Kansas City Metropolitan Area Research Articles

Measurement of Fruit and Vegetable Intake Using Skin Carotenoid Measures Among Individuals Receiving Aid from Food Pantries (P04-087-19)

ObjectivesThe purpose of this study was to understand food security and fruit/vegetable consumption among individuals receiving aid from food pantries and other food assistance agencies. MethodsAcross the US, 12.9% of people are affected by food insecurity1 and 5.5% of households report obtaining food from a food pantry2. Similarly, food insecurity affects 12.9% of the population in Kansas and 14.7% in Missouri1. After the Harvest is a nonprofit organization that helps address food insecurity by rescuing fruits and vegetables from going to waste and donating them to agencies that serve hungry people in the Kansas City metropolitan area. As part of a larger evaluation of the After the Harvest program, intercept surveys with individuals receiving aid from food pantries and other food assistance agencies were conducted at selected locations in the Kansas City area. In each survey, a demographic questionnaire and a Dietary Screener Questionnaire were administered. Food insecurity was screened using two items derived from the USDA’s Food Security Survey Module. Additionally, skin carotenoids were measured using the Veggie Meter™ as a biomarker of fruit and vegetable intake. ResultsA total of 57 food agency clients participated in the study. About 67% of the clients indicated that within the past 12 months, they had worried about their food running out before having money to buy more. Additionally, 74% reported that the food they bought didn’t last and they didn’t have money to buy more. On average, the food agency clients reported eating 1 cup of fruit per day and 1.4 cups of vegetables per day, which fell far below recommendations set by the Dietary Guidelines for Americans. Similarly, they had a Veggie Meter™ score of 175 ± 77, indicating a very low level of fruit and vegetable intake. ConclusionsFood agency clients were food insecure and had very low fruit and vegetable intakes. Efforts to increase the amount of fresh fruit and vegetable donations at food assistance agencies may represent an opportunity to improve the diets among clientele. Funding SourcesThe Hall Family Foundation.

Data deluge or data trickle? Difficulties in acquiring public data for telecommunications policy analysis

There is a paucity of granular, high-resolution broadband data in the United States, which limits the prospects of informed telecommunications policy debates. In the absence of regulation requiring telecommunication providers to accurately report service footprints, pricing, and service quality data, providers refuse to disclose this information, routinely citing competition as the primary reason for keeping network and pricing data obfuscated. In addition, many secondary datasets needed for broadband planning and policy research, such as parcel or address point data, are equally challenging to gather. These datasets are often controlled by county governments, with no overarching access policy, resulting in neighboring counties with widely divergent policies for the release of these important data. In this article we explore the challenges of open data and its impacts on telecommunication policy development. A recent project which explored the spatial provision of Google Fiber in the Kansas City metropolitan area helps to highlight these difficulties. Basic strategies for mitigating information asymmetries and the lack of data transparency for telecommunication policy analysis are discussed.

Pediatric Emergency Department Visits and Pollen Trends in the Kansas City Metropolitan Area 2013-2017

Pediatric Emergency Department Visits and Pollen Trends in the Kansas City Metropolitan Area 2013-2017

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.

People, place and pollution: Investigating relationships between air quality perceptions, health concerns, exposure, and individual- and area-level characteristics

An extensive body of research has demonstrated that air pollution exposure is associated with adverse health outcomes. Urban air quality remains a major concern for both public health officials and the general public. In the United States, air quality public awareness campaigns are major efforts of governments at every level. Yet, our understanding of relationships between ambient air pollution exposure, public perceptions of air quality, and concerns about associated health risks is incomplete. We examined 2869 individual responses to annual air quality public awareness surveys administered between 2009 and 2012 in the Kansas City metropolitan area. Our study had three objectives: 1) examine the spatial distribution of PM2.5 and O3 exposures, pollution perceptions, and pollution health concerns; 2) explore relationships between individual- and area-level characteristics and PM2.5 and O3 exposure; 3) and examine cross-sectional associations between individual- and area-level characteristics, as well as PM2.5 and O3 exposures, and pollution perception and pollution health concerns. We found inverse spatial patterns between the distribution of O3 and PM2.5 exposure levels as well as between areas where respondents perceived air pollution as worsening and areas where residents had higher concern about the health effects of pollution exposure. We also found inverse relationships between individual- and area-level demographic and socioeconomic characteristics and O3 and PM2.5 exposure. Individual-level characteristics were significantly related to pollution perceptions, while both individual- and area-level characteristics were significantly related to pollution health concerns. Public awareness campaigns should be combined with education on ways the public can protect themselves and tailored explicitly for targeting vulnerable populations (e.g., elderly, and persons with respiratory problems) and areas both socioeconomically vulnerable (e.g., higher racial segregation and poverty) and experiencing higher pollution exposure (e.g., O3 and PM2.5).

