Improving the implementation of KiVa antibullying program with tailored support: Study protocol for a cluster randomized controlled trial.

BACKGROUND: There are no evidence-based models to support the implementation of school-based bullying prevention programs. Our primary objective is to examine the impact of tailored support on the implementation of the KiVa antibullying program. Our second objective is to evaluate whether the offered support influences student outcomes (e.g., victimization, bullying perpetration). We also assess the cost-effectiveness of the provided support and conduct a process evaluation. METHODS: In a cluster randomized control trial (cRCT), we compare program fidelity between schools that receive implementation support and those that do not. Twenty-four (N = 24) schools in Finland were randomized to either the IMPRES condition (receiving support, n = 12) or the control group (KiVa as usual, n = 12). In the IMPRES condition, pre-assessment and staff training were organized, and a selected team of staff members received four mentoring sessions during one academic year. Staff and students answer questionnaires at the end of school year 0, at post-intervention (year 1) and again at the 1-year follow-up (year 2). Our primary outcomes concern two main program components - universal and indicated actions - reflecting program fidelity. As secondary outcomes, we examine the level of bullying victimization and perpetration as well as students' perception of several program fidelity indicators. Finally, we assess several tertiary outcomes, collect resource data and conduct qualitative interviews to perform additional analyses. CONCLUSION: This trial will inform us of whether implementation support can boost program fidelity and have a distal impact on bullying prevalence. TRIAL REGISTRATION: ISRCTN15558617 https://doi.org/10.1186/ISRCTN15558617.

Transcranial magnetic stimulation of early visual cortex suppresses conscious representations in a dichotomous manner without gradually decreasing their precision.

Transcranial magnetic stimulation (TMS) of early visual cortex can suppresses visual perception at early stages of processing. The suppression can be measured both with objective forced-choice tasks and with subjective ratings of visual awareness, but there is lack of objective evidence on how and whether the TMS influences the quality of representations. Does TMS decrease the precision of representations in graded manner, or does it lead to dichotomous, "all-or-nothing" suppression. We resolved this question by using a continuous measure of the perceptual error: the observers had to perceive the orientation of a target (Landort-C) and to adjust the orientation of a probe to match that of the target. Mixture modeling was applied to estimate the probability of guess trials and the standard deviation of the non-guess trials. TMS delivered 60-150 ms after stimulus-onset influenced only the guessing rate, whereas the standard deviation (i.e., precision) was not affected. This suggests that TMS suppressed representations dichotomously without affecting their precision. The guessing probability correlated with subjective visibility ratings, suggesting that it measured visual awareness. In a control experiment, manipulation of the stimulus contrast affected the standard deviation of the errors, indicating that contrast has a gradual influence on the precision of representations. The findings suggest that TMS of early visual cortex suppresses perception in dichotomous manner by decreasing the signal-to-noise ratio by increasing the noise level, whereas reduction of the signal level (i.e., contrast) decreases the precision of representations.