African Americans are overrepresented on the organ transplant waiting list because they are disproportionately impacted by certain health conditions that potentially warrant a life-saving transplant. While the African American need for transplantation is considerably high, organ and tissue donation rates are comparatively low, resulting in African Americans spending more than twice the amount of time on the national transplant waiting list as compared to people of other racial/ethnic backgrounds. There are a multitude of factors that contribute to the reluctance expressed by African Americans with respect to organ donation. This study proposes the use of an adaptation of the Organ Donation Model to explore the ways in which knowledge, trust in the donation/allocation process, and religious beliefs impact African American donation decision making. Bivariate and path analyses demonstrated that alignment with religious beliefs was the greatest driving factor with respect to attitudes towards donation; attitudes were significantly associated with donation intentions; and knowledge is directly associated with intentions to serve as a potential deceased organ donor. The significance of these variables speaks to the importance of their inclusion in a model that focuses on the African American population and offers new direction for more effective donation education efforts.

The purpose of this study is to further understanding of the association between distrust in the healthcare system and written and verbal expressions of donation intentions among African Americans. We hypothesize that distrust in the healthcare system will be significantly, positively associated with both verbal and written donation intentions. Five hundred and eighty five participants completed a 98-item survey that included scales on distrust in the healthcare system and donation intentions. Bivariate analyses (t-tests, ANOVA, chi-square tests and odds ratios) were used to explore the extent to which donation intentions and distrust in the healthcare system varied by demographic characteristics and the association between the distrust in the healthcare system scale and verbal and written donation intentions. Separate logistic regressions were performed with each of the dependent variables to see if significant associations remained while controlling for confounders. Findings based on the multiple regression indicate that when controlling the participant's education level, distrust in the healthcare system was not significantly related to written donation intentions (OR = 1.04; P = .12). When controlling for education level, health insurance status, Community Health Advocates group and marital status, distrust in the healthcare system was significantly associated with verbal donation intentions (OR = 1.08; P < 0.05). Our results suggest that distrust in the healthcare system varies in the way that it is associated with donation intentions. Future organ donation studies should be conducted to determine the pathways through which distrust in the healthcare system impacts different types of organ donation intentions.

PURPOSE OF REVIEW High prevalence of comorbidities such as diabetes, hypertension, obesity, hepatitis B and C, in minority groups, results in racial minorities being disproportionally represented on transplant waiting lists. Organ transplantation positively impacts patient survival but greater access is limited by a severe donor shortage. RECENT FINDINGS Unfortunately, minority groups also suffer from disparities in deceased and living donation. African-Americans comprise 12.9% of the population and 34% of the kidney transplant waiting list but only 13.8% of deceased donors. Barriers to minority deceased donation include: decreased awareness of transplantation, religious or cultural distrust of the medical community, fear of medical abandonment and fear of racism. Furthermore, African-Americans comprise only 11.8% of living donors. Barriers to minority living donation include: unwillingness to donate, medical comorbid conditions, trust or fear of medical community, loss to follow-up, poor coping mechanisms, financial concerns, reluctance to ask family members and friends, fear of surgery, and lack of awareness about living donor kidney transplantation. SUMMARY Transplant center-based education classes significantly and positively impact African-American concerns and beliefs surrounding living donation. Community and national strategies utilizing culturally sensitive communication and interventions can ameliorate disparities and improve access to transplantation.

The need for kidney transplantation among Asian Americans is increasing owing to hypertension, diabetes mellitus, and the shortage of available organs. This need is likely to increase as the relatively young Asian population ages. However, knowledge about organ donation and transplantation in this population has been little investigated. The objectives of this study was to develop an Organ Donation and Transplantation Knowledge Survey for use in Asian Americans and to examine its psychometric properties. Internal consistency (Cronbach alpha) and factor analyses were used to determine the reliability and validity of the survey in 121 Asian American adolescents residing on the Big Island of Hawaii. Our results indicate that the survey had adequate reliability and was psychometrically valid for evaluating knowledge about organ donation and transplantation. More studies are needed to validate the usefulness and psychometric properties of the Organ Donation and Transplantation Knowledge Survey in other groups.

This study sought to evaluate the effectiveness of Project ACTS: About Choices in Transplantation and Sharing, which was developed to increase readiness for organ and tissue donation among African American adults. Nine churches (N = 425 participants) were randomly assigned to receive donation education materials currently available to consumers (control group) or Project ACTS educational materials (intervention group). The primary outcomes assessed at 1-year follow-up were readiness to express donation intentions via one's driver's license, donor card, and discussion with family. Results indicate a significant interaction between condition and time on readiness to talk to family such that participants in the intervention group were 1.64 times more likely to be in action or maintenance at follow-up than were participants in the control group (p =.04). There were no significant effects of condition or condition by time on readiness to be identified as a donor on one's driver's license and by carrying a donor card. Project ACTS may be an effective tool for stimulating family discussion of donation intentions among African Americans although additional research is needed to explore how to more effectively affect written intentions.