Dose–response relationship between docosahexaenoic acid (DHA) intake and lower rates of early preterm birth, low birth weight and very low birth weight

As previously reported, intention-to-treat findings from our phase III randomized clinical trial found that a supplement of 600 mg docosahexaenoic acid (DHA)/day during the last half of pregnancy reduced the incidence of early preterm birth (ePTB, <34 weeks gestation) and very low birth weight (VLBW < 1500 g) offspring. Given the potentially immense clinical significance of these findings, the goal of this secondary analysis was to (1) identify maternal characteristics related with capsule intake (i.e. DHA dose exposure) and (2) determine if DHA dose was associated with low (<2500 g) and very low birth weight after controlling for any relevant maternal characteristics. Three hundred forty-five pregnant mothers were recruited from hospitals in the Kansas City metropolitan area between 2006 and 2011. Most participants (n = 299) were from the phase III trial mentioned above, but we also included 46 participants from a second smaller, randomized trial that utilized an identical intervention design and was conducted concurrent to the larger trial. Both trials assigned participants to either 3 daily capsules of vegetable oil without DHA (n = 169) or 3 daily capsules of 200 mg DHA each (n = 176). Total capsules consumed was recorded by pharmacy supervised capsule count or participant self-report when needed. Maternal age, education, race and gestational age at delivery as well as infant birth weight were available for both trials. A Bayesian linear model indicated capsule intake increased with maternal age (p = 0.0100) and years of education (p = 0.0002). A Bayesian bivariate mixture-model associated capsule intake with simultaneous lower probability of ePTB, low birth weight (LBW, <2500 g) and VLBW (p = 0.0327). This, in conjunction with the positive findings in the clinical trial, support the need for future research to examine intervention methods to improve capsule compliance strategies in younger and less educated mothers.

Access to emergency contraception in Kansas City clinics

ObjectiveTo assess the accessibility of ulipristal acetate (UPA) and copper intrauterine devices (IUDs) for emergency contraception (EC) in reproductive health centers in the Kansas City metropolitan area. Study designUsing a secret shopper method, two female investigators called the reproductive health centers listed as EC providers on the nonprofit website bedsider.org that were located within 25 miles of the University of Kansas Medical Center. We categorized clinics as Title X providers vs. not according to the grantee list from the Office of Population Affairs. Investigators inquired about obtaining a UPA prescription by phone, the availability of the copper IUD for EC and time to first available appointment for EC. We evaluated correlates of EC access and provision with Fisher's Exact Tests. ResultsWe identified 40 clinics as potential EC providers. Some clinics reported that UPA could be prescribed by phone to existing patients (13/40, 32%), while others reported that women must meet with a provider first (15/40, 38%). Few clinics offered copper IUDs as EC (3/40, 8%). Title X clinic status did not predict provision of UPA by phone or copper IUDs as EC. The average time to next available appointment was 9±9 days to discuss EC and 13±9 days for a copper IUD. ConclusionsAccessing the most efficacious forms of EC in a timely fashion presents many logistic challenges for women. ImplicationsHealthcare systems should streamline protocols, train providers and improve rapid-access referral networks to facilitate timely provision of UPA and copper IUDs for EC.

