Urologic

nursing

official

journal

of

the

American

Urological

Association

Allied

Urol

Nurs

Publisher

American

Urological

Association

Allied

Journal

description

Urologic

Nursing

the

official

journal

of

the

Society

of

Urologic

Nurses

and

Associates

SUNA

presents

the

latest

advances

in

urologic

nursing

practice

Written

by

and

for

urologic

nurses

and

associates

Urologic

Nursing

features

clinical

articles

covering

a

wide

variety

of

urologic

issues

and

clinical

procedures

Patient

education

techniques

and

research

findings

are

also

included

as

well

as

articles

discussing

the

ethical

issues

and

trends

in

this

expanding

clinical

nursing

specialty

Published

six

times

a

year

RG

Journal

Impact

This

value

is

calculated

using

ResearchGate

data

and

is

based

on

average

citation

counts

from

work

published

in

this

journal

The

data

used

in

the

calculation

may

not

be

exhaustive

RG

Journal

impact

history

Available

summer

RG

Journal

impact

over

time

RG

Journal

impact

Additional

details

Cited

halflife

data

not

available

Immediacy

index

data

not

available

Eigenfactor

data

not

available

Article

influence

data

not

available

Website

Website

description

Urologic

Nursing

website

Other

titles

Urologic

nursing

ISSN

OCLC

Material

type

Periodical

Document

type

Journal

Magazine

Newspaper

Publications

in

this

journal

What

can

we

do

Article

Nov

J

H

Hawks

Reads

Culture

Article

Jan

Barbara

Broome

America

is

a

kaleidoscope

of

cultures

ethnic

groups

and

races

As

Americas

emerging

and

changing

populations

continue

to

grow

it

is

imperative

that

health

care

providers

become

more

culturally

sensitive

and

competent

Health

care

providers

need

to

recognize

that

care

must

be

individualized

and

considerate

of

the

cultural

racial

and

ethnic

identity

of

the

recipient

of

their

care

One

of

the

many

challenges

that

confronts

health

care

and

urologic

nurses

is

learning

how

culture

can

influence

a

patients

response

to

health

and

illness

Reads

Citation

Expand

abstract

Traces

making

sense

of

urodynamics

testingPart

quantitative

analysis

of

micturition

via

the

voiding

pressure

flow

study

pressureflow

nomograms

Article

Aug

Mikel

Gray

The

voiding

pressure

flow

study

is

the

gold

standard

for

evaluating

micturition

Part

of

the

Traces

series

described

techniques

for

evaluating

micturition

via

the

voiding

pressure

flow

study

it

focused

on

interpretation

of

results

qualitatively

via

inspection

and

classification

of

flow

pattern

detrusor

contraction

amplitude

and

duration

pelvic

floor

muscle

response

to

voiding

and

urethral

resistance

This

article

discusses

quantitative

analysis

of

the

voiding

pressure

flow

study

using

nomograms

that

measure

the

magnitude

of

urethral

resistance

bladder

outflow

obstruction

andor

detrusor

contraction

strength

Reads

Expand

abstract

Traces

making

sense

of

urodynamics

testingpart

pediatric

urodynamics

Article

Mar

Mikel

Gray

While

the

majority

of

urodynamics

studies

are

performed

in

adults

with

stress

urge

and

mixed

urinary

incontinence

or

urinary

retention

urodynamic

clinicians

are

also

expected

to

evaluate

special

populations

Article

of

the

Traces

series

focuses

on

urodynamics

testing

techniques

in

infants

and

children

including

children

with

neurogenic

bladder

dysfunction

Reads

Citation

Expand

abstract

Prostate

cancer

in

the

late

hormone

refractory

disease

options

Article

Jul

Judd

W

Moul

D

R

Lipo

Prostate

cancer

is

the

most

common

tumor

and

second

most

common

cause

of

cancer

death

in

American

men

Advanced

prostate

cancer

patients

commonly

have

painful

skeletal

bony

metastases

Although

hormonal

therapy

is

very

effective

initially

hormonerefractory

prostate

cancer

may

be

associated

with

bone

pain

and

other

symptoms

such

as

urinary

obstruction

Aside

from

oral

and

parenteral

nonnarcotic

and

narcotic

medications

several

recent

FDAapproved

outpatient

medications

are

effective

for

palliation

of

painful

bony

metastases

Mitoxantrone

chemotherapy

in

combination

with

glucocorticoids

and

the

radioisotopes

and

are

now

available

Urologic

nursing

personnel

should

be

familiar

with

these

new

and

complementary

modalities

Citations

Expand

abstract

SUNA

resource

directory

Article

Jan

D

Switters

Reads

Aging

and

the

problem

of

urinary

incontinence

AHCPRs

clinical

practice

guidance

Article

Jan

Diane

Kaschak

Newman

Reads

Citations

Regarding

the

prostate

cancer

article

in

the

December

issue

Strief

Article

Jul

Debbie

Hensley

Reads

Including

CatheterAssociated

Urinary

Tract

Infections

in

the

CMS

Payment

Policy

A

Qualitative

Analysis

Article

Apr

Jennifer

A

Palmer

Grace

M

Lee

M

Maya

DuttaLinn

Christine

W

Hartmann

The

study

presented

in

this

article

addresses

the

impact

of

the

nonpayment

policy

of

the

Centers

for

Medicare

and

Medicaid

Services

CMS

on

catheterassociated

urinary

tract

infections

CAUTIs

from

the

perspective

of

infection

preventionists

With

rich

qualitative

data

it

sheds

light

on

the

daytoday

impact

of

this

recent

health

policy

on

CAUTI

prevention

Reads

Expand

abstract

Continence

nursing

at

the

dawn

of

the

century

a

futurist

perspective

Article

Sep

Mikel

Gray

Reads

for

bladder

cancer

screening

and

surveillance

Article

Jul

Mikel

Gray

Terran

W

Sims

In

more

than

Americans

will

be

diagnosed

with

bladder

cancer

American

Cancer

Society

Urethrocystoscopy

is

considered

the

gold

standard

for

bladder

cancer

diagnosis

but

it

is

not

a

screening

test

Researchers

have

been

challenged

to

develop

a

noninvasive

urine

test

that

reliably

differentiates

hematuria

associated

with

bladder

cancer

from

that

associated

with

nonmalignant

etiologies

Several

wellestablished

and

some

novel

tests

for

bladder

cancer

screening

diagnosis

and

surveillance

including

urinalysis

voided

cytology

and

the

Nuclear

Matrix

Protein

assay

one

of

a

growing

number

of

assays

developed

as

a

specific

sensitive

noninvasive

test

for

bladder

cancer

are

Citations

Expand

abstract

The

psychosocial

impact

of

urinary

incontinence

on

women

aged

to

years

Article

Oct

A

J

Valerius

The

purpose

of

this

research

was

to

describe

the

relationship

between

symptoms

of

urinary

incontinence

and

their

impact

on

daily

activities

and

the

degree

of

incontinencerelated

distress

perceived

by

to

women

A

second

purpose

was

to

identify

differences

if

any

in

impact

on

daily

life

and

degree

of

incontinencerelated

distress

perceived

among

women

with

stress

urge

and

mixed

incontinence

Guided

by

Lazarus

and

Folkmans

Stress

Appraisal

and

Coping

Theory

a

descriptive

correlational

prospective

study

N

was

conducted

using

the

Urogenital

Distress

Inventory

and

the

Incontinence

Impact

Questionnaire

A

significant

moderate

r

p

correlation

was

Reads

Citations

Expand

abstract

July

to

London

bombings

Article

Jan

Jean

Gray

Reads

Citations

Abandoning

isolated

free

PSA

screenings

for

more

comprehensive

cardiovascular

and

cancer

screening

and

education

Article

May

Mark

A

Moyad

The

time

is

ripe

to

abandon

free

PSA

screenings

and

replace

them

with

free

comprehensive

health

screenings

For

example

cardiovascular

disease

CVD

risk

screening

cholesterol

blood

pressure

that

could

also

include

PSA

weight

measurement

and

a

variety

of

other

tests

and

educational

assessments

just

make

more

sense

in

terms

of

the

larger

picture

of

influencing

allcause

morbidity

and

mortality

Numerous

reasons

are

proffered

