Fundamentals in Urology Webcast (2017): AUA Update: Office of Research
This 4-day course is designed to apply basic science knowledge and principles in development of treatment algorithms. Attendees are provided with valuable skills in developing a rational methodological approach to application of knowledge which will contribute to positive outcomes for patients. Attendees will discover the importance of the study of basic sciences and how it transfers into the lifelong learning process and medical practice. This course is designed to ensure a fundamental knowledge of the "why" behind a broad expanse of general urologic conditions. A thorough knowledge of the basic science behind the treatments will allow for better counseling and education of patients by all clinical urologic practitioners.
Pathology
Held a day prior to the Fundamentals in Urology Course, the Pathology optional course provides urologists and allied health professionals an overview of the main pathological characteristics and biology of common neoplasms of the kidney, urinary tract, prostate and testis.
Urodynamics
Held a day prior to the Fundamentals in Urology Course, the Urodynamics optional course provides a detailed overview of urodynamic testing techniques and pitfalls including hydrodynamic principles. Emphasis is placed on the interpretation of urodynamics, including recognizing abdominal and detrusor physiologic events, urethral resistance during bladder filling and micturition, urinary incontinence, and recognition of physiologic and technical artifacts.
Target Audience
- Residents
- Allied Health
- Program Directors
Learning Objectives
After attending this course, participants will be able to:
Nephrolithiasis and Infections
- Recognize the basic pathophysiology of nephrolithiasis.
- Identify the indications and options for the medical evaluation of recurrent and first time stone formers.
- Establish an effective algorithm for the medical management of nephrolithiasis.
- Distinguish the appropriate timing of diagnostic methods for treatment of bacteria and fungi in the urinary tract.
Incontinence, Ethics, Obstruction, and Pelvic Pain
- Recall the pathophysiology of pelvic organ prolapse and stress incontinence.
- Describe how to treat pelvic organ prolapse and stress incontinence conditions.
- Review foundational concepts of bioethics.
- Define the meaning of “profession”.
- Discuss key aspects of consent, capacity, research and ethics.
- Identify how to apply consent, capacity, research and ethics to the practice of urology.
- Recognize the role of prophylacitic antibiotics and lower urinary tract imaging for prenatal urinary tract dilation.
- Define the true incidence of IC/BPS and CP/CPPS in the US population.
- Recall what is currently believed about the pathophysiology of chronic pelvic pain.
- Recognize how to use the AUA guidelines to develop a treatment plan for patients with IC/BPS and CP/CPPS.
- Describe current research in pelvic pain and possible new treatment options.
Minimally Invasive Surgery, BPH, Outcomes and Pediatrics
- Identify the physics underlying laser energy, complications occurring due to pneumoperitoneum, and optimizing delivery of shock wave energy.
- Define the medical therapies designed to address benign enlargement of the prostate.
- Explain the basic development of the lower and upper urinary tract including the bladder, kidney and ureters.
- Identify clinical situations that may be encountered if aberrant development occurs in any of the above organ systems.
- Recognize the validity of randomized clinical trials.
- Recognize how to apply the results of outcomes research to clinical practice.
Imaging and Prostate Cancer
- Describe the history of M1 Prostate cancer therapies.
- Identify basics in ADT management.
- Discuss basic science and clinical outcomes of new therapies.
- Identify the appropriate indications for MRI and the basic MRI sequences used in urinary tract imaging.
- Distinguish benign from malignant renal masses.
- Recognize how an MRI of the prostate and urethra can be useful and the key features of prostate tumor on MRI.
Adrenal and Renal Physiology, Bowel Diversions, and Bladder Cancer
- Describe how fundamentals of adrenal anatomy and physiology integrate into the care of the urologic patient.
- Discuss renal physiology for the urologist, especially for the following pathologic states: TUR syndrome, upper urinary tract obstruction, post-obstructive diuresis, pregnancy, renovascular hypertension, and juxtaglomerular tumor.
- Review the major genetic alterations that are present in bladder cancers.
- Define “intrinsic subtypes”.
- Discuss their implications for disease heterogeneity and precision medicine
- Review current understanding of immunotherapy for treatment of bladder cancer.
- Explain rationale for choosing a urinary diversion based on the metabolic derangements associated with each segment of bowel.
Male Infertility, Disorders of Differentiation, and Kidney Cancer
- Explain male reproductive anatomy and physiology.
- Discuss a basic clinical overview of male reproductive medicine and surgery.
- Describe the current clinical and surgical management of all types of localized as well as advanced kidney cancer.
PSA and the Prostate, Neurogenic Bladder, and Reproductive Biology
- Review the current data on the controversies, clinical trials and laboratory testing for prostate cancer screening in asymptomatic men.
- Explain lower urinate tract neurobiology and how disease processes, such as neurologic disease; result in predictable lower urinary tract dysfunction.
- Describe penile anatomy and the physiology of erection.
- Describe the major causes of erectile dysfunction.
- Identify the basic classification, diagnosis and treatment of female sexual dysfunction.
