Kansas City Metro Area Research Articles

Novel prognostic staging system for patients with de novo metastatic breast cancer: A real-world experience.

e13167 Background: De novo metastatic breast cancer (dnMBC) is a heterogenous disease with variable survival rates. For newly diagnosed, non-MBC, the AJCC staging system incorporates non-anatomical factors, biomarkers and grade, in addition to tumor size and nodal status to define the prognostic stage group. These variables and other disease-related factors, such as sites of metastasis, have been associated with survival in MBC. Despite this, the current staging system groups all patients with dnMBC into a single prognostic group. More tools are needed to help clinicians relay important prognostic information to patients with dnMBC. Plichta et al. [1] utilized large population data sets to develop a novel staging system for dnMBC, which successfully stratified patients into four prognostic groups (IVA-D) based on disease-related variables. In this study, we sought to validate this staging system in an independent, real-world cohort of patients with dnMBC. Methods: We used a retrospective cohort of patients with MBC who received treatment in the Koontz Center for Advanced Breast Cancer (KABCC) at St. Luke’s Cancer Institute, a community-based healthcare system in the Kansas City metro area. The KABCC is a multidisciplinary clinic dedicated solely to the care of patients with MBC. Patients with dnMBC were assigned prognostic stage IVA, IVB, IVC, and IVD according to the system developed by Plichta et al. [1]. Overall survival (OS) was compared between groups using Kaplan-Meier analysis and the log-rank test. We also performed a stratified analysis based on age at diagnosis, <60 years versus ≥60 years. Results: Ninety-seven patients with dnMBC were included in the analytic cohort. Mean age at diagnosis was 60 years, and most patients self-identified as non-Hispanic White (71.1%) or Black (22.7%). Nine patients were assigned stage IVA (9.3%), 39 stage IVB (40.2%), 32 stage IVC (33%) and 16 stage IVD (16.5%). Most stage IVA were HER2 positive (66.7%), while most stage IVD were triple-negative (56.3%). OS differed significantly between the four stage groups, with mortality rates increasing as stage increased. This was true in both the overall population (p<0.001) and when patients were stratified by age at diagnosis (both p<0.05) (Table). Conclusions: In an independent, real-world cohort of patients with dnMBC, a novel prognostic staging system that incorporates biomarkers, T-stage, grade, and sites of metastasis successfully stratified patients into four prognostic groups. Our findings help to confirm the utility of this staging system in dnMBC. [Table: see text]

Genomic testing and uptake of alteration-targeted therapies among patients with hormone-receptor positive (HR+) metastatic breast cancer (MBC).

e13084 Background: There is no recognized standard of care treatment after progression on first-line endocrine therapy plus CDK4/6 inhibitor in HR+ / HER2 negative MBC. Alteration-targeted therapies (ATT) have the potential to delay initiation of chemotherapy with more favorable toxicity, and perhaps improved efficacy. Next-generation sequencing (NGS) of tumor tissue or circulating tumor DNA (ctDNA) can identify actionable mutations for targeted therapy. In this study, we sought to assess the results of genomic testing and uptake of ATT among patients with HR+ / HER2-negative MBC. Methods: We studied a retrospective cohort of patients with MBC who received treatment in the Koontz Center for Advanced Breast Cancer (KABCC) at St. Luke’s Cancer Institute, a community-based health system in the Kansas City metro area. The analytic cohort included 125 patients with HR+ / HER2-negative MBC who received treatment after progression on first-line therapy. Genomic testing was performed as a standard of care from ctDNA or tumor-tissue using commercially available NGS assays. Targetable alterations were defined as those with FDA-approved or routinely used off-label treatment regimens in MBC ( PIK3CA, PTEN, AKT, ESR1, ERBB2, BRCA1, BRCA2, PALB2 mutations; TMB >10 or PDL1+). We identified patients who received any ATT and compared them with those who did not. Overall survival (OS) and time to initiation of chemotherapy (TTC) were compared between the two groups using Kaplan-Meier analyses and the log-rank test. Results: Ninety-nine patients (79.2%) had genomic testing and 49 (39.2%) were tested prior to second-line therapy. Of those tested, 84% had at least one targetable alteration. ESR1 mutations were most common, detected in 36% of patients, followed by PIK3CA (31.2%), PTEN (12%), BRCA1/2 (7.2%) and ERBB2 (5.6%). A total of 35 patients received ATT, and around half of those (17 patients) received ATT in the second line. Alpelisib was the most common ATT (62.9%), followed by elacestrant (20%) and neratinib (14.3%). There was no significant difference in OS or TTC between the two groups. Conclusions: Approximately 80% of patients with HR+ / HER2-negative MBC in our cohort underwent genomic testing after progression on first-line therapy, and the vast majority had at least one targetable alteration identified. However, only 35 patients received ATT with most receiving alpelisib. We observed no significant improvement in OS or TTC among those who received ATT, although the numbers were small. There have been two new targeted therapies approved in the past year and many novel agents are currently under investigation in clinical trials. Newer therapies with distinct targets, improved tolerability and efficacy have the potential to improve the uptake and clinical benefit of targeted therapy in MBC.

