Contraceptive Counseling for Transgender & Gender Diverse Patients Provider Knowledge & Experience

Callahan, Kathryn Yale University ProQuest Dissertations & Theses 2025 해외박사(DDOD)

Many transgender and gender diverse (TGD) individuals have contraceptive needs. Contraceptive counseling in this population is often nuanced due to the diverse experiences and healthcare goals of TGD individuals. Testosterone therapy is an important component of gender affirming care for some transgender and gender diverse (TGD) individuals. A common misconception among patients and providers is the role of testosterone in pregnancy prevention. Testosterone is not an effective form of contraception due to its inconsistent suppression of ovulation. Previous studies have shown that some patients who use testosterone for contraception do so based on guidance from their healthcare provider. Therefore, this study aimed to evaluate providers’ education, knowledge, experience, and perception regarding contraceptive counseling for TGD patients. By gaining a deeper understanding of providers' current practices and knowledge gaps, this study aims to identify strategies to improve counseling and ensure more accurate contraceptive guidance for TGD patients.The study was granted an exemption from Yale University’s Institutional Review Board. Licensed US healthcare providers with experience providing contraceptive counseling were eligible to complete the study survey. The survey collected provider demographic information, their prior education on providing care for TGD patients, and information about their clinical practice. We assessed (1) contraception-related knowledge, (2) provider confidence providing contraceptive counseling to TGD patients, (3) perceptions of barriers that limited effective contraceptive counseling for TGD patients, and (4) practice behaviors regarding counseling of reproductive health topics. Surveys were collected anonymously through Qualtrics. Participants were recruited through professional networks and email distribution across multiple academic institutions.Forty-seven complete survey responses were collected from providers nationwide. Most respondents were physicians (91.5%) with the majority practicing in the Northeast (37%) and Midwest (39.1%). Diverse gender identity and sexual orientation were represented among respondents, with 32.6% identifying as a sexual or gender minority. Most practiced at academic institutions with resident trainees (76.6%). Respondents varied in the number of TGD patients seen per month, with 59.6% reporting fewer than five, 23.4% seeing five to ten, and 17% seeing more than ten TGD patients per month. Our respondents had a median of 2.5% (IQR 1-8.86%) TGD patients in their practice. Providers who care for significantly higher proportions of TGD patients were more likely to work in non-academic settings (p=0.011), identify as a sexual or gender minority (p<0.001), have received over 11 hours of formal TGD health education (p=0.049), and work in practices with formal staff training on TGD care (p=0.015).Nearly 30% of respondents had no TGD health education during their medical training. However, 46.8% reported 1-5 hours of formal education on TGD health during training. Providers practicing less than 10 years reported statistically more TGD health education during training than more experienced providers (p<0.002). Most respondents (91.5%) had additional TGD health education since completing their medical education, most frequently from colleagues (80.9%), medical journals or publications (72.3%), professional meetings or conferences (66%), and TGD patients (63.8%).Overall contraceptive-related knowledge was high– with respondents averaging 5.89 (SD=0.983) correct responses to the 7 knowledge-assessment questions. Providers who saw five or more TGD patients per month had significantly higher cumulative knowledge scores (mean=6.47, SD=0.772) than providers with fewer TGD patients (mean=5.5, SD=0.923); p<0.001. There was no significant difference in cumulative knowledge score by provider education, years in practice, practice environment, or identity. Despite respondents’ high knowledge scores, 27.6% lacked confidence in their ability to counsel TGD patients on their contraceptive options and 34% lacked confidence in their ability educate patients on testosterone’s impact on reproductive potential. Significantly higher confidence was associated with providers who saw five or more TGD patients each month (p<0.001), identified as a sexual or gender minority (p=0.033), or used diverse educational resources to learn more about TGD healthcare (p<0.001). Providers most frequently reported TGD patients not seeking gynecologic care as a barrier to providing contraceptive counseling (72.4%). Compared to their cisgender patients, 14.9% of providers were less likely to discuss fertility desires and family planning goals and 6.4% were less likely to discuss contraceptive options with TGD patients.Our national survey results suggest a shift in medical training to include more TGD health education, however significant gaps still exist. Our study found that providers who care for a higher number of TGD patients had significantly greater knowledge scores and confidence in counseling. Therefore, increasing exposure to TGD patients during clinical training is key to preparing the next generation of providers to deliver informed and inclusive care. Additionally, our study highlighted significant barriers to contraceptive counseling for TGD patients, including a lack of provider confidence, disparities in provider practices, and the common belief that TGD patients are reluctant to seek gynecologic care. Therefore, practices should develop a gender inclusive environment with appropriate materials and staff training to improve TGD patients’ comfort in seeking care and increase opportunities to provide contraceptive counseling.