for

this

important

change

Abandoning

this

myopic

singledisease

only

approach

must

be

embraced

by

numerous

medical

centers

and

health

professionals

before

this

comprehensive

approach

can

be

successfully

implemented

Read

Citations

Expand

abstract

The

ABCs

of

product

selection

Article

Jul

Nancy

Ann

Faller

K

F

Jeter

Read

Citation

Hormone

ablation

therapy

Lightening

the

load

for

todays

prostate

cancer

patient

Article

Mar

Phyllis

A

Matthews

Prostate

cancer

is

the

most

common

nonskin

cancer

in

the

United

States

with

more

than

million

men

currently

living

with

the

disease

Prostate

Cancer

Foundation

Hormone

ablation

therapy

has

resulted

in

much

improved

outcomes

for

thousands

of

men

with

this

disease

however

there

are

often

side

effects

that

impact

patients

quality

of

life

An

overview

of

the

use

of

hormone

ablation

therapy

and

the

critical

role

nurses

play

for

patients

undergoing

this

treatment

is

provided

Reads

Citations

Expand

abstract

Measuring

hot

flashes

in

men

treated

with

hormone

ablation

therapy

an

unmet

need

Article

Mar

Michael

Kattan

Reads

Citations

Utilization

of

superapubic

catheters

after

visual

laser

ablation

of

the

prostate

Article

Oct

C

Upson

A

Medrick

K

A

Kirby

Reads

Laser

ablation

of

the

prostate

nursing

management

Article

Jul

Helen

Crowe

Anthony

J

Costello

Read

Megestrol

acetate

for

the

treatment

of

hot

flashes

in

men

undergoing

hormone

ablation

therapy

or

orchiectomy

Article

Jan

Michelle

Lajiness

Reads

Citation

Hormone

Ablation

for

the

Treatment

of

Prostate

Cancer

The

Lived

Experience

Article

Jul

Christine

Ng

Linda

Kristjanson

Kristina

Medigovich

Reads

Citations

Evaluation

of

fluid

absorption

during

laser

prostatectomy

by

breath

ethanol

level

techniques

Article

Oct

Jane

WozniakPetrofsky

James

M

Cummings

Reads

Citation

Woman

with

incontinence

and

a

history

of

childhood

sexual

abuse

Article

Feb

Joyce

D

Wallace

Reads

Mans

search

for

ultimate

sex

Viagra

abuse

Article

Mar

Jeffrey

A

Albaugh

Susan

KelloggSpadt

Reads

Citations

Phenazopyridine

hydrochloride

the

use

and

abuse

of

an

old

standby

for

UTI

Article

Jul

Kaye

Gaines

Reads

Citations

Intravenous

access

Part

Peripheral

ivs

Article

Apr

M

Rostad

The

nursing

care

of

the

patient

with

a

peripheral

IV

requires

the

implementation

of

the

basic

principles

of

intravenous

care

Because

the

integrity

of

the

skin

is

broken

measures

are

implemented

to

prevent

the

occurrence

of

infection

Skin

preparation

of

the

venipuncture

site

is

important

in

preventing

the

introduction

of

organisms

into

the

IV

insertion

site

The

regular

care

of

the

insertion

site

and

maintenance

of

an

occlusive

dressing

prevent

further

IV

site

contamination

The

use

of

peripheral

IVs

constructed

of

certain

materials

the

use

of

normal

saline

over

heparin

flush

solution

to

maintain

IV

patency

and

an

established

routine

Reads

Citations

Expand

abstract

Intravenous

access

Part

Central

venous

lines

Article

Oct

M

Rostad

The

use

of

CVL

are

becoming

more

popular

as

medical

interventions

become

more

intense

and

the

patients

acuity

rises

The

use

of

peripherally

inserted

central

catheters

is

also

increasing

because

of

the

availability

of

high

tech

medical

care

in

the

home

and

the

delegation

of

central

catheter

insertion

to

nursing

The

nursing

care

of

the

patient

with

a

CVL

requires

the

implementation

of

strict

aseptic

site

care

and

dressing

changes

to

avoid

the

incidence

of

infection

Read

Citation

Expand

abstract

Reducing

barriers

and

improving

access

to

continence

care

examining

the

evidence

Article

Nov

Julie

Spencer

There

is

a

great

need

for

increased

community

awareness

to

encourage

women

to

seek

treatment

for

urinary

incontinence

UI

This

article

reviews

the

literature

pertaining

to

the

efficacy

of

increased

awareness

and

knowledge

of

UI

in

reducing

barriers

to

health

care

access

and

early

intervention

Discussion

focuses

on

the

implications

for

clinical

practice

based

on

the

available

evidence

Reads

Expand

abstract

Intravenous

access

Part

Venous

access

devices

Article

Jan

M

Rostad

The

nursing

care

of

the

whole

patient

not

just

the

venous

access

device

should

be

the

focus

of

the

nurse

Venous

access

devices

provide

the

nurse

with

the

rare

opportunity

to

have

assured

venous

access

for

blood

sampling

as

well

as

the

administration

of

intravenous

therapies

The

meticulous

care

of

venous

access

devices

is

essential

if

complications

are

to

be

avoided

and

their

primary

function

maintained

Reads

Citation

Expand

abstract

Accessing

and

Evaluating

Urologic

Health

Information

Differences

by

RaceEthnicity

and

Gender

Article

Mar

Courtney

B

Jackson

Elizabeth

Botelho

Journel

Joseph

Sharon

L

Tennstedt

Patients

with

urologic

symptoms

seek

information

from

a

variety

of

sources

outside

the

traditional

health

care

arena

There

are

differences

between

the

genders

and

racialethnic

groups

related

to

sources

consulted

and

confidence

in

those

sources

Reads

Expand

abstract

Organizational

accountability

in

a

just

culture

Article

Jan

Celeste

Mayer

Dale

Cronin

Policies

and

procedures

exist

to

safeguard

patients

and

protect

them

from

harm

however

a

deeper

understanding

as

to

why

a

particular

sentinel

event

occurred

and

less

focus

on

the

individual

who

made

the

error

can

have

positive

outcomes

Nursing

leaders

should

strive

to

maintain

a

just

culture

to

promote

reporting

and

learning

in

their

facility

thereby

creating

a

culture

of

safety

for

patients

Reads

Citations

Expand

abstract

Accuracy

of

ultrasound

estimates

of

urine

volume

Article

Jul

F

D

SchottBaer

L

Reaume

Ultrascan

and

actual

catheterization

volumes

were

compared

on

urology

general

surgery

and

rehabilitation

patients

The

findings

suggest

that

mean

scan

and

actual

urine

volumes

can

be

considered

equal

In

clinical

situations

where

it

is

necessary

to

determine

residual

urine

volume

the

bladder

scan

technology

is

a

good

alternative

to

an

invasive

catheterization

procedure

Read

Expand

abstract

Managing

advanced

prostate

cancer

with

Viadur

leuprolide

acetate

implant

Article

Jan

Judd

W

Moul

K

Civitelli

Viadur

leuprolide

acetate

implant

providing

a

sustained

release

of

drug

over

a

duration

decreases

serum

testosterone

in

advanced

prostate

cancer

patients

providing

longterm

palliative

medical

hormonal

therapy

Clinical

experience

suggests

Viadur

implants

are

safe

effective

and

generally

well

tolerated

The

continuous

drug

delivery

provided

by

Viadur

ensures

compliance

The

Viadur

implants

was

designed

to

be

maintenancefree

thereby

allowing

nurses

and

other

health

professionals

to

focus

on

other

patient

needs

such

as

followup

visits

and

diagnostic

tests

Viadur

is

one

aspect

of

a

comprehensive

approach

to

patient

management

which

also

includes

regular

followup

for

prostatespecific

antigen

testing

digital

rectal

examination

Reads

Citations

Expand

abstract

The

Affordable

Care

Act

can

we

all

achieve

presidential

health

Article

Oct

Peggy

wardsmith

Reads

Achieving

Excellence

Article

Sep

Susan

Lipsy

I

added

a

question

mark

to

the

title

because

I

think

that

we

should

all

be

questioning

what

is

being

achieved

in

our

schoolcollegeuniversityplace

of

work

It

also

points

an

arrow

at

our

heart

and

forces

us

to

answer

the

question

as

to

whether

or

not

as

individuals

we

are

achieving

excellence

in

our

own

