Artificial intelligence algorithms are booming in medicine, and the question of biases induced or perpetuated by these tools is a very important topic. There is a greater risk of these biases in radiology, which is now the primary diagnostic tool in modern treatment. Some authors have recently proposed an analysis framework for social inequalities and the biases at risk of being introduced into future algorithms. In our paper, we comment on the different strategies for resolving these biases. We warn that there is an even greater risk in mixing the notion of equity, the definition of which is socio-political, into the design stages of these algorithms. We believe that rather than being beneficial, this could in fact harm the main purpose of these artificial intelligence tools, which is the care of the patient.
The spectacularly biodiverse Atlantic Forest of South America has been reduced to fragmented remnants. The largest remaining inland fragment is protected by national parks on either side of the iconic Iguassu Falls on the border between Brazil and Argentina. Biodiversity in the parks has been under pressure from illegal activities such as commercial hunting, fishing and extraction of palm hearts. A proposed road through Brazil’s Igua\c{c}u National Park now further threatens the area’s biodiversity by further dividing the forest fragment and by increasing access by illegal actors. Here we analyze spatial data on illegal activities and develop a niche-based model to predict the impact of the proposed Caminho-do-Colono road. The model shows the significant increases that this road would provoke in susceptibility to illegal activities such as fishing (median 0.009 to 0.101), palm-heart extraction (median 0.087 to 0.260) and poaching (median 0.324 to 0.334). The road proposal includes downgrading the protected status of a portion of the park, which reflects a worldwide pattern of downsizing, downgrading and degazetting protected areas that is particularly evident in Brazil.
Objective: To evaluate percutaneous computed tomography (CT) and fluoroscopy-guided injection of bone cement for the treatment of symptomatic subchondral cysts of the appendicular skeleton.
Methods:A single-center prospective study involving 13 consecutive patients with symptomatic subchondral cysts was done (8 women, 5 men). The average age was 67 years. Patients were treated by percutaneous CTguided injection of bone cement into the subchondral cysts. Surgical treatment was not indicated or not wished by the patients who underwent cementoplasty. The lesions were all located in weight-bearing bones, involving the femoral head, femoral condyle, tibial plateau, talus and calcaneus respectively and consisting of subchondral cysts resulting from degenerative lesions or aseptic osteonecrosis. The clinical course of pain was evaluated using the Visual Analog Scale (VAS) before treatment, at one month and three months after treatment, with long-term follow-up from 2 months to 43 months (average follow-up: 22 months).Results: Patient follow-ups in our series show supportive results: within 13 patients, 12 patients were satisfied with a long-lasting result after the procedure had been performed, and would recommend the intervention to relatives. The average evaluation of pain was 8/10 (SD: 0,49) before treatment, 3/10 (SD: 0,66) one month after treatment and 1/10 (SD: 0,60) three months after treatment. Our results show a significant decrease of the pain felt by patients between -before procedure and one month after the procedure-(p= 0,002), -before procedure and three months after the procedure-(p=0,002), one month after the procedure and three months after the procedure (p=0,011). There were no immediate or delayed complications. We observed one asymptomatic para-articular cement leakage at the knee. One patient was not relieved after the procedure and underwent hip surgery.Conclusions: Percutaneous injection of bone cement under CT and fluoroscopy guidance seems to be an effective and safe procedure in the treatment of symptomatic subchondral cysts with a significant decrease of patient's pain and a mini-invasive approach compared to classical surgical treatment. Thus we recommend that it should be considered as a first choice of treatment for symptomatic subchondral cysts.
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