Identifying the Underserved: An Analysis of a Free Eye Clinic’s Demographics

Background: The Kansas City Free Eye Clinic (KCFEC) is a student-run free clinic dedicated to providing comprehensive eye exams and treatment to the underserved populations of the Kansas City metropolitan area. Since the clinic’s inception, volunteers have observed firsthand the great need for eye care and the impact of poor vision on health, employment, and education. As a result, services provided continue to expand, with the goal of incorporating novel communities into the treatment network. The purpose of this study was to review patient demographics in order to identify possible barriers to care and shortcomings in outreach efforts. Methods: Medical records for patients seen at the KCFEC between December 2014 and July 2016 were reviewed for demographics including age, gender, ethnicity, housing status, and insurance status. Results: Analysis of 334 patient records indicated that the average patient at KCFEC was a 45-year-old African American male who is uninsured and homeless. Certain groups, including females, individuals below 40 years of age, individuals above 65 years of age, and patients belonging to other minority groups, were not as prevalent at KCFEC. Conclusions: Further investigation of potential barriers to care disproportionately experienced by these groups will be the next step in efforts to increase the clinic’s impact. With the aid of periodic retrospective review of patient demographics, KCFEC aims to be a source of accessible and quality healthcare to a diverse group of patients in Kansas City.

Patients Armed With Their Own Genetic Data Raise Tough Questions.

With the market for direct-to-consumer genetic testing expanding rapidly, clinicians are playing catch-up.

The Effects of Fixed-Time Ramp Metering on Freeway Traffic Characteristics Using Microscopic Traffic Simulation

The effects of fixed-time ramp metering on the speed, density and flow of traffic in the influence area of freeway-ramp junctions were explored in this paper. The traffic parameters were obtained from the microscopic VerkehrIn Städten – SIMulations Model (VISSIM 5.40) stochastic simulator program. Four hundred models were built to obtain the traffic stream characteristics. Two fixed-time traffic signals for the ramp meters were assumed and applied for two different assumed geometric configurations of ramp-freeway junctions (Type I and Type II). Different traffic volume conditions were assumed for the ramps and the freeways to represent various traffic flow conditions on the downstream of the freeway. The ramp traffic volume was started from 200 vehicles per hour per lane (vphpl) to 1100 vphpl, with an increment of 100 vphpl; while, the traffic volume of the freeway was started from 400 vphpl to 2000 vphpl with an increment of 200 vphpl. Cameras and traffic detectors were installed at two sites of ramp-freeway junctions in the Kansas City metropolitan area to collect traffic data for the calibration process. The following traffic data were collected for the calibration process: the ramp traffic signal times, queue lengths on the ramp, traffic flow and composition of the ramp and freeway, speed of the vehicles at the upstream and downstream of the freeway. The relationship between the speed-flow-density of the vehicles within the ramp influence area with and without using ramp metering was obtained. The results of the study showed that ramp metering has different effects on the traffic flow characteristics based on the geometric configuration of the ramp-freeway junction and traffic flow conditions. Regarding the Type I junction, ramp metering could increase the average speed of the vehicles within the influence area when the flow was greater than 1000 vphpl; the Type II junction, however, did not show significant result. Based on these results, the study recommends that before implementing ramp metering on the ramp, a detailed study should be made of the geometric configuration of the ramp-freeway junction, and of the traffic flow conditions.

Integrating a health information exchange into a community pharmacy transitions of care service

ObjectiveTo describe the incorporation of a state health information exchange (HIE) into a community pharmacy transitions of care (TOC) service and to assess its impact on 30-day readmission rates. SettingThree suburban community pharmacies in Olathe, Kansas. Practice descriptionBalls Food Stores is a grocery store chain which operates 21 supermarket community pharmacies in the Kansas City metropolitan area. Practice innovationBalls Food Stores launched a pharmacist-led self-referral TOC study in which a state HIE was utilized to collect discharge information from patients’ electronic medical records (EMRs) to facilitate TOC comprehensive medication reviews (CMRs). EvaluationDescriptive statistics were used to assess types and outcomes of identified drug therapy problems and the ability to access Kansas Health Information Network EMRs. A chi-square test was used to assess 30-day readmissions between patients who accepted and declined the service. ResultsForty patients were identified for inclusion and 18 elected to participate in the service. The majority of participants were white females with a median age of 64.5 years. Out of 40 study patients, 85% had an EMR available; 12.5% of patients had a medication list included in their EMR hospitalization documentation. Participants who underwent the service had a statistically significantly lower rate of overall 30-day hospital readmission than those who declined (11.1% vs 36.4%, P = 0.032). Among the 18 TOC CMRs performed, 90 drug therapy problems were identified and 77 were resolved in collaboration with a patient, caregiver, or physician. ConclusionIncorporation of a state HIE into a community pharmacist-led TOC service is a novel strategy for collecting patient data. During the study, no TOC participants were readmitted within 30 days. However, pharmacists found HIE data alone was insufficient to perform TOC CMRs for the majority of participants. In order to expand state HIE utilization, more health systems will need to upload a minimum standard data set to help facilitate care.