performance

There

is

a

difference

between

doing

well

and

doing

the

best

we

can

Has

any

one

of

us

ever

achieved

our

full

potential

I

know

I

have

not

To

recognise

that

is

important

in

itselfThis

is

not

an

erudite

piece

of

educational

research

so

Reads

Citation

Expand

abstract

Metformin

prevention

of

lactic

acidosis

Article

Jul

Mary

J

McNamee

J

K

Bartek

Reads

Citation

Herbs

amino

acids

and

female

libido

Article

May

Susan

KelloggSpadt

Jeffrey

A

Albaugh

Reads

Electrostimulation

of

the

bladder

neck

in

acontractile

bladder

two

case

reports

Article

Jan

Katherine

N

Moore

Derek

Griffiths

JB

Metcalfe

P

N

McCracken

Reads

The

Affordable

Care

Act

Emphasis

on

population

health

Article

Mar

Jane

Hokanson

Hawks

Reads

Citation

Disseminating

information

for

use

in

developing

countries

a

call

to

action

Article

May

Daniel

D

Moos

A

plan

of

action

for

the

AUAA

American

Urological

Association

Allied

Inc

Article

Oct

M

Gray

A

call

to

action

for

nurses

declining

enrollment

and

the

nursing

shortage

Article

Nov

J

A

Albaugh

Once

again

nursing

and

health

care

face

a

crisis

related

to

the

continued

decline

in

nursing

school

enrollment

and

the

nursing

shortage

This

particular

shortage

seems

to

be

especially

problematic

because

of

the

increased

number

of

aging

baby

boomers

and

the

dwindling

professional

nurse

pool

Nurses

must

work

together

to

increase

understanding

and

awareness

of

the

opportunities

in

the

profession

and

to

resolve

this

crisis

There

are

specific

actions

nurses

can

take

to

improve

the

perception

of

nursing

and

renew

interest

in

a

dynamic

field

that

is

so

crucial

to

society

Read

Expand

abstract

Katz

Index

of

Independence

in

Activities

of

Daily

Living

ADL

Article

Feb

Meredith

Wallace

Kazer

Mary

Shelkey

Reads

Citations

Using

an

acuityadaptable

unit

for

urological

services

Article

Jul

Darla

Annonio

Julia

Graham

Rebecca

Ross

The

University

of

Pittsburgh

Medical

CenterShadyside

Campus

uses

an

acuityadaptable

unit

model

that

has

streamlined

patient

care

Preoperative

preparation

and

postoperative

recovery

nursing

care

on

one

designated

nursing

unit

provide

a

less

stressful

experience

for

the

surgical

patient

Reads

Expand

abstract

Acupuncture

for

urinary

urgency

in

women

over

what

is

the

evidence

Article

Mar

Katharine

K

ODell

Sarah

M

McGee

The

article

reports

on

the

potential

of

acupuncture

as

a

therapy

for

treating

urinary

urgency

UU

or

urge

urinary

incontinence

UUI

in

aging

women

Although

its

efficiency

has

not

yet

been

established

acupuncture

as

nonpharmacologic

treatment

for

UUI

or

UU

can

be

considered

safe

and

may

decrease

symptoms

Other

suggested

treatment

for

urinary

urgency

were

compared

with

acupuncture

Reads

Citations

Expand

abstract

Diagnosis

and

management

of

acute

and

chronic

prostatitis

Article

Sep

Daniel

A

Shoskes

Floyd

Katske

S

Kim

Prostatitis

syndromes

are

some

of

the

most

poorly

understood

yet

prevalent

problems

in

urology

There

is

little

controversy

over

acute

prostatitis

a

urinary

tract

infection

with

systemic

symptoms

and

signs

that

typically

responds

to

antimicrobial

therapy

By

contrast

the

chronic

prostatitis

syndromes

have

so

far

eluded

attempts

to

understand

their

pathophysiology

and

design

effective

therapies

resulting

in

great

frustration

among

patients

and

health

care

providers

An

accurate

diagnosis

and

a

multidisciplinary

approach

are

essential

to

assist

men

with

this

often

debilitating

condition

Reads

Citations

Expand

abstract

Selfcare

strategies

used

for

acute

attack

of

interstitial

cystitis

Article

Oct

D

C

Webster

T

Brennan

To

determine

the

kinds

of

selfcare

used

by

women

with

interstitial

cystitis

and

to

find

effective

ways

to

manage

symptoms

of

acute

attack

One

hundred

thirtyeight

women

with

interstitial

cystitis

completed

a

survey

indicating

how

often

they

used

and

how

effective

they

found

strategies

in

four

physical

selfcare

subdomains

medication

treatment

diet

and

body

comfort

and

three

psychologic

selfcare

subdomains

cognitivestress

reduction

distraction

and

helpseeking

Descriptions

of

symptoms

during

an

acute

attack

are

more

consistent

with

symptoms

described

at

onset

than

symptoms

experienced

currently

Physical

strategies

most

used

for

acute

attack

included

use

of

narcotics

antidepressants

and

bladder

analgesics

in

Reads

Citations

Expand

abstract

Pharmacologic

therapy

for

acute

cystitis

in

adults

a

review

of

treatment

options

Article

Oct

Karen

A

Karlowicz

This

article

is

a

review

of

the

current

pharmacologic

treatment

options

for

acute

cystitis

in

adults

It

is

intended

to

provide

the

urologic

nurse

with

practical

information

regarding

the

administration

of

the

most

frequently

prescribed

antimicrobial

drugs

Pharmacologic

agents

discussed

are

of

the

following

classes

of

antimicrobials

betalactam

antibiotics

fluoroquinolones

sulfonamides

and

urinaryspecific

antiinfectives

The

discussion

of

each

drug

class

includes

information

about

the

indications

pharmacodynamics

pharmacokinetics

and

recommended

dosage

regimens

Specific

factors

that

will

influence

the

health

care

providers

choice

of

the

most

appropriate

antimicrobial

for

the

treatment

of

acute

cystitis

are

examined

Key

teaching

points

that

should

be

Reads

Expand

abstract

Urinary

incontinence

in

an

acute

care

setting

Article

Oct

T

T

Dowd

J

M

Campbell

To

determine

the

prevalence

of

urinary

incontinence

in

an

acute

care

setting

and

the

approaches

to

the

management

of

it

An

audit

of

hospital

charts

containing

a

diagnosis

of

urinary

incontinence

was

conducted

to

gather

data

about

patient

demographics

related

factors

such

as

skin

integrity

and

orientation

urinary

tract

infections

and

nursing

interventions

The

audit

was

conducted

by

two

data

collectors

who

had

an

established

interrater

reliability

at

A

prevalence

rate

of

cases

with

a

diagnosis

of

urinary

incontinence

was

found

An

additional

of

cases

were

documented

only

in

nurses

notes

Nursing

comfort

measures

were

the

primary

Citations

Expand

abstract

Prevention

of

IncontinenceRelated

Skin

Breakdown

for

Acute

and

Critical

Care

Patients

Comparison

of

Two

Products

Article

Sep

Mary

Brunner

Carol

Droegemueller

Sonja

Rivers

William

E

Deuser

Perineal

protection

products

were

compared

for

their

efficacy

in

preventing

skin

breakdown

in

the

hospitalized

patient

with

urinary

andor

fecal

incontinence

Each

product

was

used

for

the

duration

of

the

hospital

stay

with

daily

observations

for

perineal

skin

condition

Results

indicated

the

spray

product

and

wipe

product

were

comparable

in

rate

of

skin

breakdown

prevention

Findings

suggest

the

wipe

product

is

more

costeffective

for

use

during

hospitalization

and

the

spray

product

preserves

skin

integrity

over

a

longer

period

of

time

beyond

average

hospitalization

duration

Reads

Citations

Expand

abstract

Data

provided

are

for

informational

purposes

only

Although

carefully

collected

accuracy

can

not

be

guaranteed

Discover

the

worlds

research

million

members

million

publications

research

projects

B I O O O O B I I I O O O B I I I O O B I O O O O O O O O O O O O O O O O O B I O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I I I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O

urologic nursing
american urological association allied


Does the size of the DNA molecule in base pairs correspond exactly to its sequence


