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Item type: Item , Access status: Open Access , The Inclusion Paradox: Why Inclusive Space Excludes Migrant Children, and Vice Versa(Chinese Education and Society, 2024-01-01) Zhu, F; Xue, JWhat characteristics of space predict exclusive policies? Intuitively, socioeconomically exclusive spaces–such as wealthy urban centers in China–would also be exclusive in welfare provision. Drawing from cross-district comparisons within a Chinese metropolis, we identify a counterintuitive pattern where the urban center had easier migrant school access policies than the urban fringe. This pattern has existed in both the 2010s and 2020s, surviving a major school admissions policy reform. We call this pattern the inclusion paradox. The inclusion paradox can be attributed to two causes: a compartmentalization of school access along urban district boundaries, and a tendency of fringe districts to carry more migrant population with less fiscal capacity. As a result of the inclusion paradox, migrant children were more likely excluded from school access precisely where they were more likely to live. The inclusion paradox implies that policy exclusion and spatial exclusion substitute each other, a pattern that brings migrant school access in China in conversation with unequal school access in other contexts.Item type: Item , Access status: Open Access , Composite lymphoma composed of follicular lymphoma and nodal T-follicular helper cell lymphoma: report of 3 cases highlighting histopathologic zonation of each neoplastic component(Am J Clin Pathol, 2026-03-03) Zhao, Yue; Hajjali, Ibrahim; Ju, Yaping; Carrillo, Luis; Feng, Mark; Dong, Qianze; Chen, Dongjiang; Siddiqi, Imran; Wang, EndiAbstract Objectives Composite lymphoma (CL), composed of follicular lymphoma (FL) and nodal T-follicular helper cell lymphoma (nTFHL), is an uncommon and diagnostically challenging entity. We present a small series of such cases to characterize their clinicopathologic and diagnostic features. Methods We retrospectively analyzed 3 CL cases compared with 6 control cases of FL with expanded reactive T-follicular helper cells. Results Histologically, all 3 CL cases demonstrated geographic zonation of the 2 neoplastic components, with the B-cell lymphoma residing in follicle centers (B-zones) and the T-cell neoplasm confined to perifollicular/interfollicular areas (T-zones), in contrast to a predominantly (83%) intrafollicular distribution of T-follicular helper cells in the control cases. In all CL cases, FL was suggested by histopathologic features, and the diagnosis was supported by flow cytometry. All 3 cases (100%) showed cytologic atypia and immunophenotypic aberrancy in the T-cell component, whereas none (0%) were observed in the control group. In 2 cases (66.7%), scattered Epstein-Barr virus–positive cells were seen in the T-zone, suggesting latent infection in bystander cells, again compared to none (0%) in the control. Genomic sequencing was performed in 2 cases, both (100%) showing pathogenic mutations associated with nTFHL, while none (0%) of the controls showed such mutations. Biclonality was confirmed by B-cell and T-cell receptor gene rearrangement analyses in all 3 CL cases. All patients with CL presented with an aggressive clinical course. Conclusions This series highlights the unique histopathologic characteristics of CL and underscores the importance of a multifaceted approach to diagnosis.Item type: Item , Access status: Open Access , Evolution of intestinal and multivisceral transplantation: A thirty-year United States perspective.(Intestinal Failure (New York, N.Y.), 2024-04) Samoylova, Mariya L; Kesseli, Samuel J; Park, Christine; Yerxa, John; Horslen, Simon; Jafri, Syed-Mohammed; Mavis, Alisha; Schiano, Thomas; Summers, Bryant; Barbas, Andrew S; Shaw, Brian I; Sudan, Debra L; Segovia, M CristinaBackground
The field of intestinal transplantation has significantly changed since the report of the first successful transplant in 1988. This report seeks to describe the trends in intestinal transplantation utilization and outcomes over time in the United States of America.Methods
We use the cohort of intestinal and multivisceral transplants 1990- Feb 2020 in the UNOS STAR dataset. Eras were defined as 1990-1999, 2000-2009, 2010- Feb 2020. Summary statistics were calculated by era. Patient and death-censored graft survival were assessed by era, stratified by pediatric (<18 years at transplant) and adult recipients.Results
A total of 3035 transplants were performed: 398 in the first era, 1485 in the second, 1235 in the third. The proportion of adult recipients increased over time (35 %, 44 %, 59 % respectively). Fewer livers were included for adults over time (42.8 %, 37.3 %, 36.9 %). One- and five-year patient survival improved over time in children, while adult survival plateaued. A similar trend was observed in death-censored graft survival.Conclusions
A greater proportion of intestinal transplants are now performed in adults, perhaps as a result of improvements in the intestinal rehabilitation of pediatric patients. Graft and patient survival has improved for pediatric patients but not for adults in the past decade, highlighting the ongoing need for improving long-term outcomes in adult recipients.Item type: Item , Access status: Open Access , A Pragmatic Clinical Trial of Hearing Screening in Primary Care Clinics: Effect of Setting and Provider Encouragement.(Ear and hearing, 2024-01) Smith, Sherri L; Francis, Howard W; Witsell, David L; Dubno, Judy R; Dolor, Rowena J; Bettger, Janet Prvu; Silberberg, Mina; Pieper, Carl F; Schulz, Kristine A; Majumder, Pranab; Walker, Amy R; Eifert, Victoria; West, Jessica S; Singh, Anisha; Tucci, Debara LObjectives
