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Creators/Authors contains: "Shen, Yishan"

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  1. Abstract Objectives

    Racial disparities in kidney transplant access and posttransplant outcomes exist between non-Hispanic Black (NHB) and non-Hispanic White (NHW) patients in the United States, with the site of care being a key contributor. Using multi-site data to examine the effect of site of care on racial disparities, the key challenge is the dilemma in sharing patient-level data due to regulations for protecting patients’ privacy.

    Materials and Methods

    We developed a federated learning framework, named dGEM-disparity (decentralized algorithm for Generalized linear mixed Effect Model for disparity quantification). Consisting of 2 modules, dGEM-disparity first provides accurately estimated common effects and calibrated hospital-specific effects by requiring only aggregated data from each center and then adopts a counterfactual modeling approach to assess whether the graft failure rates differ if NHB patients had been admitted at transplant centers in the same distribution as NHW patients were admitted.

    Results

    Utilizing United States Renal Data System data from 39 043 adult patients across 73 transplant centers over 10 years, we found that if NHB patients had followed the distribution of NHW patients in admissions, there would be 38 fewer deaths or graft failures per 10 000 NHB patients (95% CI, 35-40) within 1 year of receiving a kidney transplant on average.

    Discussion

    The proposed framework facilitates efficient collaborations in clinical research networks. Additionally, the framework, by using counterfactual modeling to calculate the event rate, allows us to investigate contributions to racial disparities that may occur at the level of site of care.

    Conclusions

    Our framework is broadly applicable to other decentralized datasets and disparities research related to differential access to care. Ultimately, our proposed framework will advance equity in human health by identifying and addressing hospital-level racial disparities.

     
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  2. Abstract

    This study used a three‐wave longitudinal dataset to: identify adjustment profiles of U.S. Mexican‐origin adolescents based on their physical, academic, and psychosocial health adjustment; track adjustment profile changes throughout adolescence; and examine the associations between cultural stressors, family obligation, and adjustment profile membership over time. Participants were 604 Mexican‐origin adolescents (54% female,Mage = 12.41, SD = 0.97) in Texas (Wave 1: 2012–2015; Wave 2: 2013–2016; Wave 3: 2017–2020). Three concurrent profiles (Well‐adjusted,Moderate, andPoorly‐adjusted) emerged at each wave, whereas three transition profiles (Improved,Stable well‐adjusted, andOverall poorly‐adjusted) were identified across three waves. The results suggest that cultural stressors pose risks for Mexican‐origin adolescents' adjustment, and family obligation values play a protective role in these associations.

     
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  3. This study focused on early adolescents’ stress of language brokering and examined the moderating role of family cumulative risk in the relation of language brokering to adjustment problems. Data came from self-reports of 604 low-income Mexican American adolescent language brokers (54% female; [Formula: see text]= 12.4; SD = 0.97; 75% born in the United States) and their parents (99% foreign-born) in central Texas. Path analyses revealed that brokering stress, but not frequency, was positively associated with adolescents’ adjustment problems, including depressive symptoms, anxiety, and delinquency. We also found that the relation between stress of brokering for mothers and adolescents’ depressive symptoms was stronger among families with a high cumulative risk. Further, with a high cumulative risk, adolescents exhibited delinquent behaviors regardless of the levels of stress from translating for fathers. Current findings underscore the importance of examining family contexts in assessing the consequences of language brokering for Mexican American early adolescents’ well-being. 
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  4. Language brokering is a prevalent phenomenon in ethnic minority immigrant populations. Although accruing evidence points to the beneficial impacts of healthy role identity development, research investigating the formation of a language broker role identity in language brokering adolescents is lacking in the literature. In a sample of 604 Latinx adolescents (54.3% female; Mage at Time 1 = 12.41, SD = .97), structured equation modeling was conducted with maternal warmth and hostility examined as antecedents and adolescents’ life meaning as a mediator for language broker role identities. Results revealed that life meaning mediated the positive association from maternal warmth to language broker role identity. However, the negative association from maternal hostility to language broker role identity was no longer significant when accounting for maternal warmth. Corroborating extant findings, reciprocal relations were observed between maternal parenting practices, life meaning and language broker role identity. The results attest to the importance of investigating culturally specific role identity development in immigrant populations and demonstrates the role of maternal parenting practices in affecting adolescents’ role identity formation, albeit with contrasting gender effects. 
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