How can you calculate ethanol yield in terms of percentage in GC


When doing CDNA conversion to RNA how much RNA is required Popular Answers 1 3 years ago Armin Hallmann Bielefeld University In my lab we routinely use 500 ng total RNA for a 20 µl reaction However we also tried 250 ng and 100 ng which both also worked fine Thus if the amount of total RNA is limited for some reason not so much total RNA is really required I just wonder why the concentration of your RNA is so low Frequently this is sign of problems with RNA purification and might also be an indication of RNA with a low quality Did you carefully check the quality of your RNA RNA purity and RNA integrity are most important If there is any problem with the RNA purification contaminants such as genomic DNA gDNA DNases RNases and proteases can end up in the final sample and lead to total or at least partial degradation of RNA andor DNA partial degradationdenaturation of enzymes or amplification of gDNA Carrying out your experiments with substandard RNA can have dramatic effects on your results There are several methods for evaluating your RNA before proceeding to the RT step If you assess the quality by absorbance the RNA preparation should have a minimum A 260280 ratio of about 2 However make sure that you dont work at the detection limit of your spectrophotometer because in that case the results are not reliable If you have access to an Agilent Bioanalyzer system Agilent 2100 this might be the best choice The Agilent Bioanalyzer uses microfluidics to sizeseparate and quantitate RNA in a highly reproducible way electrophoresis and flow cytometry 9 Recommendations

O O B O O B O O B O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O B O O O O O O O O O O O B O O O O O O O O O O B O O O O O O O O B O O O O O O O O O O O O B B O O B O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O B O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O