The prevalence of hearing loss increases with age. Untreated hearing loss is associated with poorer communication abilities and negative health consequences, such as increased risk of dementia, increased odds of falling, and depression. Nonetheless, evidence is insufficient to support the benefits of universal hearing screening in asymptomatic older adults. The primary goal of the present study was to compare three hearing screening protocols that differed in their level of support by the primary care (PC) clinic and provider. The protocols varied in setting (in-clinic versus at-home screening) and in primary care provider (PCP) encouragement for hearing screening (yes versus no).Design
We conducted a multisite, pragmatic clinical trial. A total of 660 adults aged 65 to 75 years; 64.1% female; 35.3% African American/Black completed the trial. Three hearing screening protocols were studied, with 220 patients enrolled in each protocol. All protocols included written educational materials about hearing loss and instructions on how to complete the self-administered telephone-based hearing screening but varied in the level of support provided in the clinic setting and by the provider. The protocols were as follows: (1) no provider encouragement to complete the hearing screening at home, (2) provider encouragement to complete the hearing screening at home, and (3) provider encouragement and clinical support to complete the hearing screening after the provider visit while in the clinic. Our primary outcome was the percentage of patients who completed the hearing screening within 60 days of a routine PC visit. Secondary outcomes following patient access of hearing healthcare were also considered and consisted of the percentage of patients who completed and failed the screening and who (1) scheduled, and (2) completed a diagnostic evaluation. For patients who completed the diagnostic evaluation, we also examined the percentage of those who received a hearing loss intervention plan by a hearing healthcare provider.Results
All patients who had provider encouragement and support to complete the screening in the clinic completed the screening (100%) versus 26.8% with encouragement to complete the screening at home. For patients who were offered hearing screening at home, completion rates were similar regardless of provider encouragement (26.8% with encouragement versus 22.7% without encouragement); adjusted odds ratio of 1.25 (95% confidence interval 0.80-1.94). Regarding the secondary outcomes, roughly half (38.9-57.1% depending on group) of all patients who failed the hearing screening scheduled and completed a formal diagnostic evaluation. The percentage of patients who completed a diagnostic evaluation and received a hearing loss intervention plan was 35.0% to 50.0% depending on the group. Rates of a hearing loss intervention plan by audiologists ranged from 28.6% to 47.5% and were higher compared with those by otolaryngology providers, which ranged from 15.0% to 20.8% among the groups.Conclusions
The results of the pragmatic clinical trial showed that offering provider encouragement and screening facilities in the PC clinic led to a significantly higher rate of adherence with hearing screening associated with a single encounter. However, provider encouragement did not improve the significantly lower rate of adherence with home-based hearing screening.Item type: Item , Access status: Open Access , Development of Measures for d/Deaf and Hard of Hearing Stigma: Introduction to the Special Supplement on Stigma Measurement Tools.(Ear and hearing, 2024-09) Stockton, Melissa A; Francis, Howard W; West, Jessica S; Stelmach, Rachel D; Troutman Adams, Elizabeth; Kraemer, John D; Saalim, Khalida; Wallhagen, Margaret I; Nyarko, Marco; Madson, Gabriel; Boafo, Neal; Owusu, Nana Akua V; Musa, Lawrence G; Alberg, Joni; Chung, Jenny Jae Won; Preston, Adam; Gyamera, Emma; Chadha, Shelly; Davis, Lisa P; Garg, Suneela; McMahon, Catherine; Olusanya, Bolajoko O; Tavartkiladze, George A; Tucci, Debara; Wilson, Blake S; Smith, Sherri L; Nyblade, LauraPeople who are d/Deaf or hard of hearing (d/DHH) often experience stigma and discrimination in their daily lives. Qualitative research describing their lived experiences has provided useful, in-depth insights into the pervasiveness of stigma. Quantitative measures could facilitate further investigation of the scope of this phenomenon. Thus, under the auspices of the Lancet Commission on Hearing Loss, we developed and preliminarily validated survey measures of different types of stigma related to d/Deafness and hearing loss in the United States (a high-income country) and Ghana (a lower-middle income country). In this introductory article, we first present working definitions of the different types of stigma; an overview of what is known about stigma in the context of hearing loss; and the motivation underlying the development of measures that capture different types of stigma from the perspectives of different key groups. We then describe the mixed-methods exploratory sequential approach used to develop the stigma measures for several key groups: people who are d/DHH, parents of children who are d/DHH, care partners of people who are d/DHH, healthcare providers, and the general population. The subsequent manuscripts in this special supplement of Ear and Hearing describe the psychometric validation of the various stigma scales developed using these methods.