Changes in Energy Intake and Diet Quality during an 18-Month Weight-Management Randomized Controlled Trial in Adults with Intellectual and Developmental Disabilities

BackgroundPrevious research indicates that individuals with intellectual and developmental disabilities (IDDs) are at risk for poor diet quality. ObjectiveThe purpose of this secondary analysis was to determine whether two different weight-loss diets affect energy intake, macronutrient intake, and diet quality as measured by the Healthy Eating Index-2010 (HEI-2010) during a 6-month weight-loss period and 12-month weight-management period, and to examine differences in energy intake, macronutrient intake, and HEI-2010 between groups. DesignOverweight/obese adults with IDDs took part in an 18-month randomized controlled trial and were assigned to either an enhanced Stop Light Diet utilizing portion-controlled meals or a conventional diet consisting of reducing energy intake and following the 2010 Dietary Guidelines for Americans. Proxy-assisted 3-day food records were collected at baseline, 6 months, and 18 months, and were analyzed using Nutrition Data System for Research software. HEI-2010 was calculated using the data from Nutrition Data System for Research. Participants/settingThe study took place from June 2011 through May 2014 in the greater Kansas City metropolitan area. Main outcome measuresThis was a secondary analysis of a weight-management intervention for adults with IDDs randomized to an enhanced Stop Light Diet or conventional diet, to examine differences in energy intake, macronutrient intake, and HEI-2010 across time and between groups. Statistical analyses performedIndependent- and paired-samples t tests and general mixed modeling for repeated measures were performed to examine group differences and changes at baseline, 6 months, and 18 months between the enhanced Stop Light Diet and conventional diet groups. ResultsOne hundred and forty six participants (57% female, mean±standard deviation age=36.2±12.0 years) were randomized to either the enhanced Stop Light Diet or conventional diet group (77 enhanced Stop Light Diet, 69 conventional diet) and provided data for analysis at baseline, 124 completed the 6-month weight-loss period, and 101 completed the 18-month study. Participants on the enhanced Stop Light Diet diet significantly reduced energy intake at 6 and 18 months (both P<0.001), but those on the conventional diet did not (both P=0.13). However, when accounting for age, sex, race, education level, and support level (mild vs moderate IDD), there was a significant decrease during the 18-month intervention in energy intake for the enhanced Stop Light Diet and conventional diet groups combined (P<0.01 for time effect), but no significant group difference in this change (P=0.39 for group-by-time interaction). There was no significant change in total HEI-2010 score at 6 and 18 months (P=0.05 and P=0.38 for the enhanced Stop Light Diet group; P=0.22 and P=0.17 for the conventional diet group), and no significant group difference at 6 and 18 months (P=0.08 and P=0.42). However, when participants’ age, sex, race, education level, and support level were accounted for, mixed modeling indicated a significant increase in total HEI-2010 scores for the enhanced Stop Light Diet and conventional diet groups combined during the 18-month intervention (P=0.01 for time effect). ConclusionsThe results of this study found that after controlling for demographic factors, individuals with IDDs can decrease their energy intake and increase their diet quality, with no significant differences between the enhanced Stop Light Diet and conventional diet groups.

Cultivating a Shared Sense of Place: Ethnic Mexicans and the Environment in Twentieth-Century Kansas City

This article explores the history, employment, and presence of ethnic Mexicans in the Kansas City metropolitan area beginning in the early twentieth century through economic, political, and natural changes, highlighting their creation of a shared sense of place. Includes analysis of the impact of railroad and commerce development, residential layout and urban planning, the major flood of 1951, and the construction of freeways after the 1950s. Local community is revealed through oral histories, population data, and specific efforts including construction of an innovative neighborhood park, maintenance and style of homes, and the revitalization of Kansas City's Westside after the 1970s.