Bullying in schools facts and intervention Article PDF Available in Kriminalistik 646 January 2010 with 6353 Reads Export this citation Dan A Olweus Norce Research Abstract Discover the worlds research 15 million members 118 million publications 700k research projects Content uploaded by Dan A Olweus Author content Download fulltext PDF 1 BULLYING IN SCHOOLS FACTS AND INTERVENTION Dan Olweus Research Centre for Health Promotion U niversity of Bergen Norwa y For two years Johnny a quiet 13 yearold was a human plaything for some of his classmates The teenagers badgered Johnny for mone y forced him to swallow weeds and drink milk mixed with detergent beat him up in the rest room and tied a string around his neck leading him around as a pet When Johnnys torturers were interrogated about the bullying the y said they pursued their victim because it was fun newspaper c lipping presented in Olweus1 993 p7 This short newspaper clipping gives a d ismal picture of the cruelt y children and youth can show towards one another under cert ain conditions And it demonstrates what a nightmare life at school can be for a victimised student of ten without the parents or the teachers knowing much about what goes on Bullying among schoolchildren is certainly a very old phenom enon Though many are acquainted with the problem it was not until fairly recently in the earl y 1970s that the phenomenon was made the object of more s ystematic research Olweus 1973a 1978 For a number of years these efforts were largely confined to Scandinavia In the late 1980s and the 1 990s however bullying among school children attracted attention a lso in several other countries such as Japan Great Britain the Netherlands Canada USA and Spain see Olweus 1993 for references In the past 10 years or so there has been an almost explosi ve development in this area both in t erms of research intervention and national policies eg Smith Morita JungerTas O lweus Catalano Slee 1999 Juvonen S Graham 2001 Espelag e Swearer 2004 Smith Pepler Ri gby 2004 In the USA this increased attention has been f uelled by some highly publicised scho ol shootings in which the tragic events have been at least partl y linked to bullyvictim problem s in the students involved Anderson et al 2001 Against this background I will now br iefly discuss the definitions of bullying a nd violence and present some research data on prevalenc e and characteristics of bullies an d victims After that my presentation will focus on the interventio n work against bullyvictim probl ems we have conducted in Norway over the past 20 years and on a ne w national intervention and preve ntion initiative 2 Definitions of school bullying and violence Already in the mid80s Olweus 1986 1993 I developed the following d efinition of bullying A student is being bullied or victim ised when he or she is exposed re peatedly and over time to negative actions on the part of one or more other students It is a negative action when som eone intentionally inflicts or attempts to inf lict injury or discomfort upon another basicall y what is implied in the definition of aggressi ve behaviour Olweus 1973b Berkowitz 1993 Negative act ions can be carried out by physical co ntact by words or in other ways such as making faces or mean gestures and intentional exc lusion from a group In order to use the term bullying there should also be an imbalance in power or strength an asymmetric relationship The student who is expos ed to the negative actions has dif ficulty defending himself or herself In a somewhat more general language bullying behaviour can be defined as intentional repeated negative unpleasant or hurtf ul behaviour by one or more pers ons directed against a person who has difficulty defending him self or herself According to this definitio n which seems to have gained considerable acceptance am ong researchers and practitioners alik e the phenomenon of bullying can thus be described as aggressive behaviour or intentional h arm doing carried out repeatedly and over tim e in an interpersonal relationship charac terised by an actual or perceived imbalance of power or strength One may add that much bullying seem s to occur without apparent provocatio n on the part of the person being targeted This def inition makes it clear that bullying can be c onsidered a form of abuse and sometimes I use the term peer abuse as a label of the phenom enon What sets it apart from other forms of abuse such as chi ld abuse and wife abuse is the con text in which it occurs and the relationship characteristics of the interacti ng parties This definition has then been operationa lised in a more concrete and studentf riendly way in my Revised Questionnaire Olweus 1996 S olberg Olweus 2003 The meaning and definition of the term violence is more controversia l Some people use the term violence or violent behaviour as ro ughly synonymous with aggression or a ggressive behaviour above With such a definition it m ay be natural to talk about psycholog ical violence and maybe 3 emotional violence Others em ploy an even wider definition and use ex pressions such as structural or institutional violence Without goi ng into detail I think such uses of the term violence are somewhat unfortunate creating conf usion and problems of operational isation and measurement For several reasons I want to argue that violenceviolent behaviour sho uld be defined as aggressive behaviour where the actor or perpetrator uses his or her own bod y or an object including a weapon to inflict relatively serious inj ury or discomfort upon another indi vidual The dictionary meaning of violence is very sim ilar implying use of physical force or power T he definition of violent offences in criminal law including hom icide aggravated assault assault ro bbery and rape is also based on a closely related understand ing In similarity with bullying violence is thus a subcategory of aggressive behaviour but with its o wn special characteristics The relationships among the three k ey terms of concern are graphically ill ustrated in the Venn diagram shown in Figure 1 Aggress ionaggressive behaviour is the genera l and overarching term the area delineated by the large out er circle whereas both bull ying and violenceviolent behaviour are subcategories of aggressive behav iour covering smaller areas within th e large circle As shown by the shaded area there is also a certai n overlap between violence and bu llying This area denotes situations in which bullying is carried out by physical means or contact abov e or expressed differently when physical means are used in the context of bullying eg hitt ing kicking shoving etc in situations where the general criteria of bullying are met The diagram also makes it clear that there is a good deal of bullying without violence eg bullying by words gestures intentional exclusion from the group etc and likewise that there is a good deal of violence that ca nnot be characterized as bullying eg an occasional fight in the sc hool yard or a row over som e trifle between unacquainted drunk people in a restaurant line Insert Figure 1 about here Admittedly the discussion above does n ot treat the definitional issues involved in enough detail or breadth but at the very least it m akes clear in what direction I think the field should move on this topic Some prevalence data On the basis of our surveys of more than 130000 Norwegian students cond ucted in 1983 with an early version of my BullyVictim Questionnaire Olweus 1996 it could be estim ated that that some 15 of the students in elem entary and lower secondary schools grades 310 r oughly corresponding 4 to ages 8 through 16 in Norway were i nvolved in bullyvictim problem s with some regularity 2 or 3 times a month either as bullies v ictims or bullyvictims Olweus 1993 T his percentage represented one student out of seven A pproximately 9 percent were victim s and 67 percent bullied other students with some regularit y Some 15 percent of the students were b oth victim and bully approximately 17 of the victim s A total of some 5 of the students were inv olved in the most serious form of bullying problem s as bullies victims or bullyvictim s occurring about once a week or more frequently As the prevalence qu estions in the Questionnaire refer to only part of the autumn term there is little doubt that the figures pr esented actually give a lowerboun d estimate of the number of students involved in bullyvictim problems during a whole year A new largescale survey of s ome 11000 students from 54 elem entary and junior high schools made in 2001 and using the sam e questions as in 1983 Olweus 1996 2002 gave much the same picture as before but we could note t wo disturbing trends 1 The percent age of victimised students had increased by approximatel y 50 from 1983 and 2 the percentage of students who were involved in the most serious f orm of bullying problems Solberg Olweus 2 003 had increased by some 65 These increases were seen as an indication of a negative socie tal development The data from the recent survey are presented i n Figures 2 and 3 Insert Figures 2 and 3 about here It is apparent then that bullying is a co nsiderable problem in Norwegian sc hools a problem that affects a very large num ber of students Survey data from other countries in large measure collected with my BullyVictim Questionnaire indicate that this problem certainly exists also outside Norway and with similar or usuall y even higher prevalence rates also see Olweus Limber 1999 Smith Morita JungerTas Olweus Slee 1999 It should be emphasised in this context that national differences in level of bullyvic tim problems must be interpreted with considerable caution since student responses may be affec ted by such factors as the availabilit y in the foreign language of appropriate words for the key term s familiarity with the concept of bull ying in the relevant culture degree of public attention to the phenom enon etc Bullyvictim problems by grade and g ender As seen in Figure 2 the percentage of students who reported being bullied d ecreased with higher grades It was the younger an d weaker students who were m ost exposed With regard to the 5 ways in which the bullying was carr ied out there was a clear trend towar ds less use of physical means physical violence in the higher gra des A considerable part of the bull ying was carried out by older students This was particularly mark ed in the lower grades As regards the t endency to bully other students depicted in Figure 3 the chang es with grades were not so clear a nd systematic as in Figure 2 However even if the results ma y vary somewhat in different cohorts of stude nts we usually find a trend towards increased bullying in hig her grades in particular for boys as was also the case in Figure 3 As evident from Figure 2 there was a tren d for boys to be somewhat mor e exposed to bullying than girls This tendency was par ticularly marked in the higher grades F igure 3 shows the percentage of students who had taken part in bul lying other students with som e regularity It is evident that a considerably larger percentage of bo ys had participated in bullying other st udents In the higher grades more than four times as m any boys as girls reported having bullied other students Bullying by physical means was m ore common among boys In contrast g irls often used more subtle and indirect ways of harassm ent such as slandering spreading rum ours and manipulation of friendship relationships Nonetheless h arassment with nonphysical m eans by words in particular was the most common form of bullying among both boys and girls An additional result was that bo ys carried out a large part of the bullying to which girls were exposed More than 50 percent of bu llied girls reported being bullied m ainly by boys An additional 1525 percent said they were bullied by both boys and girls The great m ajority of boys on the