 at a maize-nitrogen price ratio of 0.15. That share drops to 4% at a price ratio of 0.12 and 0% at a price ratio of 0.09. Our findings provide insights into the intertwined biophysical and economic underpinnings of low levels of fertilizer use in Tanzania and elsewhere in the region. Raising active carbon stocks in smallholder systems may be a strategic priority in many areas for incentivizing greater use of inorganic fertilizer, reversing land degradation, and achieving sustainable agricultural intensification.

Farmers' preferences for high-input agriculture supported by site-specific extension services: Evidence from a choice experiment in Nigeria.

Agricultural extension to improve yields of staple food crops and close the yield gap in Sub-Saharan Africa often entails general recommendations on soil fertility management that are distributed to farmers in a large growing area. Site-specific extension recommendations that are better tailored to the needs of individual farmers and fields, and enabled by digital technologies, could potentially bring about yield and productivity improvements. In this paper, we analyze farmers' preferences for high-input maize production supported by site-specific nutrient management recommendations provided by an ICT-based extension tool that is being developed for extension services in the maize belt of Nigeria. We use a choice experiment to provide ex-ante insights on the adoption potentials of site-specific extension services from the perspective of farmers. We control for attribute non-attendance and account for class as well as scale heterogeneity in preferences using different models, and find robust results. We find that farmers have strong preferences to switch from general to ICT-enabled site-specific soil fertility management recommendations which lend credence to the inclusion of digital technologies in agricultural extension. We find heterogeneity in preferences that is correlated with farmers' resource endowments and access to services. A first group of farmers are strong potential adopters; they are better-off, less sensitive to risk, and are more willing to invest in a high-input maize production system. A second group of farmers are weak potential adopters; they have lower incomes and fewer productive assets, are more sensitive to yield variability, and prefer less capital and labor intensive production techniques. Our empirical findings imply that improving the design of extension tools to enable provision of information on the riskiness of expected outcomes and flexibility in switching between low-risk and high-risk recommendations will help farmers to make better informed decisions, and thereby improve the uptake of extension advice and the efficiency of extension programs.

Iodine quantification of renal lesions: Preliminary results using spectral-based material extraction on photon-counting CT.

Objectives: To assess the range of quantitative iodine values in renal cysts (RC) (with a few renal neoplasms [RNs] as a comparison) to develop an expected range of values for RC that can be used in future studies for their differentiation. Material and Methods: Consecutive patients (n = 140) with renal lesions who had undergone abdominal examination on a clinical photon-counting computed tomography (PCCT) were retrospectively included. Automated iodine quantification maps were reconstructed, and region of interest (ROI) measurements of iodine concentration (IC) (mg/cm3) were performed on whole renal lesions. In addition, for heterogeneous lesions, a secondary ROI was placed on the area most suspicious for malignancy. The discriminatory values of minimum, maximum, mean, and standard deviation for IC were compared using simple logistic regression and receiver operating characteristic curves (area under the curve [AUC]). Results: A total of 259 renal lesions (243 RC and 16 RN) were analyzed. There were significant differences between RC and RN for all IC measures with the best-performing metrics being mean and maximum IC of the entire lesion ROI (AUC 0.912 and 0.917, respectively) but also mean and minimum IC of the most suspicious area in heterogeneous lesions (AUC 0.983 and 0.992, respectively). Most RC fell within a range of low measured iodine values although a few had higher values. Conclusion: Automated iodine quantification maps reconstructed from clinical PCCT have a high diagnostic ability to differentiate RCs and neoplasms. The data from this pilot study can be used to help establish quantitative values for clinical differentiation of renal lesions.

Estimating acid soil effects on selected cereal crop productivities in Ethiopia: Comparing economic cost-effectiveness of lime and fertilizer applications.

Acid soils are a major constraint to agricultural productivity in many parts of sub-Saharan Africa, including Ethiopia. Restoring soil pH to optimal ranges for agriculture can have a significant impact on yields, particularly for acid intolerant crops like wheat and barley. The application of agricultural lime is the standard corrective, although the large application requirements, lack of farmer awareness, and weak or non-existent lime supply chains make this a complex problem to address at scale. To date, no large-scale farmer trials of lime application have been undertaken in Ethiopia. This leaves open the question to local policy makers as to the economic benefits given the enormous capital and logistics investments required. To help address this we leverage existing spatial edaphic data and longitudinal crop surveys to simulate the productivity impact of varying lime and fertilizer applications. Our estimates find the impact of moving pH from 5.5 to 6.5, modeled as a lime soil remediation strategy, increases yields by 22% and 19% for wheat and barley, respectively. In addition, at lower pH levels our models indicate that commonly used nitrogen-based fertilizers are less cost-effective. For wheat in highly acidic soils, we find that fertilizers cost over two times as much as a single application of lime over a five-year period. The cost savings of the use of lime reaches as high as 121% of average one-year agricultural household income for wheat; with barley these savings are lower but still substantial at 24%. In general, we advocate for an integrated soil fertility management strategy that applies appropriate levels of fertilizer on pH balanced soil. If successful, Ethiopia's acid soil reclamation could become a modest version of Brazil's successful "cerrado miracle" and serve as an example for Africa.

Application of an artificial intelligence ensemble for detection of important secondary findings on lung ventilation and perfusion SPECT-CT.

RATIONALE: Single-photon-emission-computerized-tomography/computed-tomography(SPECT/CT) is commonly used for pulmonary disease. Scant work has been done to determine ability of AI for secondary findings using low-dose-CT(LDCT) attenuation correction series of SPECT/CT. METHODS: 120 patients with ventilation-perfusion-SPECT/CT from 9/1/21-5/1/22 were included in this retrospective study. AI-RAD companion(VA10A,Siemens-Healthineers, Erlangen, Germany), an ensemble of deep-convolutional-neural-networks was evaluated for the detection of pulmonary nodules, coronary artery calcium, aortic ectasia/aneurysm, and vertebral height loss. Accuracy, sensitivity, specificity was measured for the outcomes. Inter-rater reliability were measured. Inter-rater reliability was measured using the intraclass correlation coefficient (ICC) by comparing the number of nodules identified by the AI to radiologist. RESULTS: Overall per-nodule accuracy, sensitivity, and specificity for detection of lung nodules were 0.678(95%CI 0.615-0.732), 0.956(95%CI 0.900-0.985), and 0.456(95%CI 0.376-0.543), respectively, with an intraclass correlation coefficient (ICC) between AI and radiologist of 0.78(95%CI 0.71-0.83). Overall per-patient accuracy for AI detection of coronary artery calcium, aortic ectasia/aneurysm, and vertebral height loss was 0.939(95%CI 0.878-0.975), 0.974(95%CI 0.925-0.995), and 0.857(95%CI 0.781-0.915), respectively. Sensitivity for coronary artery calcium, aortic ectasia/aneurysm, and vertebral height loss was 0.898(95%CI 0.778-0.966), 1 (95%CI 0.958-1), and 1 (95%CI 0.961-1), respectively. Specificity for coronary artery calcium, aortic ectasia/aneurysm, and vertebral height loss was 0.969(95% CI 0.893-0.996), 0.897 (95% CI 0.726-0.978), and 0.346 (95% CI 0.172-0.557), respectively. CONCLUSION: AI ensemble was accurate for coronary artery calcium and aortic ectasia/aneurysm, while sensitive for aortic ectasia/aneurysm, lung nodules and vertebral height loss on LDCT attenuation correction series of SPECT/CT.