D'apres le Roman: Cross-Channel Theatrical Adaptations from Richardson to Scott

Younger, Neil Mackay ProQuest Dissertations & Theses Yale University 2016 해외박사(DDOD)

This dissertation examines adaptations of English novels into French plays in the eighteenth and early nineteenth centuries. It studies adaptations both in comparison to their source novels and by placing them in their literary and social context, demonstrating both how and why French playwrights seized upon novels from Great Britain during this period. The introduction sets the stage for the dissertation by surveying the literary landscape of the eighteenth century, showing how novels and theater interacted to a large extent during this time, as well as touching on the cross-fertilisation between English and French literature. The introduction also examines adaptation theory and how it applies to the dissertation. The first chapter explores the imitations and adaptations of Samuel Richardson's Pamela, showing how clothing---in particular the moment in Pamela when the eponymous heroine appears in peasant clothing---became a central focus of the novel's reception. The adaptations in this chapter take great interest in costume changes and use the thematics of dress to deliver their own reading of the novel and its reception, expressing their anxiety over the spread of Pamela across borders and literary modes. This anxiety, and its expression via clothing, is argued to reveal French concerns at the growing dominance of both English literature and commerce. The adaptations of Pamela participate in this broader context while delivering a cynical verdict on the virtues of the novel's central character and the motivations of those who were driving the Pamela craze itself. The second chapter examines the adaptations of Henry Fielding's Tom Jones. The adaptations of this long novel, which might have seemed rather unpromising fodder for the stage, are often quite faithful versions, but nonetheless alter potentially controversial aspects of Tom Jones , particularly the central character's illegitimacy. The French adaptations of Tom Jones mitigate Tom's bastardy, and this move is examined in the light of the intense debate about clandestine marriages and Protestant toleration in France around the time that Fielding's novel was published. Meanwhile, issues of parental authority and women's right to choose a marriage partner are emphasized in French adaptations, as they are linked to debates about slavery. Finally, a connection is suggested between these adaptations' move to defuse issues relating to legitimacy and authority and their own precarious generic status, at a time when new theatrical genres were often metaphorized as bastards. Three French adaptations of Matthew Lewis's The Monk form the subject of the third chapter. The French adaptations which this novel sparked off transform a central scene in the novel, depicting a mob storming a convent and murdering its inhabitants, to provide more positive examples of crowd behavior. The attempt to lend The Monk a useful morality is reinforced by other strategies, such as downplaying the central character's depravity; one adaptation also explores the notion of using nature as a moral basis for action, an important tenet of political thought in the earlier 1790s. Thus the unsettling and violent original work is thoroughly transformed into both politically salient and socially beneficial adaptations, which also comment on theater's potential to be a force for good in society. The final chapter examines adaptations of Guy Mannering and The Bride of Lammermoor by Walter Scott. The adaptations studied here, all from the 1820s, show how French authors during the Restoration used Scott's tales---apparently so tied to their particular setting and historical period---to tackle issues of memory and legality, important matters at a time when French society was coming to terms with its recent past. The notion of memory is also explored more satirically as one adaptation in particular lampoons the air of ancient authenticity that was thought to cling to Scott's works by satirizing the supposedly ancient morality of his novels, betraying a certain awareness of being part of a much broader trend of enthusiasm for all things Walter Scott. Memory is further satirized as vaudeville melodies circulate between Scott adaptations like songs between ancient bards. Theatrical adaptation of English novels was not only a frequent cultural practice at this time, but examining the uses to which these novels were put in their new setting can reveal much about the reception of English novels in France. Ultimately, this dissertation reveals the range of the literary and cultural implications of eighteenth- and nineteenth-century French theater's intense and prolonged contact with the English novel.

Elucidating the Mechanisms of Water and Ion Transport Under Nanoconfinement

Ritt, Cody L ProQuest Dissertations & Theses Yale University 2022 해외박사(DDOD)