Modeling the Impact of Urban Landscape Change on Urban Wetlands Using Similarity Weighted Instance-Based Machine Learning and Markov Model

Urban wetlands play important roles in providing several ecosystem services that support the urban environment. As such, scientists have studied them to understand the urban processes that lead to their continued decline. However, little attention has been given to the drivers of land-use change that may affect this fragile ecosystem in the future. Understanding this could serve as a critical step towards urban wetland management and sustainability. In this study, we utilized an integrated approach that combined Similarity Weighted Instance-based Machine Learning and Markov chain, both embedded in the IDRISI Land Change Modeler to simulate change in the landscape of three watersheds in the Kansas City Metropolitan area. The purpose was to assess the possible future impacts of urban expansion-induced landscape change on wetlands within the study area, using a retrospective approach. To achieve this, classified SPOT satellite data covering the three watersheds were used to generate historical land cover maps of the study area between 1992 and 2010 to analyze changes to the landscape. In addition, the study identified several drivers of land change associated with the historical change process in the study area, and accounted for their role in the modeling process. On this basis, the study made the prediction of urban landscape transformation to the end date of 2014. The prediction result was verified with a more accurate map that was derived from independently classifying a 2014 SPOT image of the study area. Results from this study show that impervious surfaces, which were used as an index of urban expansion, may increase by approximately the same magnitude experienced historically, which may result in a small but significant loss of wetlands and other land cover classes within the study area.

Urban governance and big corporations in the digital economy: An investigation of socio-spatial implications of Google Fiber in Kansas City

In February 2010, Google challenged US cities to compete for being the site of its first attempt at building ultra-high-speed fiber-to-the-premises (FTTP) network, promising speeds up to one hundred times faster than pre-existing broadband services. More than 1100 cities applied. Kansas City, however, was announced as the winner of the competition. This paper explores the rollout of Google Fiber in Kansas City from three different perspectives. First, we provide a close examination of urban governance and the Fiber project – highlighting numerous regulatory concessions and incentives provided to Fiber during the construction phase. Second, we explore the ways in which pre-existing digital divides and socio-economic inequalities impacted the Fiber plan for Kansas City. Finally, in an effort to better understand the geographic intricacies of Fiber service, this paper uses a novel data mining technique and exploratory spatial data analysis to highlight the provision footprints for two counties in the Kansas City metropolitan area. We conclude with a discussion of the salient policy implications of projects like Fiber for urban governance, highlighting both the promises and stark realities of such ventures.

Seroprevalence of poliovirus antibodies in the Kansas City metropolitan area, 2012–2013

ABSTRACT No indigenous cases of poliomyelitis have occurred in the US since 1979; however the risk of importation persists until global eradication is achieved. The seropositivity rate for different age cohorts with exposures to different poliovirus vaccine types and wild virus in the US are not presently known. A convenience sample was conducted in the Kansas City metropolitan area during 2012–2103 with approximately 100 participants enrolled for each of 5 age cohorts categorized based on vaccine policy changes over time in the US. Immunization records for poliovirus vaccination were required for participants <18 y of age. We evaluated the prevalence of serum antibodies to all 3 poliovirus serotypes. Seroprevalence was evaluated by demographics as well as between polio serotypes. The overall seroprevalence to poliovirus was 90.7%, 94.4%, and 83.3%, for types 1, 2, and 3, respectively. Seroprevalence was high (88.6%–96.2%) for all 3 types of poliovirus for the 6–10 y old age group that was likely to have received a complete schedule of IPV-only vaccination. Children 2–3 y of age, who have not yet completed their full IPV series, had lower seroprevalence compared with all older age groups for types 1 and 2 (p-value <0. 05). Seroprevalence was high for all 3 types of poliovirus in the population surveyed. Seroprevalence for subjects aged 2–3 y was lower than all other age groups for serotypes 1 and 2 highlighting the importance of completing the recommended poliovirus vaccine series with a booster dose at age 4–6 y.

Relation of indoor and outdoor airborne fungal spore levels in the Kansas City metropolitan area.

