Current Practices, Perceptions and Challenges of Telehealth in the Treatment of Mental Health in the U.S. Department of Veterans Affairs

Currently there are 17,964,242 million Veterans living in the U.S. Around 50% of these Veterans are over 65 years of age. Many U.S. service members – both active and retired, experience trauma and dysfunction in restructuring their lives. Mental health problems are reported in over 50% of Veterans both in active service and retired. According to the U.S. Department of Veterans Affairs (VA), ten times more suicides are reported among Veterans who did not register with the VA compared to those who do register. Longer deployments, shorter times at home between the deployments and combat exposure are the greatest contributors of physical and psychological health problems. Combat exposure has been linked with most cases of PSTD. This creates a greater need for mental health services to Veterans than any other forms of treatment. Due to the complex nature of Veterans population, characterized by an aging majority and location of many Veterans in rural areas, delivering mental health services is a huge challenge for the VA. The VA has been making efforts to ensure that all Veterans can access mental health services from where they are. Out of these efforts, integration of telehealth services to improve access to mental health care services has yielded promising results but this is not without challenges. This dissertation explores the current practices, perceptions and challenges of telehealth in the treatment of mental health in the U.S. Department of Veterans Affairs (VA)

A City Room of One\u27s Own: Elizabeth Jordan, Henry James, and the New Woman Journalist

This thesis considers the portrayal of the female journalist in the works of Elizabeth Jordan and Henry James. In 1898, Jordan, a journalist and editor herself, published Tales of the City Room, a collection of interconnected short stories that depict a close and supportive community of female journalists. It is, overall, a positive portrayal of female journalists by a female journalist. James, on the other hand, uses the female journalists in The Portrait of a Lady, “Flickerbridge,” and “The Papers” to show his discomfort toward New Journalism and the New Woman of the late-nineteenth and early-twentieth centuries. These female journalist characters are virtually alone and are often painted in grotesque or hyperbolic strokes. Taken together, the works of Jordan and James reveal the wide range of opinions the public had about female journalists. Advisor: Melissa Homestea

A City Room of One\u27s Own: Elizabeth Jordan, Henry James, and the New Woman Journalist

This thesis considers the portrayal of the female journalist in the works of Elizabeth Jordan and Henry James. In 1898, Jordan, a journalist and editor herself, published Tales of the City Room, a collection of interconnected short stories that depict a close and supportive community of female journalists. It is, overall, a positive portrayal of female journalists by a female journalist. James, on the other hand, uses the female journalists in The Portrait of a Lady, “Flickerbridge,” and “The Papers” to show his discomfort toward New Journalism and the New Woman of the late-nineteenth and early-twentieth centuries. These female journalist characters are virtually alone and are often painted in grotesque or hyperbolic strokes. Taken together, the works of Jordan and James reveal the wide range of opinions the public had about female journalists. Advisor: Melissa Homestea

Incorporating B cell activating factor (BAFF) into the membrane of rabies virus (RABV) particles improves the speed and magnitude of vaccine-induced antibody responses.

B cell activating factor (BAFF) is a member of the tumor necrosis factor (TNF) superfamily of cytokines that links innate with adaptive immunity. BAFF signals through receptors on B cells, making it an attractive molecule to potentiate vaccine-induced B cell responses. We hypothesized that a rabies virus (RABV)-based vaccine displaying both antigen and BAFF on the surface of the same virus particle would target antigen-specific B cells for activation and improve RABV-specific antibody responses. To test this hypothesis, we constructed a recombinant RABV-based vector expressing virus membrane-anchored murine BAFF (RABV-ED51-mBAFF). BAFF was incorporated into the RABV particle and determined to be biologically functional, as demonstrated by increased B cell survival of primary murine B cells treated ex-vivo with RABV-ED51-mBAFF. B cell survival was inhibited by pre-treating RABV-ED51-mBAFF with an antibody that blocks BAFF functions. RABV-ED51-mBAFF also activated primary murine B cells ex-vivo more effectively than RABV as shown by significant upregulation of CD69, CD40, and MHCII on the surface of infected B cells. In-vivo, RABV-ED51-mBAFF induced significantly faster and higher virus neutralizing antibody (VNA) titers than RABV while not adversely affecting the longevity of the vaccine-induced antibody response. Since BAFF was incorporated into the virus particle and genome replication was not required for BAFF expression in-vivo, we hypothesized that RABV-ED51-mBAFF would be effective as an inactivated vaccine. Mice immunized with 250 ng/mouse of β-propriolactone-inactivated RABV-ED51-mBAFF showed faster and higher anti-RABV VNA titers compared to mice immunized with inactivated RABV. Together, this model stands as a potential foundation for exploring other virus membrane-anchored molecular adjuvants to make safer, more effective inactivated RABV-based vaccines

APRIL:TACI axis is dispensable for the immune response to rabies vaccination.