Water scarcity is among the most prominent humanitarian crises of our time. Achieving equitable access to safe drinking water for all humankind necessitates the treatment of unconventional and underutilized sources. Pressure-driven desalination technologies are particularly well-suited for augmenting global water supplies due to their energy efficiency. In these technologies, the membrane is the critical component driving process efficacy and requires material breakthroughs to achieve paradigm-shifting performance.Attempts to improve conventional membrane materials and investigations into numerous novel materials have failed to produce the next generation of desalination membranes due to our limited understanding of the mechanisms that govern water and ion transport under nanoconfinement. Hence, the objective of this dissertation research is to elucidate fundamental synthesis–structure–performance relationships in conventional- and novel-material based membranes, in the context of how these relationships can be exploited to improve practical water treatment processes.Electrostatic interactions between the membrane and charged constituents in the feed water are central to membrane performance. These interactions depend on the extent to which the membrane is charged, yet the reasoning behind the ionization behavior of state-of-the-art polymers used for desalination has been unknown for years. This dissertation unravels the anomalous ionization behavior of nanoporous polyamide, revealing that a large portion of the ionizable moieties in polyamide films remain uncharged, and thus, unutilized, during typical operation due to extreme confinement effects. Several approaches to exploit these ionizable groups for improved performance are highlighted. Electrostatic interactions may also depend on the physicochemical characteristics of the charged constituents in solution, such as the molecular shape of ions. To help guide the development of ion-ion selective membranes, this work utilizes machine learning to assess molecular-level features that influence ion transport in nanoporous cellulose acetate membranes. The findings suggest that attention should be redirected from the ion’s bulk solvation properties to their intrinsic electrical properties for selective separations. Ion-specific adsorption reactions can also dictate the effective pore charge through charge regulation. Cation-specific transport in charged nanochannels is thus rationalized from a charge regulation perspective, representing the phenomenon as an adsorption equilibrium process. This approach enables the use of conductance measurements to indirectly probe ion-surface reactions within the nanochannels—previously inaccessible experimentally.The role of defects in novel material-based membranes, which is frequently overlooked, are identified in this dissertation. This work focuses primarily on framework defects found in two-dimensional (2D) materials. The overlapping of framework defects are found to create percolation networks that greatly hinder the separation performance of 2D lamellar membranes. It is therefore emphasized that the mitigation of defects in novel material-based membranes is imperative to achieve practically viable desalination membranes that can compete with materials already commercially available. If unavoidable, the impact of defects in 2D material-based membranes on membrane performance can be masked if the water permeability remains high for thick membranes. This would require significant slip flow through the nanochannels, a phenomenon that can be experimentally resolved by the nanofluidic devices developed in this work. An interferometry-based apparatus is also designed to enable measurement of the ultralow flow rates (~few nL h-1) that are expected from these nanochannels.Overall, this dissertation investigates transport phenomena unique to extremely confined environments that are relevant to real-world water purification technologies. Electrostatic interactions between ions and the membrane are shown to be highly important for selective separations in conventional materials, and can even go as far as to influence the intrinsic charge of the membrane. For novel materials, fabrication-induced defects critically limit their future implementation in desalination technologies, making precisely controlled nanofluidic platforms essential for understanding defect-free transport within these frameworks. This dissertation demonstrates new approaches to studying nanoconfined transport and provides insight that may lead to next-generation membranes for desalination and water purification.

Environmental Surveillance of Viral Pathogens for Identifying Infectious Disease Outbreaks

Zulli, Alessandro Yale University ProQuest Dissertations & Theses 2023 해외박사(DDOD)

The detection and quantification of viral infectious disease outbreaks is necessary for the effective implementation of public health interventions that protect human health. Communicable viral diseases are a leading cause of morbidity and mortality worldwide and prior pandemics have had acute economic and social impacts. However, the identification and tracking of community wide outbreaks for most human viruses across the developed and developing world does not occur due to resource constraints. The goal of this dissertation’s research is to develop the science and methodology that underpin the environmental surveillance of viruses, focusing specifically on wastewater monitoring for identifying and tracking viral infectious disease outbreaks within a community.In this dissertation, the viability of quantifying viral concentrations in environmental samples and associating these concentrations to epidemiological indicators is first explored. These analyses were performed using quantitative (q) PCR and droplet digital (dd) PCR techniques to quantify the number of gene copies of SARS-CoV-2, rhinoviruses, human coronavirus OC43, Mastadenovirus, and Norovirus in environmental samples. Results demonstrated that an individual student’s exposure to viruses could be estimated using concentrations measured on school desks and showed that SARS-CoV-2 concentrations in wastewater are related to clinical epidemiological indicators including case rates and hospitalizations and are a leading indicator over these measures.Mathematical models were then created and applied to rigorously predict case rates and other epidemiological indicators from environmental virus concentrations. A simple binomial model allowed for the prediction of exposure from fomites for school children rotating through classrooms. Using wastewater indicators, multi-variate weighted linear models were built and tested that accurately predicted SARS-CoV-2 cases for a variety of cities in Connecticut, USA. This model was then generalized to be location agnostic to demonstrate its broad applicability. Based on the success of SARS-CoV-2 wastewater surveillance, a variety of human respiratory viral pathogens were studied, including Influenza A, Influenza B, Human metapneumovirus (HMPV), and Respiratory syncytial virus (RSV). We showed that these agents could be successfully monitored in wastewater, that they are highly correlated to clinical case rates, and that the lead time identified by wastewater surveillance is correlated to the incubation period of the viruses.The final portion of this dissertation focuses on applying DNA sequencing and analysis approaches to broaden our target selection without the need for developing and performing individual ddPCR assays. We demonstrate that amplicon-based sequencing of wastewater samples can provide important lineage estimations of viral variants that are comparable to clinical sequencing results. Probe-based hybridization was also used to select for and amplify 66 viral pathogens and showed that the abundances of these viral sequences are reflective of the underlying viral concentrations as measured by ddPCR.Overall, this work demonstrates that wastewater surveillance is an effective and timely indicator of viral disease outbreaks in a community and is broadly applicable to a diversity of human viruses and locations.