Nutrition Literacy Among Latina/x People During Pregnancy Is Associated With Socioeconomic Position.

During pregnancy, Latina/x people experience nutrition and nutrition-related health inequities. Nutrition literacy is a potential factor impacted by these inequities. However, the nutrition literacy level of Latina/x people during pregnancy is not well investigated. The study aimed to assess the nutrition literacy level of Latina/x people during pregnancy and explore the association of nutrition literacy with socioeconomic position. This was a cross-sectional study of data collected from 2016 to 2018 within the double-blinded, randomized clinical trial Assessment of Docosahexaenoic Acid on Reducing Early Preterm Birth. A total of 112 Latina/x people during pregnancy from the Kansas City metro area were included in this study. Nutrition literacy level assessed between 12 and 20 gestational weeks using the Nutrition Literacy Assessment Instrument, both in English and Spanish. Descriptive measures were used to describe the nutrition literacy level during pregnancy. Multiple logistic regression models were used to examine the association between low nutrition literacy and socioeconomic position, adjusting for age and race. In this study, most participants demonstrated low nutrition literacy during pregnancy. Those with low nutrition literacy were 2 times more likely to have low annual household income (odds ratio [OR]= 2.74, 95% confidence interval [CI]: 0.99-7.59), 3 times more likely to prefer Spanish as their primary language of communication (OR= 3.03, 95% CI: 0.95-9.67), and 7 times more likely to be uninsured (OR= 7.47; 95% CI: 1.57-35.64). Nutrition literacy scores during pregnancy were associated with variables of socioeconomic position. Future research should focus on nutrition literacy associations with health outcomes during pregnancy and interventions to improve the nutrition literacy level of primarily Spanish-speaking people who have low household incomes and are uninsured.

Farmer attitudes and perceptions toward gleaning programs and the donation of excess produce to food rescue organizations

Food waste and food insecurity are two concurrent major public health issues. To address them, glean­ing programs can reduce waste and enhance food security by diverting produce to food pantries. To understand the experiences of farmers and gleaning programs, interviews were completed with 12 farmers who had participated in a gleaning pro­gram and 16 farmers who had not donated pro­duce through a gleaning program within the Greater Kansas City metro area. For farmers who had participated in the gleaning program, the ease of donating and tax incentives were primary bene­fits. Inadequate experience and inefficient volun­teers were cited as challenges. Farmers without experience with gleaning programs cited safety and liability issues as concerns. Because farmers communicate frequently with other farmers, food rescue organizations should consider enlisting their support. Communities and government agencies should provide financial support to improve the resources and infrastructure of gleaning organiza­tions to improve farmer-gleaner relationships.