Course Directors:
Tracey Lynn Krupski MD,MPH: Argos: Scientific Study or Trial; NCI- RAZOR: Scientific Study or Trial; Eleven Biotherapeutics ( formally Viventia): Scientific Study or Trial; American Cancer Society: Scientific Study or Trial
Jay D. Raman, MD: American Kidney Stone Management: Investment Interest; Pacific Edge Biotechnology: Consultant or Advisor, Scientific Study or Trial
Course Faculty:
Trinity J Bivalacqua MD: heat biologic: Scientific Study or Trial; photocure: Meeting Participant or Lecturer, Scientific Study or Trial; taris: Scientific Study or Trial
Robert James Evans MD,FACS: allergan: Scientific Study or Trial; urigen: Investment Interest; allergan allergan: Scientific Study or Trial; TARIS: Scientific Study or Trial; aquinox: Consultant or Advisor, Scientific Study or Trial
Patricio C. Gargollo MD: Nothing to disclose
Leonard G. Gomella, MD: Astellas: Consultant or Advisor; Janssen: Consultant or Advisor; Wolters Kluwer: Health Publishing; McGraw Hill: Health Publishing; Merck Manual: Health Publishing; Canadian Journal of Urology: Health Publishing; MDx Health: Consultant or Advisor; Merck Pharmaceuticals: Consultant or Advisor; Bayer: Consultant or Advisor
Mikel L. Gray, PHD: Laborie Medical: Meeting Participant or Lecturer; 3M Inc: Consultant or Advisor
C.D. Anthony Herndon MD,FAAP,: Nothing to disclose
Tracey Lynn Krupski MD,MPH: Argos: Scientific Study or Trial; NCI- RAZOR: Scientific Study or Trial; Eleven Biotherapeutics ( formally Viventia): Scientific Study or Trial; American Cancer Society: Scientific Study or Trial
Alexander Kutikov, MD, FACS: UrologyMatch.com LLC: Leadership Position; Visible Health, Inc: Leadership Position; Genomic Health, Inc: Consultant or Advisor, Meeting Participant or Lecturer; Novartis, Inc: Consultant or Advisor
Richard Kao Lee, MD: Nothing to disclose
W. Marston Linehan, MD: Nothing to disclose
Puneet Masson MD: Nothing to disclose
Victor William Nitti MD: Astellas: Health Publishing, Scientific Study or Trial; Allergan: Health Publishing, Scientific Study or Trial; Serenity Pharmeuticals: Investment Interest; Cook Myosite: Scientific Study or Trial; Medtronic: Scientific Study or Trial
Afshan Ornan, MD: Nothing to disclose
Gladell Paner, MD: Amirsys, Inc.: Health Publishing
Michel Arthur Pontari MD: Lilly: Consultant or Advisor; aquinox: Consultant or Advisor, Scientific Study or Trial
Glenn M. Preminger, MD: Boston Scientific: Consultant or Advisor; Endourological Society: Leadership Position; UpToDate: Health Publishing; Retrophin: Consultant or Advisor, Meeting Participant or Lecturer
Jay D. Raman, MD: American Kidney Stone Management: Investment Interest; Pacific Edge Biotechnology: Consultant or Advisor, Scientific Study or Trial
William Stuart Reynolds MD,MPH: Nothing to disclose
Charles Douglas Scales Jr., M.D.: NIH/National Institute on Aging: Scientific Study or Trial; Society of Urology Chairpersons and Program Directors: Scientific Study or Trial; Filament Biosolutions: Scientific Study or Trial; NIH/National Institute of Diabetes and Digestive and Kidney Diseases: Scientific Study or Trial; Gilead: Consultant or Advisor; Astra-Zeneca: Scientific Study or Trial
Eric Alan Singer, MD, MA: Nothing to disclose
Ryan P. Smith MD: Nothing to disclose
Necole M Streeper MD: Nothing to disclose
Duong D. Tu, MD: Nothing to disclose
Michael B. Williams MD,MS: Astellas: Scientific Study or Trial; Jannsen: Scientific Study or Trial; Pacific Edge Diagnostics: Consultant or Advisor
Planner Disclosures
Education Council
Timothy Charles Brand, M.D.: Nothing to disclose
Anthony A. Caldamone MD: Nothing to disclose
Peter Robert Carroll, MD, MPH: NIH: Scientific Study or Trial; Department of Defense: Scientific Study or Trial; AUA Update: Leadership Position; Genomic Health: Scientific Study or Trial
Matthew S. Christman MD: Nothing to disclose
Jody Donaldson: Nothing to disclose
Shelby Englert: Nothing to disclose
Matthew Thomas Gettman, MD: Nothing to disclose
Inderbir Singh Gill ,MD, M.Ch.: Nothing to disclose
Howard B. Goldman, MD: allergan: Consultant or Advisor; astellas: Consultant or Advisor; Medtronic: Consultant or Advisor, Meeting Participant or Lecturer, Scientific Study or Trial; Cook: Scientific Study or Trial; Nuvectra: Consultant or Advisor; Axonics: Consultant or Advisor
William C. Huang, MD: Photocure: Scientific Study or Trial; Karl Storz: Scientific Study or Trial
William C. Hulbert Jr. MD: Nothing to disclose
Brant Inman, M.D., MS, FRCSC: Dendreon: Scientific Study or Trial; Abbott Laboratories: Scientific Study or Trial; Genentech Inc: Scientific Study or Trial; Combat Medical: Consultant or Advisor; FKD Therapies: Consultant or Advisor; AstraZeneca: Consultant or Advisor; Taris Biomedical: Consultant or Advisor