Insights on the Functional Importance of Molecular Motions in Phosphatases

Zavala, Erik Xavier Yale University ProQuest Dissertations & Theses 2024 해외박사(DDOD)

Enzymes are biomolecules that catalyze biological reactions, and as such, demand thorough investigation so that manipulation of their associated biological processes can be achieved. Biological processes are made up of complex pathways where enzymes play a key role in regulating pathway flux. Enzymes are a diverse subset of biomolecules and different classes of enzymes regulate pathway activity in different ways. For example, phosphatases and kinases are the enzymes responsible for regulating the phosphorylation levels of proteins. Phosphatases remove phosphates by catalyzing the hydrolysis of phosphate groups and kinases attach phosphate groups by catalyzing the transfer of phosphates from adenosine triphosphate (ATP) to their target protein. Protein phosphorylation is an important type of post-translational modification that alters the functionality of a protein and has profound effects on cellular signaling networks. The phosphorylation state of an enzyme can enhance or inhibit the catalytic rate of as well as enable or hinder the enzyme's ability to interact with other proteins. Because protein phosphorylation influences protein and cellular function, it is imperative to pursue a strong understanding of the enzymes that regulate it. The work I present here will focus solely on two types of phosphatases, protein tyrosine phosphatases (PTPs) and protein histidine phosphatases (PHPs).Phosphatases themselves are subject to regulation and the many ways in which this occurs is the core of this thesis. Ultimately, the catalytic activity of a phosphatase is a result of how favorably it can interact with its substrates and how fast it can catalyze its reaction. However, it is the interactions occurring intramolecularly that regulate the enzyme-substrate interaction. This is because the ability of a phosphatase to perform its function is fundamentally defined by its structural conformation at a given point in time and changes to its conformation over time. For a phosphatase to be catalytically active, its active site must be structured in a manner that allows for the chemistry needed to occur to be physically possible. These catalytically active conformations can be thought of as 'on' states, whereas conformations that are not catalytically active can be thought of as 'off' states. Phosphatases, like many proteins, can sample a wide range of conformations because they are dynamic molecules with different parts constantly moving and interacting with each other. The interacting parts often form a residue network where the motion of one residue influences the motions of another despite being spatially distant, a phenomenon known as allostery. Undoubtedly, the active site should be investigated when establishing the structure-function relationship of an enzyme, but so should allosteric sites and the network of residues bridging the two sites. A varying number of residues can make up a protein and as the size of the protein increases, so too does the complexity of the intramolecular interactions. We can simplify this by categorizing the conformations as either 'on' or 'off' and framing questions with this mindset. Despite this two-state approach, the diversity of proteins often gives rise to unique and discrete interactions governing their function. Identifying these interactions provides a path for the development of targeted drug therapeutics and so a technique that can inform on these interactions is needed. NMR spectroscopy is especially suited for characterizing dynamic structural features and will be heavily featured in this thesis. NMR spectroscopy can provide atomistic information on the entire protein structure as well as inform on the dynamics of those structures. Using NMR, I have studied four different phosphatase systems, mPTPA, VHR, SsoPTP, and PHPT1. In this thesis I present mechanistic insights to better understand their function.