other hand more than 80 were bullied ch iefly by boys In summary boys were more often victim s and in particular perpetrators of direct bullying This conclusion is in good agreem ent with what can be expected from research on sex differences in aggressive behaviour It is well docum ented that relations among boys are b y and large harder tougher and more aggressive than am ong girls eg Maccoby 1986 T hese differences certainly have both biological and socialenviro nmental roots It may be added that be ing a bully or a victim is something that can last for a long tim e often for several years Olweus 1 977 1979 2003 The results presented here should b y no means be construed as implying th at we do not need to pay attention to bullying problem s among girls As a matter of cours e such problems must be acknowledged and counteracted whet her girls are the victims of bullying or the y themselves 6 perpetrate such behaviour No doubt being bullied in indirect and subtle ways can be equally hurtful and damaging as being bullied in mor e open and direct ways Briefly about the origins of bullyvictim p roblems The research evidence collected so far clearly suggests that personalit y characteristics or typical reaction patterns in combination with ph ysical strength or weakness in the case of boys are important for the development of these problem s in individual students At the sam e time environmental factors such as the attitudes routines and beha viour of relevant adults in particular teachers and principals play a major role in determ ining the extent to which the problems will manifest themselves in a larger unit such as a classroom or a school s ee Olweus 1993 The attitudes and be haviour of relevant peers as manifested in group processes and mechanisms are certainl y also important Accordingly analyses of the causes of bullyvictim problems must be pursued on several different levels Characteristics of typical victims and b ullies The most common type of victim s the passive or submissive victims us ually have some of the following characteristics are cautious sensitive quiet withdrawn and shy are anxious insecure unhapp y and have low selfesteem are depressed and engage in suicidal ideation much more often than their pe ers often do not have a single good f riend and relate better to adults than to peers If they are boys they are often phys ically weaker than their peers Some of these characteristics have ver y likely contributed to mak ing them victims of bullying At the same time it is obvious that the re peated harassment by peers m ust have considerably increased their insecurity and generall y negative evaluation of thems elves Accordingly part of these characteristics are both causes and conse quences of bullying There is also another clearly sm aller group of victims the provocative v ictims or bullyvictims who are characterised by a com bination of both anxious and aggressive re action patterns These students often have problems with concentr ation and may struggle with readin g and writing difficulties They often behave in wa ys that may cause irritation and tensi on around them Some of these students can be characterised as hyperactive It is not uncomm on that their behaviour provokes many students in the class thus resultin g in negative reactions from a large part of or even the entire 7 class The dynamics of bullyvictim problems in a class with provocative vic tims differ in part from problems in a class with pass ive victims Olweus 1978 2001a Bullies tend to exhibit some of the f ollowing characteristics strong needs to dominate and subdue other students and to get their own way are impulsive and easily angered show little empathy toward students who are victimised are often defiant and aggressive to ward adults including parents and teachers are often involved in other antisocial or r ulebreaking activities such as vanda lism delinquency and drug use If they are boys they are often phys ically stronger than boys in general and their victims in particular It may be added that in contrast to what is commonly belied they do not hav e special problems with their selfesteem As regards the possible psychological so urces underlying bullying behaviour the pattern of empirical findings suggests at least t hree partly interrelated motives Firs t the bullies have strong needs for power and dominance the y seem to enjoy being in control and to subdue others Second considering the family conditions under which many of them have been rear ed Olweus 1980 1993 it is natural to assume that they have de veloped a certain degree of host ility toward the environment such feelings and impulses m ay make them derive satisfaction from inflicting injury and suffering upon other individuals Finally there is clearl y an instrumental or benefit com ponent to their behaviour Bullies often coerce their victims to provide them with money cigarettes b eer and other things of value In addition it is obvious that th eir aggressive behaviour is in man y situations rewarded in the form of prestige Some group mechanisms When several students jointly engag e in the bullying of another student c ertain social psychologicalgroup mechanism s are likely to be at work Several such m echanisms have been discussed in some detail in Olweus 1 978 1993 Because of space lim itations they are only listed here 1 Social contagion 2 W eakening of the control or inhibitions agains t aggressive tendencies 3 Diffusion of responsibility and 4 Gr adual cognitive changes in the perce ptions of bullying and of 8 the victim All of these mechanisms can contribute to an understanding and exp lanation of why certain students who are usually nice and non aggressive participate in bullying without great misgivings The Bullying Circle Bullies and victims naturally occup y key positions in the configuration of bull yvictim problems in a classroom or school but other stud ents also play important roles and d isplay different attitudes and reactions toward an acute bull ying situation Figure 4 outlines the Bull ying Circle and represents the various ways in which m ost students in a classroom or school with bull yvictim problems are involved in or affected by them Olweus 2001a 2001b Insert Figure 4 about here A question of fundamental human right s The victims of bullying form a large grou p of students who have been and s till often are to a considerable degree neglected b y the school For a long time I have argued th at it is a fundamental human right for a child to feel safe in s chool and to be spared the oppression a nd repeated humiliation implied in bullying No student should be afraid of going to school for fear of bei ng harassed or degraded and no parent should need to worry about such things happe ning to his or her child Already in 1981 I proposed introduction of a law against bullying at school At that time there was little political support for the idea In 1994 however this suggestion was f ollowed up in Sweden with a new school law article including f ormulations that are very sim ilar to those expressed above In addition the law and associated regulati ons place responsibility for realisation of this goal including development of an intervention program against bullying for the individual sc hool with the principal A similar law article has now been introduce d in Norway and several other cou ntries see eg Smith et al 1999 The Olweus Bullying Prevention Program The Olweus Bullying Prevention Pr ogram has been developed and eval uated over a period of more than 20 years Olweus 1993 2001b It builds on four key principles derive d chiefly from research on the development and m odification of the implicated problem behaviours especially aggressive behaviour These principl es involve creating a schooland idea lly also a home environment characterised by 9 warmth positive interest and involvem ent from adults firm limits on unacceptable behaviour consistent application of nonpunitive no nphysical sanctions for unaccepta ble behaviour or violations of rules adults who act as authorities and posit ive role models The overriding message of the program is We dont accept bullying at our s chool and will see to it that it comes to an end An important goal is to change the op portunity and reward structures in such ways that there are fewer possib ilities and rewards for bullying behav iour in school and elsewhere The listed principles have been translat ed into a number of specific m easures to be used at the school classroom and individual levels O lweus 1993 2001b Figure 5 shows the set of core components that our statistical anal yses and experience with the program have shown particularly important in any implementation of the program 1 Insert Figure 5 about here Researchbased evaluations of the O BPP We have now conducted six largescale evaluations of the program in Nor way comprising several hundred schools and m ore than 30 000 students Here I will onl y give a brief summary of four of the evaluations three of which are p art of a new national initiative to be desc ribed below The latter three projects running from 2001 to 200 3 and comprising three independent c ohorts of schools have the same structure and have given very similar results Accordingly to sim plify presentation the results from these projects will be com bined in this context In all four projects to be described we ha ve employed a variant of what is us ually called a selection cohort design the charac teristics of which have been discuss ed in more detail elsewhere Cook Campbell 1979 Olweus 200 4a We focus here in particular on st udents in grades 4 through 7 with modal ages of approxim ately 10 to 13 years where important com ponents of the program were more fully implemented In all statistical an alyses the hierarchical or nested s tructure of the data with students nested within classroom s nested within schools have been tak en into account All main conclusions are based on results that are statistically significant or usuall y highly significant 10 The First Bergen Project The first evaluation of the effects of the Olweus Bullying Prevention Program involved data from approximately 2500 students in 42 elementary and lower secondar y schools in Bergen Norway The students were followed studen ts for two and onehalf years fr om 1983 to 1985 Olweus 1991 2004 Olweus Alsaker 1991 The m ain results can be summar ised in the following points Marked reductions by 50 percent or m ore in selfreported bullyvictim problems for the periods studied with 8 and 20 m onths of intervention respectively B y and large the results applied to both boys and girls and to stud ents from all grades studied Sim ilar results were obtained for a kind of aggregated pe er rating variables and teacher ratin gs Clear reductions in general antisocial be haviour such as vandalism fighting with the police pilfering drunkenness and truanc y Marked improvement as regards vario us aspects of the social climate of th e class improved order and discipline m ore positive social relationships and a m ore positive attitude to schoolwork and the schoo l At the same time there was an inc rease in student satisfaction with school life Detailed analyses of the quality of the data and the possibility of alternative inter pretations of the findings led to the following conclusi ons Olweus 1991 It is very diff icult to explain the results obtained as a consequence of a underrep orting by the students b gradua l changes in the students attitudes to bullyvictim problems c repeated measurement and d conc omitant changes in other factors including general tim e trends In addition a clear dosageresponse re lationship r51 n80 was establ ished in analyses at the classroom level which is the natura l unit of analysis in this case Those teac hersclassrooms that obtained larger reductions in bullyvic tim problems had implemented three im portant