CONTEXT Public education campaigns about organ donation are common, but their association to actual attitudes, beliefs, and decisions about organ donation among family members of donation-eligible individuals is unknown. OBJECTIVE To examine the sources of organ donation information identified by donor and nondonor families who participated in a large-scale study to examine factors that influence organ donation decisions. DESIGN Semistructured telephone survey conducted after a passive recruitment strategy. SETTING AND PARTICIPANTS Participants were 285 next of kin of donor-eligible individuals (147 donors, 138 nondonors) from one organ procurement organization. RESULTS Most (85.6%) of next of kin were exposed to at least 1 source of donation information that was important to them, although the types of donation information they were exposed to varied widely. White and educated adults were more likely to have been exposed to more donation information than had minorities and persons with less education. Favorable attitudes and beliefs about organ donation, donor designation, and sharing donation intentions with others were all associated with more exposure to different types of donation information. Donation consent was more likely when next of kin had been exposed to more donation information in the months preceding the family member's death. CONCLUSIONS When examined in the context of other recent research, these findings argue for continued development and implementation of public education campaigns for organ donation, with an emphasis on repeated exposure over time.

BACKGROUND Blacks are disproportionately affected by chronic kidney disease, but are far less likely to undergo live donor kidney transplantation (LDKT) than whites. We assessed the differential effectiveness in blacks and whites of a home-based (HB) LDKT educational approach. STUDY DESIGN A planned secondary analysis of a previously published randomized trial. SETTING & PARTICIPANTS 132 patients (60 black, 72 white) approved for kidney transplantation at 1 kidney transplant center in the southeastern United States. INTERVENTION Assignment to receive either standard clinic-based (CB) transplant education (n = 69) or CB plus an HB (CB + HB) LDKT education program (n = 63). The HB education program was culturally sensitive for blacks, including using a minority health educator, brochures that highlight minority transplant recipients and donors, and discussion of race-specific outcome data. OUTCOMES Primary outcomes were proportions of patients with live donor inquiries, evaluations, and transplants 1 year after study participation. MEASUREMENTS Medical record and questionnaire data. RESULTS 69 patients were assigned to the CB group, and 63 to the CB + HB group. After 1 year, there were 96 living donor inquiries (72.7%), 62 living donor evaluations (47.0%), and 54 LDKTs (40.9%). Patients assigned to the CB + HB group were more likely to have had living donor inquiries (odds ratio [OR], 1.7; confidence interval [CI], 1.2 to 3.0), a living donor evaluated (OR, 2.7; CI, 1.4 to 5.4), and LDKT (OR, 3.0; CI, 1.5 to 5.9). The effect was greater in blacks than whites for living donor evaluations and LDKT, but not for living donor inquiries (treatment-by-race interaction, P < 0.001, P < 0.001, and P = 0.8, respectively). Blacks in the CB + HB group were more likely to have had at least 1 living donor inquiry (51.7% versus 77.4%), at least 1 living donor evaluated (17.2% versus 48.4%), and LDKT (13.8% versus 45.2%) than those in the CB group. By comparison, whites in the CB + HB group were more likely to have had at least 1 living donor inquiry (72.5% versus 87.5%), at least 1 living donor evaluated (47.5% versus 71.9%), and LDKT (42.5% versus 59.4%) than those in the CB group. LIMITATIONS Single-center study with greater dropout rate in the CB + HB group. CONCLUSIONS These results suggest that a culturally sensitive LDKT education program that reaches out to blacks and their social support network can overcome some barriers to LDKT in this population.

OBJECTIVE To explore the association between different types of knowledge related to donation and transplantation and the expression of donation intentions via one's driver's license, a donor card, or sharing one's wishes with family. METHODS Cross-sectional data were gathered via self-administered questionnaire from 425 Black adults, age 18 years and older who were recruited from nine churches in a large metropolitan area in the southeast United States. RESULTS Results indicate that knowledge of the allocation system and experiential knowledge of a transplant recipient are associated with donation intentions after controlling for age, gender, and highest level of education. However, the following types of knowledge were unrelated to donation intentions: donation-related statistics (including an understanding of African Americans' overrepresentation among those in need), the donation process, the process for determining medical suitability, and religious institutions' support for donation. CONCLUSIONS Findings suggest that the relationship between donation-related knowledge and donation intentions is complex and may depend on the specific type of knowledge being measured. PRACTICE IMPLICATIONS Knowledge of the allocation system and experiential knowledge of a recipient may be critical aspects of the donation decision-making process. Research findings suggest the need for an educational approach that seeks to improve the specific types of knowledge that are most strongly associated with donation intentions.