Environmental control is an important component of asthma management for persons with asthma. A damp indoor environment and elevated airborne spore levels are factors in housing environmental control. We investigated if indoor airborne fungal spore levels correlated with outdoor ground-level airborne fungal spores or outdoor centrally collected spore levels as to types and abundance. Air collections were taken from home interiors, outdoor areas adjacent to the homes, and at a central location in the metropolitan area at the approximate same time. All air collections were examined and enumerated microscopically, and airborne spore estimates per cubic meter of air were reported for total fungal spores and for 11 identifiable spore groups. The 244 homes in the study were typical of the North American Midwest. The overall mean total spore counts in spores per cubic meter of air was indoors (4076 spores/m3), outdoors at ground level (8899 spores/m3), and outdoor metropolitan area (8342 spores/m3). All of the major indoor taxa were strongly correlated with the mean total spores present in the home. Total outdoor ground spore levels were highly correlated with levels of major outdoor taxa, such as ascospores and Cladosporium. Correlations of indoor spore levels with outdoor spore levels are strong for most major outdoor taxa. Indoor Aspergillus-Penicillium and Chaetomium are significantly correlated between indoor and local ground-level outdoor air. Although conditions may exist where indoor or outdoor spore levels were not well aligned, in most circumstances, the outdoor airborne spore community was reflected in the indoor airborne spore community.

Beyond Profiling: The Institutional Sources of Racial Disparities in Policing

AbstractAmerican policing faces a crisis of legitimacy. A key source of this crisis is a widespread police practice commonly endorsed by police leaders to fight crime. This is the investigatory stop, used to check out people who seem suspicious and to seize illegal drugs and guns and make arrests. Using data from an original scientific survey of drivers in the Kansas City metropolitan area, the authors show that racial disparities in police stops are concentrated in investigatory vehicle stops. In these stops, but not others, officers disproportionately stop African Americans and question and search them. The overwhelming majority of people stopped in this way are innocent, and the experience causes psychological harm and erodes trust in and cooperation with the police. Many of the most controversial police shootings during the past two years occurred in these stops. Reforming this practice is an essential step toward restoring trust in the police.

Patient Satisfaction With Pharmacist-Led Chronic Disease State Management Programs

Purpose: To assess patient satisfaction, perception of self-management, and perception of disease state knowledge with pharmacist-led diabetes and cardiovascular disease state management (DSM) programs. Methods: A self-insured chain of grocery store pharmacies in the Kansas City metropolitan area administers pharmacist-led diabetes and cardiovascular DSM programs for eligible employees and dependents. A modified version of the Diabetes Disease State Management Questionnaire was used to assess patient satisfaction with the DSM programs. Demographic information was also collected. Survey items were based on a 5-point Likert scale (1 = strongly disagree and 5 = strongly agree). Patients were eligible to complete the survey if he or she had been in at least 1 DSM program for 6 months. Data were assessed using descriptive statistics and analysis of variance. Results: Across 20 pharmacies, 281 eligible participants were identified, and 46% (n = 128) completed a survey. Means for summed items relating to overall satisfaction (8 items), self-management (5 items), and knowledge (4 items) were 36.6/40 (standard deviation [SD] = 3.9), 20.9/25 (SD = 3.4), and 17.6/20 (SD = 2.1), respectively. Participant comments further indicated that the program and pharmacists are helpful and increase motivation and accountability. Conclusions: Positive patient responses to the program support use of pharmacist-led DSM programs.

REMOTELY-SENSED URBAN WET-LANDSCAPES: AN INDICATOR OF COUPLED EFFECTS OF HUMAN IMPACT AND CLIMATE CHANGE

Abstract. This study proposes the concept of urban wet-landscapes (loosely-defined wetlands) as against dry-landscapes (mainly impervious surfaces). The study is to examine whether the dynamics of urban wet-landscapes is a sensitive indicator of the coupled effects of the two major driving forces of urban landscape change – human built-up impact and climate (precipitation) variation. Using a series of satellite images, the study was conducted in the Kansas City metropolitan area of the United States. A rule-based classification algorithm was developed to identify fine-scale, hidden wetlands that could not be appropriately detected based on their spectral differentiability by a traditional image classification. The spatial analyses of wetland changes were implemented at the scales of metropolitan, watershed, and sub-watershed as well as based on the size of surface water bodies in order to reveal urban wetland change trends in relation to the driving forces. The study identified that wet-landscape dynamics varied in trend and magnitude from the metropolitan, watersheds, to sub-watersheds. The study also found that increased precipitation in the region in the past decades swelled larger wetlands in particular while smaller wetlands decreased mainly due to human development activities. These findings suggest that wet-landscapes, as against the dry-landscapes, can be a more effective indicator of the coupled effects of human impact and climate change.