Obesity Economics for the Western United States

Health Economics and Policy,

Use of National Standards to Monitor HIV Care and Treatment in a High Prevalence City-Washington, DC.

We sought to benchmark the quality of HIV care being received by persons living with HIV in care in Washington, DC and identify individual-level and structural-level differences. Data from the DC Cohort, an observational HIV cohort of persons receiving outpatient care in DC, were used to estimate the Institute of Medicine (IOM) and Department of Health and Human Services (HHS) quality of care measures. Differences in care by demographics and clinic type were assessed using χ2 tests and multivariable regression models. Among 8,047 participants, by HHS standards, 69% of participants were retained in care (RIC), 95% were prescribed antiretroviral therapy (ART), and 84% were virally suppressed (VS). By IOM standards, 84% were in continuous care; and 78% and 80% underwent regular CD4 and VL monitoring, respectively. Screening for syphilis, chlamydia, and gonorrhea was 51%, 31%, and 26%, respectively. Older participants were 1.5 times more likely to be RIC compared to younger participants (OR: 1.5; 95% CI: 1.3, 1.8). Participants enrolled in community-based clinics were more likely to be RIC (OR: 1.7; 95% CI: 1.4, 2.0) versus those enrolled at hospital-based clinics. Older participants were more likely to achieve VS than younger participants (OR: 1.8; 95% CI: 1.5, 2.2) while Black participants were less likely compared to white participants (OR: 0.4; 95% CI: 0.3, 0.5). Despite high measures of quality of care, disparities remain. Continued monitoring of the quality of HIV care and treatment can inform the development of public health programs and interventions to optimize care delivery

Attainment and maintenance of pubertal cyclicity may predict reproductive longevity in beef heifers

We hypothesized the manner that heifers achieve puberty may indicate their future reproductive longevity. Heifers with discontinued or delayed cyclicity during puberty attainment may have irregular reproductive cycles, anovulation, and infertility in their first breeding season contributing to a shorter reproductive lifespan. Therefore, plasma progesterone (P4) was measured from weaning to breeding on 611 heifers born 2012–2017 and four pubertal classifications were identified: (1) Early; P4 ≥ 1 ng/ml \u3c March 12 with continued cyclicity, (2) Typical; P4 ≥ 1 ng/ml ≥ March 12 with continued cyclicity, (3) Start-Stop; P4 ≥ 1 ng/ml but discontinued cyclicity, and (4) Non-Cycling; no P4 ≥ 1 ng/ml. Historical herd records indicated that 25% of heifers achieved puberty prior to March 12th in the 10 years prior to the study. Start-Stop and Non-Cycling yearling heifers were lighter indicating reduced growth and reproductive maturity traits compared with Early/Typical heifers. In addition, Non-Cycling/Start-Stop heifers were less responsive to prostaglandin F2 alpha (PGF2α) to initiate estrous behavior and ovulation to be artificially inseminated. Non-Cycling heifers had fewer reproductive tract score-5 and reduced numbers of calves born in the first 21-days-ofcalving during their first breeding season. Within the Start-Stop classification, 50% of heifers reinitiated cyclicity with growth traits and reproductive parameters that were similar to heifers in the Early/Typical classification while those that remained non-cyclic were more similar to heifers in the Non-Cycling group. Thus, heifers with discontinued cyclicity or no cyclicity during puberty attainment had delayed reproductive maturity resulting in subfertility and potentially a shorter reproductive lifespan

Vascular Endothelial Growth Factor A 165 rescues steroids, inflammation and follicle arrest in High Androstenedione cows

A population of cows with excess androstenedione (A4; High A4) in follicular fluid, with follicular arrest, granulosa cell dysfunction, and a 17% reduction in calving rate was previously identified. We hypothesized that excess A4 in the ovarian microenvironment caused the follicular arrest in High A4 cows and that vascular endothelial growth factor A would rescue the High A4 phenotype. In trial 1, prior to culture, High A4 ovarian cortex (n=9) had greater numbers of early stage follicles (primordial) and fewer later-stage follicles compared to controls (n=11). Culture for 7 days did not relieve this follicular arrest; instead, High A4 ovarian cortex had increased indicators of inflammation, anti-Mullerian hormone, and A4 secretion compared to controls. In trial 2, we tested if vascular endothelial growth factor A (VEGFA) angiogenic (165) and antiangiogenic (VEGFA165b) isoforms could rescue the High A4 phenotype. High A4 (n=5) and control (n=5) ovarian cortex was cultured with (1) PBS, (2) VEGFA165 (50 ng/mL), (3) VEGFA165b (50 ng/mL), or (4) VEGFA165+VEGFA165b (50 ng/mL each) for 7 days. Follicular progression increased with VEGFA165 in High A4 cows with greater early primary, primary, and secondary follicles than controls. Similar to trial 1, High A4 ovarian cortex secreted greater concentrations of A4 and other steroids and had greater indicators of inflammation compared to controls. However, VEGFA165 rescued steroidogenesis, oxidative stress, and fibrosis. Both VEGFA isoforms reduced specific pro-inflammatory cytokines in High A4 cows to control levels. Thus, VEGFA165 may be a potential therapeutic to restore the ovarian steroidogenic microenvironment to promote folliculogenesis

Alterations in Circulating Steroid Hormones, Lipids, Hepatic Steroid Inactivation Enzymes, and Ovarian Cortex and Follicular Fluid Cytokines in Cows with Androgen Excess

Abstract not available (author request). Advisor: Andrea S. Cup

Alterations in Circulating Steroid Hormones, Lipids, Hepatic Steroid Inactivation Enzymes, and Ovarian Cortex and Follicular Fluid Cytokines in Cows with Androgen Excess

Abstract not available (author request). Advisor: Andrea S. Cup

Obesity Economics for the Western United States

The estimated obesity-related health care costs across the Western region in 2008 were $16.2 billion (this is an inflation-adjusted estimate based on the work of Finkelstein, Fiebelkorn, and Wang (2004)). 25 The Western populations, the percentage of obese adults in each state, and the estimated annual obesity-related expenditures by state are summarized in Table 1. The cost estimates include only direct health care expenditures related to obesity. The actual cost of obesity is much higher and includes not only obesity-related illness and disease, but also indirect costs resulting from missed work days and lower worker productivity as well as valued activities foregone as an opportunity cost (Trogdon et al., 2008)

The Effects of Androgens on Bovine and Human Granulosa Cells

A subpopulation of cows in the Physiology herd has been identified as subfertile due to sporadic or chronic anovulation. This decrease in fertility could be lost profits for farmers and raises questions about ovulation disorders in women. Granulosa cells, a type of cell that is essential to ovarian follicle development, was investigated to determine if high concentrations of a hormone, androstenedione, could impact the follicular environment enough to cause anovulation disorders. Previous studies suggested that excess androgen may decrease the number of functioning granulosa cells by preventing them from proliferating within the follicle. Fewer granulosa cells mean fewer cells that are available to convert androstenedione to estrogen; and estrogen is required for the development of the follicle and ovulation. This research experience determined that when primary granulosa cells are subjected to high concentrations of androstenedione the rate of proliferation decreases based on the reduced proliferation promoting genes within the cells. These tests were done on primary granulosa cells from bovine as well as an immortalized granulosa cell line from humans