components of the intervention program including es tablishment of class rules against bull ying and use of regular class meetings to a greater extent t han those with smaller changes T his finding provides corroborating evidence for the h ypothesis that the changes observed were a consequence of the intervention program and not of som e other irrelevant factor Results in connection with the New National Initiative 11 As mentioned the research project ass ociated with New National Initiative ag ainst Bullying comprised more than one hundred schoo ls with approximately 21000 students in grades 4 7 These schools applied for participation in the Olweus Bullying Prevention Program at three different time points the autumn of 2001 the spr ing of 2002 and the autumn of 2002 at which they also took the Olweus BullyVictim Questionnaire f or a base line assessm ent The second measurement with the same instrument occurred one year later when the schools had work ed with the program for approximately 8 months Figures 6 and 7 present the results w ith the data from the three cohorts collapse d Insert Figures 6 and 7 about here For boys and girls combined the l evel of being bullied 2 or 3 times a m onth in the past couple of months before intervention was 142 percent second bar f rom right in Figure 6 One year later after approximately 8 m onths of intervention this figure had been reduc ed to 94 percent a relative reduction by 34 percent In Figure 7 the variable portrayed is bul lying other students The genera l pattern of results was very similar to what was reported for being bullied in Figure 6 but at a lower level as expected For boys and girls combined the rel ative reduction amounted to 44 percen t from 55 percent to 31 percent Basically similar results were obtained when the data were analysed separat ely for the two genders the four grades and when a stricter criterion about once a week or more often was used in classifying students as being bullied or b ullying other students Mark ed improvements could thus be registered also for students who had bee n involved in the most serious f orm of bullyvictim problems Solberg Olweus 2003 It should be remembered that in calcu lating the percentages of reduction reported above we did not just follow the same subjects over t ime and calculated the degree of change for each participant from base line to followup Such an approach would not take into acc ount the changes that naturally occur with age A critical as pect of the selection cohort design is that the key comparisons are being made between ageequi valent groups Olweus 2004 2005 In our study for example the data for grade 5 students at followup af ter 8 months of intervention were c ompared with the base 12 line data before intervention for the grade 5 students in the same s chools The same procedure was followed for the other grades In more detailed analyses we could re gister a number of changes in other areas or dimensions which also strongl y supported the interpretation that the pos itive results were a consequence of the intervention As an illustration the students reporte d about more active intervention in bullying situations from both teachers and peers at followup as c ompared to base line Also at followup there were clearl y more students who responded that the hom eroommain classroom teacher had made m uch or a good deal to counter bullying in the c lass in the past few months The logic or structure of the extended s election cohort design indicates that a history interpretation may be a possible threat to the validity of the results Cook Campbell 1979 Olweus 2004 This implies that the researc her must try to rule out or minim ise the possibility that general time trends or some irrelevant factor c oncomitant to the intervention could acc ount for the results As explained in some detail in a different art icle Olweus 2005 our results indica te that without systematic and effective intervention t he levels of bullyvictim problem s characterising successive largely comparable cohorts of s chools at different time points or a cohort of schools followed over tim e will be quite stable at least for a period of a couple of years This result repr esents an important verification of an assumption that up to now has had a less systematic em pirical underpinning Most importantly this verification implies th at a history interpretation in term s of general time trends or special media attention for exam ple can not reasonably be invoked as an exp lanation of the positive changes in the level of bullyvictim pr oblems in our intervention schools in the Ne w National Initiative Project It should also be mentioned that for appr oximately half of the schools fr om the first cohort we obtained followup data 32 schools w ith about 4000 students two years after th e first measurement occasion and approximately 6 months af ter the implementation phase of the O lweus Bullying Prevention Program had ended T hese data showed that the reductions gain ed after one year were maintained or even slightly increased after two years These schools were ro ughly similar to the total cohort of schools in terms of problem levels at Time 1 and degree of reduct ion of problems between Time 1 and Time 2 These results indica te that the Time 1Time 2 reducti ons were not a temporary and shortlived phenomenon conting ent on constant participation in the program Although the follow 13 up period so far was relatively lim ited the findings suggest that these sc hools may have actually changed their culture readiness and com petence to deal with and preve nt bullyvictim problems in a more longterm way While systematic use of the program with students in grades 4 through 7 has consistently produced very positive results which seem to be relatively unique in an inter national perspective see Smith Pepler Rigby 2004 it should also be mentioned that the effec ts have been more variable with students from lower secondar y school grades In about half of our evaluat ion projects results with students in that age range have been less successful than with younger stud ents when the evaluation has been made after 8 months of inter vention Recent analyses have shown however that after 20 months of intervention results w ith students in the higher age range h ave been almost as good as for the younger students after 8 months of intervention It is clearly more diff icult to get consistently good results for lower secondary schoolsan d it takes somewhat longer time to ach ieve such results The need for evidencebased intervent ion programs As bullyvictim problems have gradu ally been placed on the official schoo l agenda in many countries a number of suggestions ab out their handling and prevention hav e been proposed Some of these suggestions and approaches seem illconceived or maybe even count erproductive such as excessive focus on changing the victim s behaviour to make them less vulnerable to bullying Others appear meaningful and potentiall y useful A key problem however is that m ost of them have either failed to document positive results or h ave never been subjected to s ystematic research evaluation Therefore it is difficult to know which pro grams or measures actuall y work and which do not Yet it is the results with the students that count not how adults might feel about usin g the program user satisfaction The situation is well illustrated by the fol lowing facts Recently a US expert c ommittee under the leadership of a respected crim inologist professor Delbert Elliott m ade a systematic evaluation of more than 500 presumably violence or problembehaviour preventing programs according to certain minimumlevel criteria see Elliott 1999 These criteria were that the program had produced positi ve effects on relevant target groups s tudents in this case in a relatively rigorous sc ientific evaluation that the effects had lasted for at least o ne year 14 that the program had produced positi ve results in at least one site beyond the or iginal one Only 10 of the programs four of which ar e schoolbased satisfied the specif ied criteria These socalled Blueprint or evidencebased or model programs are now being implemented in a number of sites in the USA A similar evaluation by an officiall y appointed departmental committee was recently made in Norway In this case 57 program s designed to counteract andor prevent problem behaviour and in use in Norwegian schools were eva luated Rapport 2000 Only one progr am was recommended for further use without reservations The fact that the Olweus Bullying Pre vention Program is one of the 10 n ow 11 Blueprint programs Olweus Limber 1999 and maybe in particular was the program selected by the Norwegian committee is likely to be an important background for the rece nt governmentfunded national initiative in Norway A new national initiative against bull ying in Norway In late 2000 the Department of Educ ation and Research UFD and the D epartment of Children and Family Affairs BFD decided th at the Olweus Bullying Prevention Pro gram was to be offered on a largescale basis to Norwegian elem entary and lower secondar y schools over a period of years In building up the organisation and infras tructure for this national initiative two overr iding principles guided our work to try to ensure that the program was implemented according to the intentio ns of the program designer that is with reason able fidelity quality control to try to get the program implemented in a reasonable number of schoolscom munities in a relatively limited period of tim e say 5 or 6 years To accommodate both of these princ iples at the same time we use a fourl evel strategy of dissemination a kind of train thetrai ner model The Olweus Group agains t Bullying and Antisocial Behaviour at the HEMILc entre at the University of Bergen trai ns and supervises specially selected instructor candidat es who each train and supervise k ey persons from a number of schools ideally about five schools per instructorcandidate These k ey persons are then 15 responsible for leading recurrent staff discussion groups at each participating s chool The basic structure of the model is shown in Fi gure 8 Insert Figure 8 about here The training of the instructor candidates c onsists of 1011 wholeday assem blies distributed over a period of some 16 months In bet ween the wholeday meetings the instruc tor candidates receive ongoing consultation via teleph one or email with members of my group After having successfully completed the training peri od they will be assigned status as certified Olweus trainers In implementing this trainthe trainer m odel in the USA some modif ications have been made to accommodate cultural differences and practical constraints In particular t he number of wholeday assemblies have been reduced to four or f ive and the Bullying Prevention Coor dinating Committees at the individual schools have been accorded greater respons ibility than in Norway An important task for the trainer cand idates is to hold a twoday training with sp ecial key persons from each participating schoo l or in the USA with members of the coordinating committee see Olweus Limber 1999 T he trainer candidates are also in volved in the administration of the BullyVictim Questio nnaire Olweus 1996 Solberg O lweus 2003 and in interpreting and communicating the resu lts to the individual school The Qu estionnaire survey is important vehicle for creating awarenes s and involvement among staff students and parents In addition the key persons receive continui ng supervision and assistance fr om their trainer candidates Establishment of staff discussion groups at each participating school is an important tool for effective dissemination and implem entation of the program These groups with up to 15 participants meet regularly for approximately 90 m inutes every other week under the leader ship of the