BODIPY as a Chromophore and an Anchor to Metal Oxides for Solar Fuel Applications

Jayworth, Josephine A Yale University ProQuest Dissertations & Theses 2024 해외박사(DDOD)

To meet current goals for carbon neutral economies it is important to transition to renewable energy sources and storage solutions. Solar radiation is a cheap and abundant source of renewable energy, but it suffers in grid scale applications due to being intermittent and diffuse. Similar to how plants use sunlight to store energy in the form of sugar via photosynthesis, artificial systems can store solar energy in the form of chemical bonds as solar fuels. One such type of artificial system is a water splitting dye sensitized photoelectrochemical cell (WS-DSPEC), which will be discussed throughout this thesis. WS-DSPECs are introduced as well as the design principles for building an efficient and robust photoanode. An effective photoanode requires strong surface immobilization strategies for attachment of molecular dyes and catalysts to the semiconductor surface. Several different attachment methods are discussed. Additionally different photosensitizers are reviewed and with special attention paid to BODIPY (4,4-difluoro-4-bora-3a,4a-diaza-sindacene).Covalent attachment of molecules to metal oxide surfaces typically demands the presence of an anchoring group that in turn requires synthetic steps to introduce. BODIPY chromophores have long been used in dye-sensitized solar cells, but carboxylic acid groups typically had to be installed to act as surface anchors. In this thesis we find that even without the introduction of such anchors, the unmodified BODIPY can bind to TiO2 surfaces via its BF2 group through boron-oxygen surface bonds. Dipyrrin, the parent molecule of BODIPY, is also capable of binding directly to TiO2 surfaces, likely through its chelating nitrogen atoms. These binding modes prove to be even more robust than that of an installed carboxylate and offer a new way to attach molecular complexes to surfaces for (photo)catalytic applications since, once bound, we show in this thesis that surface bound BODIPY and dipyrrin derivatives exhibit ultrafast photoinjection of electrons into the conduction band of TiO2.Advancement toward dye-sensitized photoelectrochemical cells to produce solar fuels by solar-driven water splitting requires a photosensitizer that is firmly attached to the semiconducting photoelectrodes. Covalent binding enhances the efficiency of electron injection from the photoexcited dye into the metal oxide. Optimization of charge transfer, efficient electron injection, and minimal electron-hole recombination are mandatory for achieving high efficiencies. In this thesis, a BODIPY-based dye exploiting an innovative surface-anchoring mode via boron is compared with a similar dye bound by a traditional carboxylic acid anchoring group. Through terahertz and transient absorption spectroscopic studies, along with GFN-xTB calculations, we find that, when compared to the traditional carboxylic acid anchoring group, electron injection of boron-bound BODIPY is faster into both TiO2 and SnO2. In addition, binding stability is improved over a wide range of pH. Subsequent photoelectrochemical studies using a sacrificial electron donor showed this combined dye and anchoring group maintained photocurrent with good stability over long-time irradiation. This recently discovered binding mode of BODIPY shows excellent electron injection and good stability over time, making it promising for future investigations. Finally, for a functional WS-DSPEC photoanode there needs to be both an effective photosensitizer and catalyst combined. There are various different designs for these photoanodes, which are discussed in detail in this thesis. Three different arrangements of the BODIPY photosensitizer and an iridium water oxidation catalyst were synthesized for photocatalysis. While none were effective for water oxidation, lessons were extracted regarding the charge transport properties of the different photoanodes and insights into to future designs.

The Church's Book: Theology of Scripture in Ecclesial Context in the Work of John Howard Yoder, Robert Jenson, and John Webster

East, Bradley Raymond ProQuest Dissertations & Theses Yale University 2017 해외박사(DDOD)

Theological interpretation of Scripture has been ascendant in recent decades, and theologians and biblical scholars from a variety of backgrounds, areas of expertise, and ecclesial commitments have rallied around it. Increasingly, however, divisions are fraying the heretofore united front against historical criticism's dominance in academic biblical interpretation. This dissertation is an exploration of the reasons for these divisions. Its motivating thesis is that differences in ecclesiology lie behind disagreements about bibliology, which manifest in turn as divergences over theological interpretation. Prior to and operative within judgments about the nature, authority, and interpretation of the Bible stand judgments about the being, mission, and authority of the church. But the relationship between the two is not so linear as that. For the connections between them are direct and materially operative, and only more so when they remain implicit and therefore unexamined. Every account of the Bible both assumes and implies an account of the church, and vice versa: the lines of influence are reciprocal and circular. The Bible is always the church's book, the church always the community under the Bible's authority. This dissertation responds, diagnostically and constructively, to this situation through engagement with particular figures. Specifically, it expounds one specific strand of bibliology influenced by the great Protestant theologian Karl Barth: the work, respectively, of John Howard Yoder, Robert Jenson, and John Webster. Each of these theologians is a contemporary Barthian of a sort, a student but not a disciple of the Swiss master. Given Barth's influence over the development of theological interpretation, this commonality is helpful both genetically (all three trace their thought to the--proximate--source) and substantively (their proposals share enough to make disagreement intelligible, and interesting). Moreover, Jenson, Webster, and Yoder represent, between them, the three great traditions of western Christendom: catholicism, the magisterial reformation, and the radical reformation. The specific ways in which their ecclesial commitments shape, inform, and at times determine their theological treatments of Scripture provide ideal examples of the phenomenon at issue in this dissertation. Across five chapters, the project's principal aim is to demonstrate as well as examine the inseparable relationship between theology of Scripture and theology of the church. Along the way, the positions and proposals represented by Yoder, Jenson, and 'Webster come to light, and critical analysis of each highlights their respective strengths and shortcomings. In fulfilling these tasks the dissertation serves both as an initial reception of these theologians' bibliologies and as a critique of a feature--at times a problem--endemic to the current renewal of theological interpretation of Scripture.