The purpose of this article is to review the literature from 1980 to 2005 regarding organ donation decision making by African Americans for themselves and their loved ones and recommend improvements in subsequent studies. Using the behavioral model of health services utilization as an organizing framework, the review procedure consists of a (1) search of health and medical literature using several key words and eight indexes,(2) selection of articles based on specific criteria, and (3) review of each article with regard to the population and sample used, study design, dependent variables addressed, and its findings. The review indicates that predisposing, enabling, and need factors each influence African Americans' organ donation decision making. Retrospective chart reviews provide a good design for future multivariate analyses of the many factors influencing African American decision making. Interventions to influence decision making should emphasize both community education and the process of organ procurement.

The influence of perceptions of organ allocation on willingness to donate organs is unclear. We performed a national study assessing the relation of public perceptions of organ allocation to willingness to donate organs, and we assessed the contribution of beliefs regarding discrimination in health care to observed associations. Among 845 participants, a majority (65%) reported that they less than "mostly" understand allocation, and most (71%) reported that they believe allocation is "unfair" or are "unsure" of its fairness. Participants reporting less understanding were less willing to donate (56%) than persons reporting greater understanding (67%)(p < 0.01). Participants believing allocation is "unfair" or who are "unsure" about fairness were less willing to donate (54%) than persons believing allocation is "fair"(68%)(p < 0.01). Associations were stronger among certain demographic subgroups. Participants with the least favorable perceptions of allocation were more likely than their counterparts to believe that race and income discrimination occur in transplantation and to believe that they personally experienced income discrimination in health care. Adjustment for these beliefs partially attenuated associations between perceptions regarding allocation and willingness to donate. Interventions enhancing transparency and perceived fairness of organ allocation may improve willingness to donate, particularly if they address concerns regarding discrimination in transplantation and health care.

In vitro neutral detergent fiber (NDF) digestibility (NDFD) is an empirical measurement of fiber fermentability by rumen microbes. Variation is inherent in all assays and may be increased as multiple steps or differing procedures are used to assess an empirical measure. The main objective of this study was to evaluate variability within and among laboratories of 30-h NDFD values analyzed in repeated runs. Subsamples of alfalfa (n=4), corn forage (n=5), and grass (n=5) ground to pass a 6-mm screen passed a test for homogeneity. The 14 samples were sent to 10 laboratories on 3 occasions over 12 mo. Laboratories ground the samples and ran 1 to 3 replicates of each sample within fermentation run and analyzed 2 or 3 sets of samples. Laboratories used 1 of 2 NDFD procedures: 8 labs used procedures related to the 1970 Goering and Van Soest (GVS) procedure using fermentation vessels or filter bags, and 2 used a procedure with preincubated inoculum (PInc). Means and standard deviations (SD) of sample replicates within run within laboratory (lab) were evaluated with a statistical model that included lab, run within lab, sample, and lab × sample interaction as factors. All factors affected mean values for 30-h NDFD. The lab × sample effect suggests against a simple lab bias in mean values. The SD ranged from 0.49 to 3.37% NDFD and were influenced by lab and run within lab. The GVS procedure gave greater NDFD values than PInc, with an average difference across all samples of 17% NDFD. Because of the differences between GVS and PInc, we recommend using results in contexts appropriate to each procedure. The 95% probability limits for within-lab repeatability and among-lab reproducibility for GVS mean values were 10.2 and 13.4%, respectively. These percentages describe the span of the range around the mean into which 95% of analytical results for a sample fall for values generated within a lab and among labs. This degree of precision was supported in that the average maximum difference between samples that were not declared different by means separation was 4.4% NDFD. Although the values did not have great precision, GVS labs were able to reliably rank sample data in order of 30-h NDFD (Spearman correlation coefficient = 0.93) with 80% of the rankings correct or off by only 1 ranking. A relative ranking system for NDFD could reduce the effect of within- and among-lab variation in numeric values. Such a system could give a more accurate portrayal of the comparative values of samples than current numeric values imply.