Hospital Collaboration in Response to the COVID-19 Pandemic in Kansas City Metropolitan Region

IntroductionSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2, aka COVID-19) virus has evolved into a World Health Organization-declared pandemic which has strained our regional critical care and hospital resources.MethodsA Critical Care Task Force was established between Kansas City area intensive care units to allow for preparedness for potential surges by sharing of bed capacity both in the ICU and hospital, and ventilator capacity as well as weekly web-based meetings to share resource concerns and best practice. This Task Force also collected patient information to understand the dynamics of community impact and resource needs better. This effort allowed for compilation and dissemination of information regarding data that describe characteristics of patients with COVID-19 compared to a random sample of medical ICU patients with conditions other than COVID-19.Demographic and therapeutic factors affecting patients admitted to medical intensive care units in the Kansas City metro area are reported from May 5, 2020 until June 2, 2020 using a retrospective case-control study examining gender, race, and therapeutic options including modes of ventilation, vasopressor requirements, renal-replacement therapy, and disposition.ResultsDuring data collection, patients being treated for COVID-19 in intensive care units in the Kansas City metropolitan area were more likely to be older, less likely to be white, and less likely to be immunosuppressed as compared to those being treated for non-COVID illnesses. They were more likely to require non-invasive ventilation and undergo prone positioning but were equally likely to require invasive ventilation and other organ supportive therapy.ConclusionsHospitalized patients being treated for COVID-19 in the Kansas City metropolitan area have similar demographics to those being reported in the U.S. including age and race. Additionally, establishing a Critical Care Task Force in response to the pandemic allowed for preparation for a potential surge, establishing capacity, and disseminating timely information to policy makers and critical care workers on the front line.

Latinxs in the Kansas City Metro Area: Policing and Criminalization in Ethnic Enclaves

This study explores the socio-spatial, economic, and policing inequities experienced by Latinxs in the Kansas City metropolitan using geographic, census, and police data as well as qualitative analysis of interviews and workshops. Data show there has been an expansion of Latinx enclaves over time in the metropolitan area and suggest that enclaves function as both a protective factor for Latinxs against socio-structural hardship and also render them highly visible as targets for disproportionate criminalization. To redress the latter, we offer planning recommendations for community development and policing that promote socio-spatial equity in law enforcement practices while adapting to demographic shifts.

Farmer Views Towards Donating Excess Produce to a Food Rescue Organization (P03-006-19)

ObjectivesAn estimated 20 billion pounds of edible fruits and vegetables are wasted at the farm level every year, often due to being unmarketable or the farm growing excess.1 This wasted food could go towards meeting the hunger and nutritional needs of the one in eight Americans who are food insecure.2 Food distribution agencies are typically unable to provide a balanced diet for their clients.3 Rescuing or gleaning excess produce from farms can reduce food waste while providing fresh, nutritious food to people in need. However, there is limited information on what factors farmers take into consideration when deciding to donate excess produce. The purpose of this project was to learn about farmers’ views towards donating excess produce to food agencies. MethodsSemi-structured interviews with fruit and vegetable farmers in the greater Kansas City metro area were completed as part of a larger program evaluation of the gleaning and food rescue agency, After the Harvest. Interviews were digitally recorded, transcribed, and analyzed for common themes across responses. ResultsInterviews were completed with 32 farmers. Sixteen farmers had previously donated produce to the gleaning agency and sixteen had not. Most reported having excess produce because they had grown more than they could harvest or sell. Excess produce was either donated to the gleaning agency, left in the field, composted, fed to animals, or donated directly by the farmer to food banks or churches. Farmers who had donated liked doing so because they want the food they grow to be consumed, the produce goes to people who need it, and the donation took very little time and effort. Those who had not donated were concerned about the amount of time it would take to organize the donation, having volunteers in their fields, and that the crops with excess amounts would be worth gleaning and donating to food agencies. Overall, farmers were very willing to donate excess produce and most were willing to have volunteer gleaners at their farms. ConclusionsFarmers like to know the food they grow gets consumed but often do not have the time or resources to handle excess produce and are most likely to donate when it is made easier for them to do so. Food rescue agencies should provide flexible donation options to farmers and communicate to farmers that they can donate produce without losing time or money. Funding SourcesThe Hall Family Foundation.