The Fragmented Gateway to Collective Repentance: Race, Policing, and the Black Church in America

Denney, Matthew G. T Yale University ProQuest Dissertations & Theses 2023 해외박사(DDOD)

This dissertation examines the response of Black faith communities to policing and racial inequality in America. I explore the puzzle of why policing has compelled unique levels of mass mobilization for racial justice among Black faith communities, despite significant disagreement, while other areas of entrenched inequality have not received the same level of attention, despite more widespread agreement. This project draws on historical-archival research, ethnographic work based in New Haven, focus group interviews with Black faith leaders from around the country, and a large national survey to provide a holistic picture of the role of Black faith communities in conversations around policing and racial inequality.Part 1 (chapters 1-2) provides an overview of theory to understand race, policing, and the Black Church: policing as a fragmented gateway to collective repentance. In this framework, racial violence compels mobilization around policing and serves as a gateway through which Black faith communities call for collective repentance, which includes acknowledging histories of racial sins, stopping injustice, and seeking repair from the harms done. Racial violence serves this role because it provides visible displays of injustice and contestable targets in the form of policing. But mobilization around policing becomes fragmented due to internal debates about defunding the police, external resistance to broader racial justice, and religious-political cross pressures. Chapter 1 provides the background, method, and overview. Chapter 2 describes each core component of the argument, with representative evidence from focus group interviews and survey data.Part 2 (chapters 3-4) situates this framework in historical perspective and anchors the voices of contemporary Black faith communities to the Black prophetic tradition. This section does this by providing a historical case study from 1933 to 1945. Chapter 3 provides an analysis of how critical changes in policing during this time set policing on development trajectories and further ingrained racial inequalities. At the same time, Black faith communities offered alternative visions grounded in protecting vulnerable Americans and addressing socioeconomic inequality. This time period both exacerbated inequalities whose sources would be submerged over time, and it also constrained the ability of policing to serve as an agent for bringing socioeconomic inequality.Part 3 provides three contemporary case studies of approaches by faith communities to policing, entitled Reform, Representation and Relationships, and Resistance. I argue that all of these pathways involve Black faith communities who are working toward expansive visions of racial justice that mirror the key tenets of collective repentance. At the same, all of these approaches face significant structural and internal constraints that produce fragmentation. The Reform chapter follows a campaign by a Faith-Based Community Organization in Connecticut to automatically expunge some criminal records in Connecticut. The Representation chapter traces the role of Black faith leaders in influencing the New Haven Police Department through positions of leadership and brokerage relationships. The Resistance chapter draws on examples from around the country to analyze the role of Black faith communities during the George Floyd protest wave in 2020. I argue that, contrary to common wisdom, the Black Church has not experienced a unilateral decline in its role in mass resistance. Rather, it has experienced stability in some areas and decline in others. Specifically, I argue that the Black Church retains the most important pastoral role in mass resistance around racial justice. The prophetic role remains strong as well, but it has experienced some decline. Most significantly, the Black Church has experienced a precipitous decline in organizational strength, and this exerts a downward pressure on its prophetic capacity. Despite the obstacles in each of these pathways, the Black Church still provides a critique of American racism and a holistic vision of racial justice.The conclusion brings together the different themes from the dissertation: the historical developments, the different approaches to policing, and the difficulty of achieving socioeconomic equality. I highlight another approach that has become common since 2020: task forces to reimagine policing. Black faith leaders on these task forces connect policing to fundamental racial inequalities, but they experience resistance and fragmentation. Drawing on the whole of my research and the voices of Black churches and Christians, I describe a vision for reimagining repentance that starts from a posture of repentance, then moves into domains of entrenched inequality.