The goal of this in vitro study was to determine the influence of isotrichid protozoa (IP) on the conversion of glucose (Glc) to glycogen (Glyc) and transformation of Glc into fermentation products. Treatments were ruminal inoculum mechanically processed (blended) to destroy IP (B+, verified microscopically) or not mechanically processed (B-). Accumulated microbial Glyc was measured at 3h of fermentation with (L+; protozoa+bacteria) or without (L- predominantly protozoa) lysis of bacterial cells in the fermentation solids with 0.2 N NaOH. Two 3-h in vitro fermentations were performed using Goering-Van Soest medium in batch culture vessels supplemented with 78.75 mg of Glc/vessel in a 26.5-mL liquid volume. Rumen inoculum from 2 cannulated cows was filtered through cheesecloth, combined, and maintained under CO(2) for all procedures. At 3h, 0.63 and 0.38 mg of Glc remained in B- and B+. Net microbial Glyc accumulation (and Glc in Glyc as % of added Glc) detected at 3h of fermentation were 3.32 (4.69%),-1.42 (-2.01%), 6.45 (9.10%), and 3.65 (5.15%) mg for B-L-, B+L-, B-L+ and B+L+, respectively. Treatments B+ and L+ gave lower Glyc values than B- and L-, respectively. Treatment B+L- demonstrated net utilization of α-glucan contributed by inoculum with no net Glyc production. With destruction of IP, total Glyc accumulation declined by 44%, but estimated bacterial Glyc increased. Microbial accumulation of N increased 17.7% and calculated CH(4) production decreased 24.7% in B+ compared with B-, but accumulation of C in microbes, production of organic acids or C in organic acids, calculated CO(2), and carbohydrates in cell-free medium did not differ between B+ and B-. Given the short 3-h timeframe, increased N accumulation in B+ was attributed to decreased Glyc sequestration by IP rather than decreased predation on bacteria. After correction for estimates of C from AA and peptides utilized by microbes, 15% of substrate Glc C could not be accounted for in measured products in B+ or B-. Approximately 30% of substrate Glc was consumed by energetic costs associated with Glc transport and Glyc synthesis. The substantial accumulation of Glyc and changes in microbial N and Glyc accumulation related to presence of IP suggest that these factors should be considered in predicting profiles and amounts of microbial products and yield of nutrients to the cow as related to utilization of glucose. Determination of applicability of these findings to other soluble carbohydrates could be useful.

Microbial fermentation of carbohydrates in the hindgut of dairy cattle is responsible for 5 to 10% of total-tract carbohydrate digestion. When dietary, animal, or environmental factors contribute to abnormal, excessive flow of fermentable carbohydrates from the small intestine, hindgut acidosis can occur. Hindgut acidosis is characterized by increased rates of production of short-chain fatty acids including lactic acid, decreased digesta pH, and damage to gut epithelium as evidenced by the appearance of mucin casts in feces. Hindgut acidosis is more likely to occur in high-producing animals fed diets with relatively greater proportions of grains and lesser proportions of forage. In these animals, ruminal acidosis and poor selective retention of fermentable carbohydrates by the rumen will increase carbohydrate flow to the hindgut. In more severe situations, hindgut acidosis is characterized by an inflammatory response; the resulting breach of the barrier between animal and digesta may contribute to laminitis and other disorders. In a research setting, effects of increased hindgut fermentation have been evaluated using pulse-dose or continuous abomasal infusions of varying amounts of fermentable carbohydrates. Continuous small-dose abomasal infusions of 1 kg/d of pectin or fructans into lactating cows resulted in decreased diet digestibility and decreased milk fat percentage without affecting fecal pH or VFA concentrations. The decreased diet digestibility likely resulted from increased bulk in the digestive tract or from increased digesta passage rate, reducing exposure of the digesta to intestinal enzymes and epithelial absorptive surfaces. The same mechanism is proposed to explain the decreased milk fat percentage because only milk concentrations of long-chain fatty acids were decreased. Pulse-dose abomasal fructan infusions (1 g/kg of BW) into steers resulted in watery feces, decreased fecal pH, and increased fecal VFA concentrations, without causing an inflammatory response. Daily 12-h abomasal infusions of a large dose of starch (~4 kg/d) have also induced hindgut acidosis as indicated by decreased fecal pH and watery feces. On the farm, watery or foamy feces or presence of mucin casts in feces may indicate hindgut acidosis. In summary, hindgut acidosis occurs because of relatively high rates of large intestinal fermentation, likely due to digestive dysfunction in other parts of the gut. A better understanding of the relationship of this disorder to other animal health disorders is needed.

