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BackgroundRacism is a longstanding driver of health inequities. Although medical education is a potential solution to address racism in health care, best practices remain unknown.ObjectiveWe sought to evaluate the impact of participation in a curriculum addressing racism on pediatric residents' racial biases and empathy.MethodsA pre-post survey study was conducted in 2 urban, university-based, midsized pediatric residency programs between July 2019 and June 2020. The curriculum sessions included Self-Reflection on Implicit Bias, Historical Trauma, and Structural Racism. All sessions were paired with empathy and perspective-taking exercises and were conducted in small groups to facilitate reflective discussion. Wilcoxon signed rank tests were used to assess changes in racial bias and empathy. Linear regression was used to assess the effect of resident characteristics on racial bias and empathy.ResultsNinety of 111 residents receiving the curriculum completed pre-surveys (81.1%), and among those, 65 completed post-surveys (72.2%). Among participants with baseline pro-White bias, there was a statistically significant shift (0.46 to 0.36, P=.02) toward no preference. Among participants with a baseline pro-Black bias, there was a statistically significant shift (-0.38 to -0.21, P=.02), toward no preference. Among participants with baseline pro-White explicit bias, there was a statistically significant shift (0.54 to 0.30, P

Aim: To evaluate a lesion detection algorithm designed to detect focal cortical dysplasia (FCD) in children undergoing stereoelectroencephalography (SEEG) as part of their presurgical evaluation for drug‐resistant epilepsy. Method: This was a prospective, single‐arm, interventional study (Idea, Development, Exploration, Assessment, and Long‐Term Follow‐Up phase 1/2a). After routine SEEG planning, structural magnetic resonance imaging sequences were run through an FCD lesion detection algorithm to identify putative clusters. If the top three clusters were not already sampled, up to three additional SEEG electrodes were added. The primary outcome measure was the proportion of patients who had additional electrode contacts in the SEEG‐defined seizure‐onset zone (SOZ). Results: Twenty patients (median age 12 years, range 4–18 years) were enrolled, one of whom did not undergo SEEG. Additional electrode contacts were part of the SOZ in 1 out of 19 patients while 3 out of 19 patients had clusters that were part of the SOZ but they were already implanted. A total of 16 additional electrodes were implanted in nine patients and there were no adverse events from the additional electrodes. Interpretation: We demonstrate early‐stage prospective clinical validation of a machine learning lesion detection algorithm used to aid the identification of the SOZ in children undergoing SEEG. We share key lessons learnt from this evaluation and emphasize the importance of robust prospective evaluation before routine clinical adoption of such algorithms. What this paper adds: The focal cortical dysplasia detection algorithm collocated with the seizure‐onset zone (SOZ) in 4 out of 19 patients.The algorithm changed the resection boundaries in 1 of 19 patients undergoing stereoelectroencephalography for drug‐resistant epilepsy.The patient with an altered resection due to the algorithm was seizure‐free 1 year after resective surgery.Overall, the algorithm did not increase the proportion of patients in whom SOZ was identified. [ABSTRACT FROM AUTHOR]

We performed a secondary analysis of the Moving to Opportunity (MTO) social experiment to investigate the impact of different types of housing assistance and neighborhood environments on long-term patterns of healthcare use for specific conditions and across different types of healthcare services. MTO participants, who were randomized at baseline, were linked to up to 21 years' worth of all-payer hospital discharge and Medicaid data. Among the 9,170 children at the time of randomization, those who received a voucher had subsequent hospital admissions rates that were 36% lower for asthma and 30% lower for mental health disorders compared with the control group; rates of psychiatric services, outpatient hospital services, clinic services, and durable medical equipment were also lower among the voucher groups. Findings for adults were not statistically significant. The results suggest that housing policies that reduce neighborhood poverty exposure as a child are associated with lower subsequent healthcare use for specific clinical conditions and types of services. [ABSTRACT FROM AUTHOR]

An updated zoning policy eliminating all alcohol outlets (liquor stores) in residential districts was implemented to reduce high rates of violent crime in Baltimore City. Diverse stakeholders were engaged in group model building (GMB) activities to develop causal loop diagrams (CLDs) that elucidate the impact of the new zoning policy on crime, and more broadly, the potentially unintended social and environmental consequences of the policy. Three distinct groups, community advocates, city officials/academics, and community residents, participated in three separate GMB sessions. Three CLDs, one from each stakeholder group, were created to depict the possible outcomes of the zoning policy. Our findings offer insight into potential unintended consequences of removing liquor stores from residential areas that may undermine the policy. Community members described the need for additional supports related to mental health and substance use, opportunities for investment in the community, access to other goods and services, and community‐police relations to ensure the policy achieved its intended goal of reducing violent crime. Our findings highlight the importance of timely engagement of local stakeholders to understand how complex neighborhood dynamics and contextual factors could impact the effectiveness of a zoning policy change. Highlights: The complex interplay between neighborhood context and the alcohol environment is poorly understood.Using systems thinking, diverse stakeholders developed causal loop diagrams.Baltimore City alcohol zoning policy was linked to diverse social and environmental consequences.Removing alcohol outlets may result in unintended consequences, including an increase in crime. [ABSTRACT FROM AUTHOR]