Evaluation of EPT macroinvertebrate metrics in small streams located within the non-connected stormwater management region of Kansas City, Missouri, USA

AbstractDuring 2012-2014, we evaluated macroinvertebrate communities in streams draining the non-connected stormwater management region (Municipal Separate Storm Sewer System, or MS4) within the Kansas City metropolitan area utilizing the Missouri bioassessment protocols. Trends in aquatic life impairment status based on Missouri's Macroinvertebrate Stream Condition Index (MSCI), as well as richness and abundance of EPT indicator metrics (Ephemeroptera, Plecoptera, Trichoptera), were compared between rural control sites and both transitional and urban stream sites representing varying stages of land use conversion. As compared to non-urban control sites, EPT taxa richness was significantly lower at MS4 urban sites during all three years (p = 0.007 – 0.013) and MS4 transitional sites during one of three years (p=0.48). EPT abundance (%) was significantly lower at MS4 urban sites during all years (p = 0.008 – 0.013) and MS4 transitional sites during one of three years (p=0.34). Mean EPT abundances ranged between 0.6% - 10.3% at urban MS4 sites, and always exceeded 18% at control sites. Both EPT richness and abundance were lower at the MS4 control site but means for EPT and other core metrics at this site were most often similar to non-urban control sites based on analysis of variance (ANOVA). MS4 transitional sites with active development in their watersheds were partially-supporting in their impairment status, and EPT metrics had lower means and generally more variability than control sites. Temporal trends indicate non-urban control and MS4 control sites consistently meet fully-supporting impairment status based on overall MSCI scores, but no study sites currently meet regional expectations (as defined by state reference streams) for either of the EPT metrics. Results indicate that Missouri and Kansas biocriteria for both EPT metrics are not consistently being met at any stream sites in the Kansas City metro area, including fully-supporting control sites and MS4 streams that receive stormwater runoff in watersheds with urban development that is well-established or currently transitioning to urban or suburban land uses.

Latinas and Latinos in the Midwest: Pocos, pero bien Contados

Latinas and Latinos in the Midwest:Pocos, pero bien Contados Ruben O. Martinez (bio) and Juan D. Coronado (bio) Near midnight on July 5, 2017, a 47-year-old Latino male walking on a sidewalk in a commercial area in Lansing, Michigan, was assaulted by two White Americans in what was investigated as a hate crime. The suspects, motivated by the hostile social and political environment of today, defined by nativism and racial intolerance, yelled, "Trump hates you" at the victim as they pummeled him into a bloody mess. The two male perpetrators then stapled a note on the victim's chest that read, "Go back to Mexico, Wetback." Within two weeks of the brutal crime, on July 18, representatives from the Latino community gathered with other community leaders, along with elected and appointed officials to publically condemn the cowardly act of hatred and violence. The event occurred because Latino and Latina leaders called for public condemnation; up to that point elected officials had remained silent on the incident. Although the Latino community in Michigan, as in the Midwest (apart from Chicago), may not be as large as in other parts of the country, the condemnation on that given day was firm and resounding—Lansing is a welcoming city, not a city of hate. Como dicen en Mexico, Pocos, pero bien contados. (As they say in Mexico, "Few, but very well represented.") Pocos, pero bien contados is an accurate description of the Latino/a population in Michigan and in the rest of the Midwest. Despite representing only 5% of the population in Michigan and 7.6% in the entire Midwest (mostly in Chicago), there is a handful of Latinas and Latinos that are keenly aware of the challenges facing their communities.1 As in all minority communities there are community leaders who step up to resist acts of oppression and civil and human rights violations. Such is the case with Latinos and Latinas in the Midwest, who, despite their relatively low numbers, pursue progressive change in their neighborhoods, cities, states, and region. Across the Midwest, statewide Latino-focused commissions concentrate on issues confronting Latino communities. In today's highly polarized political climate, which is in direct response to the stagnant economy of recent years and the demographic "change of colors" in the United States, Latinos face a nativist pushback by White Americans who view them, regardless of citizenship, not only as a threat to "traditional" American culture but as "outsiders" taking jobs from White Americans. Trump's slogan "Make America Great Again" represents the nativist sentiments held by many Americans in a period of increasing income and wealth inequality brought about by the policies of free-market ideologues. Today, Latinos are a visible and growing minority population, one that has been in the Midwest for over a century.2 Their largest numbers were initially in the Kansas City metro area in the first third of the last century, but presently Chicago and its surrounding suburbs have the largest concentration. These days, Latinos are found throughout the 12 Midwestern states (Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin); they are in urban and rural areas, in factories, service occupations, food processing plants, transportation, and educational institutions, to name but a few. Their presence continues to grow daily, and will continue to do so through natural increase, as they are a relatively young and fertile population. Further, because of their relative youth, they tend to have higher labor participation rates than White Americans, contributing significantly to the economy. Finally, Latinos embrace the democratic values that are the foundation of the American state, and thereby contribute to its preservation. Despite the public view that Latinos are newcomers to the Midwest, they actually have an extensive history in the region dating back to the sixteenth century—1541 to be exact—when Francisco Coronado visited the area in present-day Kansas and Hernando de Soto explored the Mississippi River in areas that are part of present-day Midwestern states.3 By the turn of the nineteenth century the newly established Santa Fe Trail linked Independence, Missouri, with Santa Fe, New Mexico, establishing overland economic ties with [End Page...