There is significant need to develop a single-dose rabies vaccine to replace the current multi-dose rabies vaccine regimen and eliminate the requirement for rabies immune globulin in post-exposure settings. To accomplish this goal, rabies virus (RABV)-based vaccines must rapidly activate B cells to secrete antibodies which neutralize pathogenic RABV before it enters the CNS. Increased understanding of how B cells effectively respond to RABV-based vaccines may improve efforts to simplify post-exposure prophylaxis (PEP) regimens. Several studies have successfully employed the TNF family cytokine a proliferation-inducing ligand (APRIL) as a vaccine adjuvant. APRIL binds to the receptors TACI and B cell maturation antigen (BCMA)-expressed by B cells in various stages of maturation-with high affinity. We discovered that RABV-infected primary murine B cells upregulate APRIL ex vivo. Cytokines present at the time of antigen exposure affect the outcome of vaccination by influencing T and B cell activation and GC formation. Therefore, we hypothesized that the presence of APRIL at the time of RABV-based vaccine antigen exposure would support the generation of protective antibodies against RABV glycoprotein (G). In an effort to improve the response to RABV vaccination, we constructed and characterized a live recombinant RABV-based vaccine vector which expresses murine APRIL (rRABV-APRIL). Immunogenicity testing in mice demonstrated that expressing APRIL from the RABV genome does not impact the primary antibody response against RABV G compared to RABV alone. In order to evaluate the necessity of APRIL for the response to rabies vaccination, we compared the responses of APRIL-deficient and wild-type mice to immunization with rRABV. APRIL deficiency does not affect the primary antibody response to vaccination. Furthermore, APRIL expression by the vaccine did not improve the generation of long-lived antibody-secreting plasma cells (PCs) as serum antibody levels were equivalent in response to rRABV-APRIL and the vector eight weeks after immunization. Moreover, APRIL is dispensable for the long-lived antibody-secreting PC response to rRABV vaccination as anti-RABV G IgG levels were similar in APRIL-deficient and wild-type mice six months after vaccination. Mice lacking the APRIL receptor TACI demonstrated primary anti-RABV G antibody responses similar to wild-type mice following immunization with the vaccine vector indicating that this response is independent of TACI-mediated signals. Collectively, our findings demonstrate that APRIL and associated TACI signaling is dispensable for the immune response to RABV-based vaccination

The Sensitivity of Infants with Spina Bifida to Sensory Information

Spina bifida (SB) is the most common neural tube defect in the United States. These babies move their legs less often and demonstrate motor milestones significantly later in life than their typically developing (TD) peers. Research has shown TD infants move their legs more or less often depending on the quality and quantity of sensory information they have available to them. Significant milestones such as crawling and walking rely on intra-limb coupling, which occurs when one limb adapts to contextual environmental factors depending on the position of the other limb. Current motor development processes are rooted in theoretical concepts from the Dynamic Systems Theory and the Theory of Neuronal Group Selection. The purpose of this study was to determine if infants with lumbar or sacral SB would move their legs more or less often when confronted with changes in sensory information while seated in an infant seat designed to facilitate movement

Occupational Therapists’ Perspectives During the COVID-19 Pandemic

On March 11, 2020, the World Health Organization declared the outbreak of the coronavirus disease 2019 (COVID-19) as a global pandemic. Hospitals, nursing homes, and communities worldwide were flooded with patients diagnosed with COVID-19, resulting in the increased need for medical care and treatment by health care professionals, such as occupational therapists. This study analyzes output from a quantitative online survey design, which was created on SurveyMonkey and included 43 questions. Data from the survey were collected, categorized, and measured through the SurveyMonkey computer system and included information gathered from 204 occupational therapists from October 2020 to February 2020. Based on the survey results, occupational therapists believe that their profession has an ethical duty to provide skilled interventions to patients diagnosed with COVID-19. The majority of the occupational therapists were worried about their health and their family’s health as a result of COVID-19. In addition, many of the. therapists reported a close contact and subsequent positive test for COVID-19. Health care administrators and leaders should use the common perspectives among health care workers to guide them as they provide additional support and implement changes during the COVID-19 pandemic. Interventions that could be implemented by health care administrators include self-care training, psychological support, and safe opportunities to engage in meaningful activities