Thirty-eight lactating dairy cows including 6 ruminally cannulated cows were used in a feeding study to assess effects of feed sources that differed in dietary nonfiber carbohydrate (NFC) composition and ruminal degradability of dietary protein (RDP) on production, ruminal, and plasma measures. The design was a partially balanced, incomplete Latin square with three 21-d periods and a 3 x 2 factorial arrangement of treatments. Samples and data were collected in the last 7 d of each period. Feed sources that differed in NFC profile were dry ground corn (GC; starch), dried citrus pulp (DCP; sugar and pectins), and sucrose+molasses (SM; sugar). Dietary RDP was altered by providing CP with soybean meal (+RDP) or substituting a heat-treated expeller soybean product for a portion of the soybean meal (-RDP). Diets were formulated to be isonitrogenous and similar in NFC concentration. Cows consuming GC had the greatest milk urea nitrogen and milk protein percentage and yield, tended to have the greatest dry matter intake, but had a lesser milk fat percentage compared with cows consuming DCP and SM. Sucrose+molasses diets supported greater dry matter intake, milk protein yield, and 3.5% fat- and protein-corrected milk yield than did DCP diets. On -RDP diets, milk protein percentage was less and milk urea nitrogen and protein yield tended to be less than for +RDP diets. Dry ground corn diverged from DCP and SM in the effect of NFC x RDP, with cows consuming GC having lesser milk yield, 3.5% fat- and protein-corrected milk yield, and efficiency with -RDP as compared with +RDP, whereas these production measures were greater with -RDP than +RDP for cows consuming DCP and SM. In contrast, in situ NDF digestibility at 30h for GC and SM was greater for -RDP as compared with +RDP, but the reverse was true for DCP. The lowest ruminal pH detected by 6h postfeeding was also influenced by the interaction of NFC x RDP, with cows consuming SM having a lower pH with +RDP than with -RDP and cows consuming DCP having a similar pH on either RDP treatment. Total rumen volatile fatty acid concentrations did not differ among diets, but acetate molar percent was greater for DCP than for SM, and GC had the lowest molar percent for butyrate and valerate and greatest branched-chain volatile fatty acid concentration. Valerate molar percent and NH(3) concentration tended to be greater with +RDP than with -RDP. Plasma glucose and insulin were both greater in cows receiving SM than in those receiving DCP. Protein degradability, NFC source, and their interactions affected lactation, ruminal, and blood measures, suggesting that these dietary factors warrant further consideration in diet formulation.

BACKGROUND Previous multivariate analysis performed between April 1, 1994, and December 31, 2000 from the Organ Procurement Transplant Network/United Network for Organ Sharing (OPTN/UNOS) database has shown that kidneys from black donors were associated with lower graft survival. We compared graft and patient survival of different kidney donor-to-recipient ethnic combinations to see if this result still holds on a recent cohort of US kidney transplants. METHODS We included 72,495 recipients of deceased and living donor kidney alone transplants from 2001 to 2005. A multivariate Cox regression method was used to analyze the effect of donor-recipient ethnicity on graft and patient survival within 5 years of transplant, and to adjust for the effect of other donor, recipient, and transplant characteristics. Results are presented as hazard ratios (HR) with the 95% confidence limit (CL) and P values. RESULTS Adjusted HRs of donor-recipient patient survival were: white to white (1); and white to black (1.22; P =.001). Graft survival HRs were black to black (1.40; P <.001); black to white (1.35; P <.001); black to Hispanic (0.87; P =.18); and black to Asian (0.69; P =.05). SUMMARY Black donor kidneys are associated with significantly lower graft survival when transplanted into whites or blacks and are only associated with lower patient survival when these kidneys are transplanted into white recipients. The graft and patient survival rates for Asian and Latino/Hispanic recipients, however, were not affected by donor ethnicity. This analysis underscores the need for research to better understand the reasons for these disparities and how to improve the posttransplant graft survival rates of black kidney recipients.

Methods for processing feedstuffs before analysis can affect analytical results. Effects of drying temperature (corn silage), preservation method (corn grain), and grinding method (corn silage and grain) on starch analysis values were evaluated. Corn silage samples dried at 55 or 105 degrees C and grain samples dried at 55 degrees C were ground to pass the 1-mm screen of an abrasion mill or cutting mill and analyzed for free glucose and starch corrected for free glucose. Starch analyses were performed in triplicate to assess the effect of treatment on precision of starch determination. Drying at 105 degrees C decreased free glucose and tended to decrease starch detected in silage. Decreased free glucose and starch values in silages dried at 105 degrees C may have been caused by the destruction of glucose and production of Maillard products through nonenzymatic browning. Maillard products with reducing activity could potentially interfere with the glucose oxidase-peroxidase glucose detection method used. Compared with the cutting mill, grinding samples through the abrasion mill increased the precision of starch measures in silage, likely due to the effect of the finer particle size produced by the abrasion mill allowing more accurate subsampling of a more homogeneous matrix. Starch values were greater for grain ground with an abrasion mill than with a cutting mill, with the difference greater for dry-rolled than for high-moisture corn. For starch analysis of corn silage and corn grain, drying at lower temperatures (55 degrees C) in forced-air ovens and grinding through the 1-mm screen of an abrasion mill or its equivalent is recommended.