Association Roundtable

Insights and advice from leaders of local and state biomedical associationsWe have started a junior chapter of our Danish Society for biomedical engineering and they have seats on our board. This gives a revitalization of our society and our board. It gives early contact to future colleagues and better contact to the universities. And it gives the junior members a great network for their career.”Kim Dremstrup, PhD, President, Danish Society for Biomedical Engineering“After observing other association websites, we noted there was not much updating of information. Everything just seemed stagnant—something that is not good in a dynamic field such as healthcare technology management. Pursuant to the resolution of this challenge, our Information Blog was established. Each weekday a new helpful message is posted on the blog. It could be something about an upcoming webinar, a new best practice, a meeting announcement, or something technology oriented that affects our field. When these blog items are posted, our system automatically e-mails the post to our member and associate subscribers, which at this time total 246.”Dick Felton, Past President, Healthcare Technology Management Association of Ohio“We have always been involved with our local technical college. We recommend hiring talented individuals from other technical fields and training them in biomedical principles using our technical college. This way you help local individuals, the community, and create cost savings for the hospital.”Horace Hunter, Executive Director, Georgia Biomedical Instrumentation Society“We have begun two programs which are quite popular.“The first program is a certification study group. We've held weekly study groups at two Kansas City metro area hospitals which teleconference with the highly successful CABMET group. We augment that with additional training. For instance this year I taught a 2 hour X-ray fundamentals course. As a result of this program we've certified over 30 new CBET and CRES technicians. We've also held A+ training.“The other program we've instituted which seems quite popular is a raffle for a trip to the AAMI annual conference. A ticket is awarded to individuals who contribute something meaningful to the organization or profession. Examples would be teaching a class, writing an article which is published in a professional publication, or recruiting a new corporate sponsor.”Dan DeMaria, CBET, CRES, President, Healthcare Technology Management Association of the Midwest (HTMA-MW)

Community pharmacy-based medication therapy management services: financial impact for patients