specially trained key persons The meetings are typically organized around im portant components or themes of the program as described in Olweus C ore Program against Bullying A T eacher Handbooks Olweus 2001b and the book Bull ying at school What we know and what we c an do Olweus 1993 Conductas de acoso y am enaza entre escolares1998 The m ain goals of these meetings are the following to provide more detailed and com prehensive knowledge of the intervention program and its various components 16 to provide the participants with the possib ility of testing through role pla ying and in other ways ideas and practical solutions to various problem situations in a secure e nvironment to stimulate faster implementation of the various components of the program to share experiences and viewpoints with others in similar situations and to lear n from others positive and negative experiences to create and maintain motivation and c ommitment to stimulate cooperation and coordinat ion of program components an d activities to develop and maintain a wholeschool polic y Although staff discussion groups may be perceived by som e in the school society as rather timeresourceconsuming the inform al feedback we have received so far certainly suggests that these meetings are seen as very valuable by most participants In man y ways these meetings around the program actually serve to stimulate organ isational development of the school A distinct advantage here is that the major goal of this f orm of school development is directed to wards the students To create a safe and positive learning en vironment Up to now some 125 instructor candidat es have finished or are in training and more than 450 schools from all over Norway participat e in the program We perceive all of this as a break through for the systematic longterm and researc hbased work against bullyvictim problems in school and hope to see similar developments in other cou ntries Factors of importance for good results The practical work within this national in itiative and the research associat ed with it in particular the largescale evaluations of the program that is has perm itted has given us very valuable experiences If I should tr y to summarise some of these experiences in a nutshell I would use the following overview diagram Insert Figure 9 about here In order to secure good results in sc hoolbased antibullying work we need adults in particular teachers and other school personnel and parents to some extent who have at least a certain degree of engagement or invo lvement and a reasonable level of a wareness of the nature and level of bullyvictim problems in the p articular school through a careful sur vey for example But It is 17 not enough that adults are engaged and aware of the problem s They must also have a decent knowledge of and practical skills in us ing intervention measures and eff orts that research has shown to be effective To achieve this a s ystematic enhancement of the com petence of the school personnel must take place In addition a good the im plementation model is absolutel y necessary Even a good program may fail if the implementation m odel does not measure up with the quality of the program In summary there are several important f actors or dimensions that mus t be considered and addressed in antibullying work but I am very confident that systematic work along these lines will produce good and lasting outcom e results 18 References Anderson M Kaufman J Simon T R Barrios L Paulozzi L Ryan G Ham nond R Modzeleski W Feucht T Potter L the SchoolAssociated Violent Dea ths Study Group 2001 Schoolassociated violent deaths in the United States 19941999 Journ al of the American Medical Association 286 26952702 Berkowitz L 1993 Aggression Its caus es consequences and control Ne w York McGrawHill Cook TD Campbell DT 1979 Quasiexperimentation Chicago Rand McNally Elliott D 1999 Editors introduction I n D Olweus S Limber 1999 Blu eprints for violence prevention Bullying Prevention Pro gram Institute of Behavioral Scienc e University of ColoradoBoulder USA Espelage DL Swearer S M 2004 Eds Bullying in American schoo ls Mahwah NJErlbaum Juvonen J Graham S 2001 Eds Peer harassment in school New York Guilford Publications Maccoby EE 1986 Social group ings in childhood their relationship to pr osocial and antisocial behavior in boys and girls I n D Olweus J Block M Radk eYarrow Eds Development of antisocial and prosocia l behavior New York Academic Press Olweus D 1973a Hackkycklingar och översittare Forskning om skolmobbning Stockholm Almqvist Wiksell Olweus D 1973b Personality and aggressio n I JK Cole DD Jensen Ed s Nebraska Symposium on Motivation 1972 Lincoln Universit y of Nebraska Press Olweus D 1977 Aggression and peer acc eptance in adolescent boys Two sh ortterm longitudinal studies of ratings Child Development 48 1301 1313 Olweus D 1978 Aggression in the schools Bullies and whipping boys Washington DC Hemisphere Wiley Olweus D 1979 Stability of aggressive react ion patterns in males A Revie w Psychological Bulletin 86 852875 Olweus D 1980 Fam ilial and temperamental determinants of aggressive behavior in adolescent bo ys A causal analysis Developmental Ps ychology 16 644660 Olweus D 1986 Mobbning vad vi vet och vad vi kan göra Stock holm Liber 19 Olweus D 1993 Bullying at scho ol What we know and what we can do Oxford Blackwell Publishers Published in Spanish in 19 98 as Conductas de acoso y am enaza entre escolares Madrid Ediciones Morata Olweus D 1996 The Revised Olweus BullyVictim Questionnaire Mim eo Bergen Norway Research Centre for Health Prom otion University of Bergen Olweus D 2001a Peer harassm ent A critical analysis and some im portant issues In J Juvonen S Graham Eds Peer harassm ent in school pp320 New York G uilford Publications Olweus D 2001b Olweus core progr am against bullying and antisoci al behavior A teacher handbook Research Centre for Health Promotion HEMIL Center Bergen Nor way Olweus D 2002 Mobbing I skolen N ye data om omfang og forandring over t id Manuscript Research Centre for Health Promotion H EMIL Center Bergen Norway Olweus D 2004a Bullying at scho ol Prevalence estimation a useful e valuation design and a new national initiative in Norway Associat ion for Child Psychology and Ps ychiatry Occasional Papers No 23 pp 517 Olweus D 2004b The Olweus Bull ying Prevention Program Design and implementation issues and a new national initiative in Norway pp 1336 In PK Smith D Pepler and K Rigby eds Bullying in schools How successful can interv entions be Cambridge Universit y Press Olweus D 2005 A useful evaluation design and effects of the Olweus Bu llying Prevention Program Psychology Crime Law 11 3894 02 Solberg M Olweus D 2003 Preva lence estimation of school bull ying with the Olweus BullyVictim Questionnaire Aggressive Behavior 29 239268 Olweus D Limber S 1999 Bluepr ints for violence prevention Bul lying Prevention Program Institute of Behavioral Science Univer sity of ColoradoBoulder USA Rapport 2000 2000 Vurdering av pr ogram og tiltak for å redusere pro blematferd og utvikle sosial kompetanse Evaluation of program s and measures to reduce problem behaviour and develop social competence Oslo Norway Kirk e undervisnings og forsk ningsdepartementet Smith P K Morita Y JungerTas J Olweus D Catalano R Slee P 1 999 Eds The nature of school bullying A cross national perspective London Routle dge Smith PK Pepler D and Rigby K Eds Bullying in schools How succ essful can interventions 20 be Cambridge University Press Footnote 1 The intervention package consis ts of the book Bullying at school what we know and what we can do Olweus 1993 also in Spanish 1998 Olweus core program against bullying and antisocial behavior A teacher handbook Olweus 2001b the Revised O lweus BullyVictim Questionnaire Olweus 1996 with acc ompanying PCprogram and a v ideo cassette on bullying Olweus Limber 1999 More inform ation about the intervention program and ordering of materials can be obtained from Olweusonlineno 21 FIGURE 1 Bullying Violence Bullying with physical violent means Aggression OL WEUS GR OU P AGA I N S T B U L L Y I N G 22 FIGURE 2 PERCENTAGE VICTIMIZED STUDENTS N10 800 0 5 10 15 20 Girls 18 163 144 10 6 67 95 46 Boys 202 176 1 27 125 103 99 6 4 5 6 7 8 9 10 Grades 4 7 Boys Girls 152 Grades 810 Boys G irls 80 OL WEUS GR OU P AGA I N S T B U L L YI N G 23 FIGURE 3 PERCENTAGE BULLYING STUDENTS N 10 800 0 5 10 15 20 Girls 42 35 35 24 39 63 45 Boys 78 97 79 74 78 114 103 4 5 6 7 8 9 10 Grades 47 Boys Girls 58 Grades 810 Boys Girls 74 OL WEUS GR OU P AGA I N S T B U L L YI N G 24 FIGURE 4 THE BULLYING CIRCLE Students modes of reactionroles in an acute bullying situation Take an active part but do not start the bullying Start the bullying and take an active part Support the bullying but do not take an active part Like the bullying but do not display open support Watch what happens is none of my business dont take a stand Dislike the bullying and help or try to help Dislike the bullying and think they ought to help but dont do it The one who is exposed the victim The bully bullies Follower Henchman Supporter passive bullybullies Passive supporter possible bully Disengaged onlooker Possible defender Defender of the victim B C D E A Y G F OL WEUS GR OU P AGA I N S T B U L L YI N G 25 FIGURE 5 OVERVIEW OF THE OLWEUS BULLYING PREVENTION PROGRAM i GENERAL PREREQUISITES AWARENESS AND INVOLVEMENT ON THE PART OF ADULTS MEASURES AT THE SCHOOL LEVEL QUESTIONNAIRE SUR VEY SCHOOL CONFERENC E DAY EFFECTIVE SUPERV ISION DURING RECESS AND LUNCH TIMES STAFF DISCUSSION G ROUPS FORMATION OF COORD INATING GROUP OL WEUS GR OU P AGA I N S T B U L L YI N G MEASURES AT THE CLASSROOM LEVEL CLASSROOM RULES AGAINST BULLYING CLASSROOM MEETINGS WITH STUDENTS MEETINGS WITH PARENTS OF THE CLASS MEASURES AT THE INDIVIDUAL LEVEL SERIOUS TALKS WITH BULLIES AND VICTIMS SERIOUS TALKS WITH PARENTS OF INVOLVED STUDENTS DEVELOPM ENT OF INDIVIDUAL INTERVENTION PLANS 26 FIGURE 6 PERCENTAGE BULLIED STUDENTS IN GRADES 47 Dat a fro m 3 co ho r t s of s c ho ol s w hi c h b eg an i mp lem ent ing t he O lw eus BP Pr ogr am in 200 120 03 nu mb er of st ude nt s 21 000 13 3 15 14 2 86 1 02 9 4 0 5 10 15 20 G irls Bo ys C om bin ed Percentage bullied students reduced by 34 in one year from 142 to 94 girls reduction by 35 from 133 to 86 boys reduction by 32 from 15 to 102 Left bars before intervention Right bars after 8 months with the Olweus BP Program 27 FIGURE 7 PERCENTAGE BULLYING STUDENTS IN GRADES 47 Dat a fro m 3 co ho r t s of s c ho ol s w hi c h b eg an i mp lem ent ing t he O lw eus BP Pr ogr am in 200 120 03 nu mb er of st ude nt s 21 000 Percentage bullying students reduced by 44 in one year from 55 to 31 girls reduction by 48 from 33 to 17 boys reduction by 42 from 76 to 44 Left bars before intervention Right bars after 8 months with the Olweus BP Program 33 76 55 17 44 3 1 0 5 10 G irls Boy s C om bin ed OL WEUS GR OU P AGA I N S T B U L L YI N G OL WEUS GR OU P AGA I N S T B U L L YI N G 28 FIGURE 8 Training of instructors The Oslo c lass Instru ctor 1 School 1 35 k ey staff Teacher discu ssion group all teachin g st aff S chool 5 35 k ey staff In stru ctor 15 The Berg en class The Narvik class The Olweusg roup HEMIL Cen tre TRAINING OF INSTRUCTORS OL WEUS GR OU P AGA I N S T B U L L YI N G OL WEUS GR OU P AGA I N S T B U L L YI N G 29 FIGURE 9 FACTORS OF KEY IMPORTANCE AWARENESS INVOLVEMENT KNOWLEDGE OF RESEARCHBASED COUNTERMEASURES POSITIVE RESULTS COMPETENCE ENHANCING

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O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O 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O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I I O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O B I I O O O O O O O O O O O O O B O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O 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