BACKGROUND In 1977, Opelz et al (Transplant Proc 9:137, 1977) introduced research that identified ethnic disparities in the relative risk of graft loss when African American donors or recipients were targeted. Current research from the Organ Procurement and Transplantation Network (OPTN) reveals a continuation of these trends. While 1-year graft survival rates for a kidney are 92.1% for Caucasians, 94.1% for Asians, and 92.9% for Latinos, the comparative rate is 88.9% for African Americans. This study extends research on health disparities by examining relative differences in graft and patient survival rates when the organ donors are African American. A number of factors have been introduced as possible determinants of disparate outcomes by ethnicity in terms of graft survival rates. This descriptive study was designed to test the hypothesis: There are no differences in the relative risks associated with graft survival rates and mortality based upon differences in the ethnicity of the donors. MATERIALS AND METHODS Data were obtained from the OPTN/United Network for Organ Sharing (UNOS) Registry from April 1, 1994 to December 31, 2000. A total of 118,769 transplants were analyzed, including 77,689 living and deceased donor kidney transplants, 26,124 deceased donor liver transplants, and 14,956 deceased donor heart transplants. A multivariate Cox regression model was used to determine the relative risk of graft loss and cardiac transplant mortality for different ethnicities when the organ donors were African American. RESULTS The study found that the relative risk of kidney graft loss was 21.3%(P <.01) higher between African American donors and Caucasian recipients than between Caucasian donors and other recipients. With liver transplants, the use of an African American donor increased the risk of graft loss by 21.5%(P <.001). When African American donors gave kidneys and livers to other African Americans, the relative risks of kidney graft loss were 50.9% higher for a kidney (P <.001) and 36.6% higher for a liver (P <.001) if both the donors and recipients were African American. The relative risk of mortality was 51.3% higher (P <.001) when African American hearts were transplanted into other African Americans. No significant differences existed in terms of the relative risk of cardiac mortality (P <.29) when African American hearts were transplanted into Caucasian recipients. When African American donors provided kidneys and livers to Latinos and Asians, the relative risk of graft loss fell below the rates for Caucasian donors and recipients. However, the differences were not statistically significant. CONCLUSIONS Our data have identified a pressing need to conduct clinical and prospective research that can isolate the causes of these suboptimal outcomes. This is particularly important since the number of African American organ donors has escalated as a result of recent health outreach and education efforts.

Selected vessel types and conditions used for in vitro fermentation were compared to evaluate their effects on determinations of neutral detergent fiber (NDF) digestibility (NDFD) in 2 replicate 48-h fermentations. Treatments included 50-mL polyethylene centrifuge tubes with gas-release valves (treatment 1); 50-mL polyethylene centrifuge tubes with continuous gassing with CO2 (treatment 2); 50-mL polyethylene centrifuge tubes sealed, oriented horizontally, and shaken continuously parallel to the long axis of the tube, with manual gas release (treatment 3); 125-mL Erlenmeyer flasks with continuous gassing with CO2 (treatment 4); and 125-mL serum vials sealed with stoppers and crimp seals with (treatment 5) or without (treatment 6) manual gas release. Goering and Van Soest medium and blended ruminal inoculum from 4 lactating cows were used. Substrates were alfalfa hay, corn silage, ryegrass hay, and soyhulls. Gas was released and measured in treatments 3 and 6 at 3.0, 5.5, 9.0, 11.5, 23.5, 29.5, and 47.5 h by using a syringe with a hypodermic needle. Vessels from each treatment were harvested at 0, 6, 12, 24, 30, and 48 h for NDF analysis, with NDFD calculated as 1 -[(residual NDF, g - residual NDF in fermentation blank, g)/sample NDF, g]. Medium pH did not decline below 6.3 for any treatment. Average values for NDFD for 24 through 48 h were 0.576, 0.639, 0.688, 0.668, 0.679, and 0.681 for treatments 1 through 6, respectively (standard error of the difference = 0.008). The lowest NDFD was noted for treatment 1, which differed from all other treatments; treatments 3, 4, 5, and 6 did not differ by treatment or by the interaction of treatment and substrate. Treatments 1 and 2 gave lower NDFD values than the other treatments, but these differences were not consistent and differed by substrate, with alfalfa showing the fewest differences among treatments and soyhulls the most. Net energy of lactation values for substrates, as predicted from differences in 48-h NDFD, were 7 to 15% lower for treatment 1 than for the average of all other treatments. Slopes of the gas production per gram of substrate dry matter curves differed between treatments 3 and 5. In conclusion, measured NDFD was altered by fermentation treatment, with polyethylene tubes + gas-release valves giving the lowest values. Consequently, NDFD values may not be comparable across fermentation methods, but the effect will vary among feedstuffs. The combination of methods used for sealing, gassing, or agitating vessels may have a greater impact on NDFD than does vessel type.

