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Background: Real-time prediction of histologic features of small colorectal polyps may prevent resection and/or pathologic evaluation and therefore decrease colonoscopy costs. Previous studies showed that computer-aided diagnosis (CADx) was highly accurate, though it did not outperform expert endoscopists., Objective: To assess the diagnostic performance of histologic predictions by general endoscopists before and after assistance from CADx in a real-life setting., Design: Prospective, multicenter, single-group study. (ClinicalTrials.gov: NCT04437615)., Setting: 6 centers across the United States., Participants: 1252 consecutive patients undergoing colonoscopy and 49 general endoscopists with variable experience in real-time prediction of polyp histologic features., Intervention: Real-time use of CADx during routine colonoscopy., Measurements: The primary end points were the sensitivity and specificity of CADx-unassisted and CADx-assisted histologic predictions for adenomas measuring 5 mm or less. For clinical purposes, additional estimates according to location and confidence level were provided., Results: The CADx device made a diagnosis for 2695 polyps measuring 5 mm or less (96%) in 1252 patients. There was no difference in sensitivity between the unassisted and assisted groups (90.7% vs. 90.8%; P = 0.52). Specificity was higher in the CADx-assisted group (59.5% vs. 64.7%; P < 0.001). Among all 2695 polyps measuring 5 mm or less, 88.2% and 86.1% ( P < 0.001) in the CADx-assisted and unassisted groups, respectively, could be resected and discarded without pathologic evaluation. Among 743 rectosigmoid polyps measuring 5 mm or less, 49.5% and 47.9% ( P < 0.001) in the CADx-assisted and unassisted groups, respectively, could be left in situ without resection., Limitation: Decision making based on CADx might differ outside a clinical trial., Conclusion: CADx assistance did not result in increased sensitivity of optical diagnosis. Despite a slight increase, the specificity of CADx-assisted diagnosis remained suboptimal., Primary Funding Source: Olympus America Corporation served as the clinical study sponsor., Competing Interests: Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M24-0086.

One of the most prominent means for sustainable agriculture and ecosystem management are Arbuscular Mycorrhizal (AM) inoculants. These inoculants establish beneficial symbiotic relationships with land plant roots, offering a wide range of benefits, from enhanced nutrient absorption to improved resilience against environmental stressors. However, several currently available commercial AM inoculants face challenges such as inconsistency in field applications, ecological risks associated with non-native strains, and the absence of universal regulations. Currently, regulations for AM inoculants vary globally, with some regions leading efforts to standardize and ensure quality control. Proposed regulatory frameworks aim to establish parameters for composition, safety, and efficacy. Nevertheless, challenges persist in terms of scientific data, standardization, testing under real conditions, and the ecological impact of these inoculants. To address these challenges and unlock the full potential of AM inoculants, increased research funding, public-private partnerships, monitoring, awareness, and ecosystem impact studies are recommended. Future regulations have the potential to improve product quality, soil health, and crop productivity while reducing reliance on chemical inputs and benefiting the environment. However, addressing issues related to compliance, standardization, education, certification, monitoring, and cost is essential for realizing these benefits. Global harmonization and collaborative efforts are vital to maximize their impact on agriculture and ecosystem management, leading to healthier soils, increased crop yields, and a more sustainable agricultural industry., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)