To determine the direct financial impact for patients resulting from Medication Therapy Management (MTM) interventions made by community pharmacists. Secondary objectives include evaluating the patient and physician acceptance rates of the community pharmacists' recommended MTM interventions. This was a retrospective observational study conducted at 20 Price Chopper and Hen House grocery store chain pharmacies in the Kansas City metro area from January 1, 2010 to December 31, 2010. Study patients were Medicare Part D beneficiaries eligible for MTM services. The primary outcome was the change in patient out-of-pocket prescription medication expense as a result of MTM services. Of 128 patients included in this study, 68% experienced no out-of-pocket financial impact on their medication expenses as a result of MTM services. A total of 27% of the patients realized a cost-savings (USD440.50 per year, (SD=289.69)) while another 5% of patients saw a cost increase in out-of-pocket expense (USD255.66 per year, (SD=324.48)). The net financial impact for all 128 patients who participated in MTM services was an average savings of USD102.83 per patient per year (SD=269.18, p<0.0001). Pharmacists attempted a total of 732 recommendations; 391 (53%) were accepted by both the patient and their prescriber. A total of 341 (47%) recommendations were not accepted because of patient refusal (290, 85%) or prescriber refusal (51, 15%). Patient participation in MTM services reduces patient out-of-pocket medication expense. However, this savings is driven by only 32% of subjects who are experiencing a financial impact on out-of-pocket medication expense. Additionally, the majority of the pharmacists' recommended interventions (53%) were accepted by patients and prescribers.

Acoustics of the pipe organ

An organist’s perspective on pipe organ acoustics. The range of frequencies produced by a large pipe organ covers 10 Hz to over 10,000 Hz. Three significant pipe organs in the Kansas City metro area will be discussed: the Julia Kauffman Casavant at the Kauffman Center for the Performing Arts in Kansas City (installation completed early 2012) and the two magnificent instruments at Community of Christ Headquarters in Independence, MO (installations in 1993 and 1959). The acoustic qualities of individual pipes, groups of pipes, and the rooms in which these instruments reside affect the approach which these organs’ builders took in designing these one-of-a-kind pipe organs, and the approach each artist takes when making music with them.

A Qualitative Analysis of Barriers, Challenges, and Successes in Meeting the Needs of Hurricane Katrina Evacuee Families

Hurricane Katrina caused many individuals to evacuate to towns and cities throughout the United States. Psychological First Aid (PFA) is a treatment program designed to help clinicians and other disaster relief workers address the needs of adults, youth, and families immediately following disasters. We conducted focus groups with disaster relief and evacuee service providers in the Kansas City Metro Area as an exploratory study to identify their perceptions of the needs of evacuees. Participants identified a number of mental health needs, as well as displacement-related challenges, including loss of social support, material loss, unemployment, and other stressful life events that were secondary to the hurricane. Many of these needs are consistent with principles presented in the PFA manual. We also found that service providers faced unique challenges when attempting to assist evacuees. We discuss implications of these findings for treatment programs and provide suggestions for addressing barriers to care.

The Nature of Metropolitan Governance in Urban America

The evidence in this study demonstrates that the dominant pattern of metropolitan governance in the Kansas City metro area across 46 cities and 28 public services is one of intergovernmental cooperation, punctuated by conflict. Contrary to what would be predicted by theories of cooperation, the scope of cooperation is negatively related to the number and percent of joint intergovernmental service arrangements and that the scope of cooperation increases when a municipality transfers a service to another public entity or a municipality specializes in a regional service.

A Comparison Of Vehicle Air Pollution EmissionsBetween Different Geodemographic Groups InThe Kansas City Metro Area (USA) UsingRemote Sensing

Five unique target groups were created geodemographically for the entire Kansas City metro area (USA). The target group design was based on the Mosaic system produced by Applied Geographic Solutions. The quantitative classification system grouped metro households according to the following six criteria: attitudes and actions about environmental issues, propensity to use a certain aged vehicle, tendency to do automotive maintenance, media preferences, types of messages they are likely to respond to, probable means to educate about environmental impacts of vehicle use, and probable range of personal vehicle emissions (from high polluter to efficient). Vehicle emissions testing sites were selected based on target group representation, and remote sensing equipment was used to discretely monitor emissions from passing cars. It was hypothesized that vehicle emissions would not vary among target groups. Data analysis revealed significant differences among the groups for individual pollutants. However, the ranking of the groups according to the amount of pollutant emitted is not consistent from pollutant to pollutant. Thus, overall results showed that vehicle emissions were relatively homogeneous throughout the metro area, and the null hypothesis could not be conclusively rejected. Key pollutants monitored included CO, CO2, hydrocarbons, and NOx.