Paleoenvironmental Context of Early Stone Age Archaeology: An Analysis of the Gona Fauna Between ~3 and 1 Ma

Leiss, Amanda Christie ProQuest Dissertations & Theses Yale University 2022 해외박사(DDOD)

The advent of tool-making has long been associated with expanding grasslands in Africa. My dissertation reconstructs paleoenvironments at Gona, in the Afar region of Ethiopia, between ~3–1 Ma (1) to make inferences about how hominins were utilizing the paleo-landscape and interacting with mammalian communities and (2) to investigate whether the environment was influential in the development of stone tools. This time period spans the origin of our genus Homo and the evolution of Homo erectus, and it provides evidence of increased behavioral complexity (stone tools), brain expansion, and the acquisition of large nutrient-rich food sources (animal carcasses). Because of the scarcity of fossil and artifact-bearing deposits, little is known about the paleoenvironment during this time. There is an opportunity to address this at Gona, with its long record of Early Stone Age (ESA) archaeology, including among the earliest stone tools (Oldowan), evidence of carcass processing at ~2.6 Ma, and early Acheulean assemblages at 1.7 Ma. The emergence of the Acheulean is noteworthy for the standardized and purposeful technique which required a preconception of form (Semaw et al., 2009). Mammalian fossils throughout this sequence that are relatively understudied have the potential to help interpret the context in which these anatomical and behavioral changes occurred, specifically between ~3–1 Ma.I collected bovid tribal abundance, ecomorphological, and stable isotope data to reconstruct habitats throughout four intervals and analyzed them temporally and spatially in association with stone tools. As part of the Gona Research Project, my study complements and contributes to ongoing taphonomic, lithic, and geologic studies to provide a significant contribution to better understand the origin and evolution of stone tool technology. Tool use is a key innovation linked to behavioral and cognitive advances that led to the evolution of our species.The first chapter introduces the central concepts and explains the dissertation format. Chapter 2 provides the geological, paleontological, and archaeological context for the fossil and archaeological localities included in this dissertation. I discuss the research design used in this dissertation and place these localities into four temporally constrained study intervals or units that range from 2.96 to 0.81 Ma, spanning the emergence of Acheulean technology at Gona. Chapter 3 reports new stable carbon and oxygen isotope enamel values from large herbivores. I reconstruct faunal diets through analyses of δ13Cenamel from fossil assemblages of paleontological and archaeological contexts and then compare them to a large dataset of published stable carbon isotopes from enamel and pedogenic carbonates from eastern Africa to place my observations at Gona in a regional framework. Using community assemblage data and the proportion of grazers (as indicated by taxa with high δ13Cenamel values), I find that the habitats at Gona had more C4 grassy resources between ~3-1 Ma than all other contemporaneous fossil and archaeological localities in eastern Africa. Statistically significant increases in carbon values in the Lower Acheulean study interval provide further evidence for increased exploitation of grassy habitats.Alcelaphini bovids in particular are significantly enriched in δ13Cenamel values in archaeological contexts compared to paleontological contexts during the Lower Acheulean study interval. Alcelaphini from archaeological contexts in the Lower Acheulean study interval are also significantly enriched in δ13Cenamel compared to Alcelaphini from archaeological contexts in the Oldowan study interval. Chapter 4 presents the results of my bovid ecomorphological analyses of multiple elements and bovid tribal abundances. I find more open ecomorphs and Alcelaphini bovids in archaeological compared to paleontological contexts suggesting an increased reliance on open environments during the Lower Acheulean study interval. These data demonstrate an increase in open settings at the emergence of the Acheulean and a long-term increase in edaphic grasslands at Gona, with a marked increase at ~1.26 Ma. Chapter 5 summarizes the conclusions of this study and the implications for hominin behavior. These new data from Gona fill a significant gap in the eastern African Plio-Pleistocene paleoenvironmental record. I provide a nearly continuous sequence of paleoenvironmental and behavioral land use patterns by early Homo during the Early Stone Age. Overall, this study supports the hypothesis that the Acheulean technology was an adaptation to increased grasslands in eastern Africa.