Cantarovich M, Birk P, Ekbeg H, Delmonico F, Schoenberg R, Garcia C, Manyalich M, Wall W, Arbogast H, Sherry W, Young-Kipp S, Cantarovich F. First global forum on education on organ donation and transplantation for schools. Abstract:  The Transplantation Society, in collaboration with the Canadian Society of Transplantation, organized a forum on education on ODT for schools. The forum included participants from around the world, school boards, and representatives from different religions. Participants presented on their countries' experience in the area of education on ODT. Working groups discussed about technologies for education, principles for sharing of resources globally, and relationships between education, and health authorities and non-governmental organizations. The forum concluded with a discussion about how to best help existing programs and those wishing to start educational programs on ODT.

OBJECTIVES Transplanting is the sole therapy for the majority of organ insufficiencies, but the lack of organ donation limits transplanting. We evaluated the effect of education about "Organ Donation and Transplantation" over the false beliefs of the participants. MATERIALS AND METHODS This interventional study was performed in a military unit between January and March 2010. Data on organ donation and demographic characteristics were collected by a questionnaire. The researcher gave the lesson, and then collected the data by the same questionnaire 2 months later. RESULTS The rate of volunteering for organ donation increased from 45.4% to 84.8%(P <.001). Rate of consent for organ donations by relatives increased from 41% to 80.3%(P <.001). Also, general knowledge about organ donation increased from 34.8% to 93.7%(P <.001). Wrong beliefs about organ donation disappeared after the education. The entire organ donation rate among the volunteer participants increased from 60% to 84%(P <.001). No significant relation was found between volunteering to donate organs, and education and economic status. CONCLUSIONS Education could correct false information and might lead to higher organ donation rates. This education (which gave positive results in a military unit) could become widespread.

The theory of planned behaviour is one of the most widely used models of decision-making in the health literature. Unfortunately, the primary method for assessing the theory's belief-based expectancy-value models results in statistically uninterpretable findings, giving rise to what has become known as the 'expectancy-value muddle'. Moreover, existing methods for resolving this muddle are associated with various conceptual or practical limitations. This study addresses these issues by identifying and evaluating a parsimonious method for resolving the expectancy-value muddle. Three hundred and nine Australian residents aged 18-24 years rated the expectancy and value of 18 beliefs about posthumous organ donation. Participants also nominated their five most salient beliefs using a dimensional salience approach. Salient beliefs were perceived as being more likely to eventuate than non-salient beliefs, indicating that salient beliefs could be used to signify the expectancy component. The expectancy-value term was therefore represented by summing the value ratings of salient beliefs, an approach that predicted attitude (adjusted R2 = 0.21) and intention (adjusted R2 = 0.21). These findings suggest that the dimensional salience approach is a useful method for overcoming the expectancy-value muddle in applied research settings.

Despite the persistent belief that Asians are the "model minority" there is accumulating evidence of health concerns within Asian subgroups. In this study, we implemented a cross-sectional participatory community health assessment in an urban city in Massachusetts, to understand differences and similarities in demographics, health and healthcare access in Chinese and Vietnamese adults. We gathered qualitative data from community stakeholders to inform the development of a community health assessment tool. The tool elicited information on healthcare access, health status, behavioral health and chronic disease history and treatment. Healthcare access issues and poor health status, particularly among Chinese participants and mental health symptomotology in both groups were areas of concern. These findings revealed important health concerns in two Asian ethnic groups. Studies are needed to better understand these concerns and inform programs and policies to improve health outcomes in these Asian ethnic groups.

African Americans are overrepresented on the organ transplant waiting list because they are disproportionately impacted by certain health conditions that potentially warrant a life-saving transplant. While the African American need for transplantation is considerably high, organ and tissue donation rates are comparatively low, resulting in African Americans spending more than twice the amount of time on the national transplant waiting list as compared to people of other racial/ethnic backgrounds. There are a multitude of factors that contribute to the reluctance expressed by African Americans with respect to organ donation. This study proposes the use of an adaptation of the Organ Donation Model to explore the ways in which knowledge, trust in the donation/allocation process, and religious beliefs impact African American donation decision making. Bivariate and path analyses demonstrated that alignment with religious beliefs was the greatest driving factor with respect to attitudes towards donation; attitudes were significantly associated with donation intentions; and knowledge is directly associated with intentions to serve as a potential deceased organ donor. The significance of these variables speaks to the importance of their inclusion in a model that focuses on the African American population and offers new direction for more effective donation education efforts.