Utilizing Meta-Analytical and Causal Inference Methods to Evaluate the Impacts of Environmental Risk Factors on Non-Hodgkin Lymphoma

Shi, Xiaoting Yale University ProQuest Dissertations & Theses 2024 해외박사(DDOD)

Non-Hodgkin lymphoma (NHL) is one of the most common hematologic malignancies in the world. Despite substantial efforts to identify causes and risk factors for NHL over the past few decades, the etiology of NHL is largely unclear. The overarching goal of this three-part dissertation is to use different meta-analytical and causal inference methods to identify and evaluate potential environmental risk factors for NHL. For the first project of this dissertation, we conducted an umbrella review to summarize the range, strength, and consistency of all associations between environmental risk factors and NHL reported in published meta-analyses. We identified 85 meta-analyses of summary level data reporting 257 associations for 134 unique environmental risk factors and 10 NHL subtypes. The vast majority of (79, 93%) meta-analyses of summary level data were rated as having critically low quality based on established evidence rating criteria. Most (225, 88%) associations presented either non-significant or weak evidence. Only 5% of the associations, primarily those for autoimmune and infectious diseases, were supported by the highest level of evidence (P < 10-6, at least 1000 NHL cases, largest study in the review reporting a nominally significant result, minimal between-study heterogeneity, and no evidence of publication bias). Autoimmune diseases have long been suspected as possible risk factors for NHL, and potential mechanisms for the relationship include chronic inflammation, antigen stimulation, and overlapping genetic susceptibility. To demonstrate the use of meta-analytical and causal inference methods to identify and evaluate potential environmental risk factors for NHL, we selected all ten statistically significant associations between autoimmune diseases and NHL (Behcet's disease, coeliac disease, dermatitis herpetiformis, psoriasis, rheumatoid arthritis, sarcoidosis, systemic lupus erythematosus, Sjogren's syndrome, systemic sclerosis, and type 1 diabetes [T1D]) for further evaluation in the second and third projects of the dissertation. In particular, given that these associations were all from observational studies, which are generally susceptible to different biases, this project highlighted the need for additional research evaluating their validity.For the second project of this dissertation, we (1) systematically identified and summarized quantitative bias analysis (QBA) methods proposed in the peer reviewed literature and generated a comprehensive classification tool that can facilitate the identification of QBA methods for studies with similar characteristics, and (2) used the classification tool and QBA methods to evaluate the impact of a potential unmeasured confounder (Epstein-Barr virus [EBV] infection) on the associations between the ten autoimmune diseases and NHL. We identified 55 QBA methods for summary level data, of which half (28, 51%) were designed for unmeasured confounding. Using the classification tool, we identified and applied five QBA methods for unmeasured confounding to the associations between ten autoimmune diseases and NHL. These analyses suggested that while effects of EBV infection as an unmeasured confounder could not significantly change the observed associations between autoimmune diseases and NHL risk, other unmeasured confounders, such as those with significant differences in prevalence rates between general population and autoimmune disease patients, could nullify or even reverse the observed associations from meta-analyses of observational studies.For the third project of this dissertation, we conducted a series of Mendelian randomization (MR) analyses to evaluate the associations between the previously identified ten autoimmune diseases and risk of NHL. The MR studies, which were carried out using large-scale genetic association studies, are less susceptible to unmeasured confounding than conventional observational studies. We observed negative associations between T1D and the risk of NHL, and between sarcoidosis and the risk of NHL (odds ratio [OR] 0.95, 95% confidence interval [CI]: 0.92 to 0.98, and OR 0.92, 95% CI: 0.85 to 0.99, respectively). No significant associations were found between the other eight autoimmune diseases and NHL risk. The findings from this MR study suggested that the effect estimates from conventional observational studies evaluating the associations between autoimmune diseases and an elevated risk of NHL may have been overestimated due to confounding. To triangulate the evidence, we compared the consistency of results in terms of direction and significance from the umbrella review (which identified meta-analyses, Project 1), bias analyses (Project 2), and MR analyses (Project 3). While results from the meta-analyses suggested that all ten autoimmune diseases were significantly associated with an increased risk of NHL, the bias anayses suggested that three were not significantly associated with and four were signficantly associated with a decreased risk of NHL, respectively. The MR analyses suggested that only two autoimmune diseases (T1D and sarcoidosis) were signficantly associated with a decreased risk of NHL; the other eight autoimmune diseases were not significantly associated with NHL. Overall, none of the associations were aligned across all three approaches.By combining meta-analytical and causal inference methods, we found that the associations between ten autoimmune diseases and an increased risk of NHL from published observational studies and meta-analyses are likely susceptible to unmeasured confounders. Future studies are warranted to further examine the impact of additional unmeasured confounders and other systematic errors (i.e., information and selection bias) on the associations between the ten autoimmune diseases and NHL. The novel integration of different meta-analytical and causal inference approaches for evidence triangulation proposed in this dissertation can serve as a template to guide researchers in environmental epidemiology when conducting investigations of environmental risk factor-health outcome associations.