The IIFF model of organ donation holds that the simultaneous presence of four factors directly influence donor registration:(1) immediate and complete registration opportunity (ICRO),(2) information,(3) focused engagement, and (4) favorable activation. Two field experiments examined the impact of an ICRO on organ donation registration. In Study 1, participants were at town halls where they knew organ donation was to be discussed. Registration cards were distributed and then collected at the end of the session in half of the town halls. For the other half, participants were asked to mail in completed cards. In three US cities, participants given an ICRO registered at a significantly greater rate (z = 4.865, p < 0.05). Study 2, targeting Hispanics at a swap meet, differed in that the registration impact of awareness of the availability of an ICRO was investigated. Participants made aware of an ICRO registered at a significantly greater rate (z = 4.1, p = 0.000).

This study investigates antecedents and outcomes of entertainment television consumption in organ donation with the Orientation₁-Stimulus-Orientation₂-Response (O₁-S-O₂ -R) model. It reveals that organ donation knowledge seems significantly related to recall of entertainment television programs and attitudes toward organ donation. Meanwhile, recall of entertainment television programs significantly predicts people's perception of medical mistrust, which in turn negatively predicts attitudes toward organ donation, while attitudes toward organ donation significantly predict behavioral intention in signing a donor card. It also suggests significant mediation relationships among the pre-orientation variable, stimulus, post-orientation variable, and attitudinal and behavioral outcomes. This study provides an integrative theoretical framework to study media effects on organ donation and empirical evidence for "entertainment miseducation"(Morgan, Harrison, Chewning, Davis,& DiCorcia, 2007).

This research examines the impact of a Spanish language mass media campaign on living organ donation attitudes and behavioral intentions among Spanish dominant Hispanics in Tucson, Arizona. Impact was assessed via a pretest/posttest control group quasiexperimental design with Tucson, Arizona, as the intervention community and Phoenix, Arizona, as the control. Preintervention focus groups provided qualitative data to guide intervention development, while telephone surveys in both communities provided quantitative data to assess campaign impact. Analyses reveal pretest/posttest differences in the intervention community such that posttest intentions regarding living organ donation behaviors increased from pretest. No such differences were observed in the control community. Subsequent analyses revealed differences between respondents in the intervention community exposed to the campaign vs. those in the same community not exposed to the campaign. Exposed respondents reported more positive living organ donation behavioral intentions than nonexposed respondents. Implications for research and practice are discussed.

Culturally focused education about deceased donation is needed for American Indians (AIs). This study tested a program designed to impact intention to serve as a deceased donor for reservation dwelling AIs. A pre/posttest design and a community-based participatory research approach were used. The study was based upon the Transtheoretical Model. Adult participants (N = 1580, 58% women) were from four Northern Plains reservations. An outreach coordinator delivered the program using print and video materials. The outcome was stage of motivational readiness (SMR) to serve as a deceased donor. McNemar's test was used to compare pre- to postintervention changes in SMR. At baseline, 55% of participants were not thinking about being a donor (precontemplation stage) and 45% were thinking about it (contemplation stage). Postintervention, 43.1% of participants were unchanged in SMR and 56.9% progressed in SMR. Of those who progressed, 26.5%(n = 418) changed to the contemplation stage, 19.4%(n= 306) changed to the preparation stage (signed a donor card or joined a registry), and 11.1%(n = 175) confirmed a discussion of the decision with family (action stage). Progression in SMR from pre/post was significant, chi(2)(1)= 18.32, p < 0.05. The intervention resulted in important changes in deceased donor intentions for reservation dwelling AIs.

This study compared African Americans, Asian Americans, Hispanic Americans, Native Americans, and White Americans on their intentions to enroll in a state organ donor registry and to talk with family about organ donation. The overall results showed that attitudes and subjective norms from the theory of planned behavior were significantly related to intention to enroll whereas perceived behavioral control was not. Attitudes, subjective norms, and perceived behavioral control were significantly related to intention to talk with family. The differences among ethnic groups were small, but the relationship between attitudes and intention to enroll was stronger for Asian Americans and weaker for African Americans than for White Americans. The implications of these and other findings are discussed for organ donation campaigns.