Mark L. Jordan MD,FACS: Nothing to disclose
Hari K. Koul, MSC,PHD: Novartis Pharmaceuticals: Consultant or Advisor; Urologic Research: Leadership Position; PLOS one: Leadership Position; OMICS group: Leadership Position; Open Access Publishing: Leadership Position, Health Publishing
Martin A. Koyle MD: Nothing to disclose
Yair Lotan ,MD: abbott: Scientific Study or Trial; Cepheid: Consultant or Advisor, Scientific Study or Trial; Pacific Edge: Scientific Study or Trial; FKD: Scientific Study or Trial; MDxHealth: Consultant or Advisor, Scientific Study or Trial; biocancell: Scientific Study or Trial; Genomic Health: Scientific Study or Trial; GenomeDx Biosciences Inc: Scientific Study or Trial; photocure: Consultant or Advisor, Scientific Study or Trial
Nicole Lara Miller ,MD: Present: Boston Scientific Corporation: Consultant or Advisor, Meeting Participant or Lecturer; Practical Reviews In Urology: Health Publishing
Manoj Monga, MD, FACS: Fortec: Other; endourology society: Leadership Position
Victor William Nitti MD: Astellas: Health Publishing, Scientific Study or Trial; Allergan: Health Publishing, Scientific Study or Trial; Serenity Pharmeuticals: Investment Interest; Cook Myosite: Scientific Study or Trial; Medtronic: Scientific Study or Trial
Christopher Porter, MD: Nothing to disclose
Ganesh V. Raj MD, PhD: Ptares: Owner, Product Development; C-diagnostics corp: Consultant or Advisor, Investment Interest; amgen: Meeting Participant or Lecturer; Johnson and Johnson: Consultant or Advisor, Owner, Product Development; Astellas: Meeting Participant or Lecturer; ASTELLAS: Consultant or Advisor, Meeting Participant or Lecturer; Janssen: Owner, Product Development; BAYER: Consultant or Advisor, Meeting Participant or Lecturer; SANOFI: Consultant or Advisor, Meeting Participant or Lecturer; Gaudium: Leadership Position, Investment Interest, Owner, Product Development; Medivation: Consultant or Advisor, Meeting Participant or Lecturer, Scientific Study or Trial
Jay D. Raman, MD: American Kidney Stone Management: Investment Interest; Pacific Edge Biotechnology: Consultant or Advisor, Scientific Study or Trial
Heather Schultz, NP: SUNA: Meeting Participant or Lecturer
Karl-Dietrich Sievert ,MD, PhD: AMS: Meeting Participant or Lecturer; Medtronics: Meeting Participant or Lecturer, Scientific Study or Trial; Allergen: Consultant or Advisor, Meeting Participant or Lecturer, Scientific Study or Trial; Neotract: Meeting Participant or Lecturer; Stimguard: Meeting Participant or Lecturer, Scientific Study or Trial
Joseph A. Smith Jr.,MD: Nothing to disclose
Ryan Patrick Terlecki, MD, FACS: American Medical Systems: Consultant or Advisor, Other; Allergan: Scientific Study or Trial
Edouard John Trabulsi, MD: Nothing to disclose
Accreditation Statement
The American Urological Association (AUA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Credit Designation
The American Urological Association designates this enduring material for a maximum of 30.75 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
If you have already received credit for this course by attending it or watching it live you cannot receive additional credit.
Other Learners
The AUA is not accredited to offer credit to participants who are not MDs or DOs. However, the AUA will issue documentation of participation that states that the activity was certified for AMA PRA Category 1 Credit™.
Evidence Based Content
It is the policy of the AUA to ensure that the content contained in this CME activity is valid, fair, balanced, scientifically rigorous, and free of commercial bias.
AUA Disclosure Policy
All persons in a position to control the content of an educational activity (i.e., activity planners, presenters, authors) participating in an educational activity provided by the AUA are required to disclose to the provider any relevant financial relationships with any commercial interest. The AUA must determine if the individual’s relationships may influence the educational content and resolve any conflicts of interest prior to the commencement of the educational activity. The intent of this disclosure is not to prevent individuals with relevant financial relationships from participating, but rather to provide learners information with which they can make their own judgments.
Resolution of Identified Conflict of Interest
All disclosures will be reviewed by the program/course directors or editors for identification of conflicts of interest. Peer reviewers, working with the program directors and/or editors, will document the mechanism(s) for management and resolution of the conflict of interest and final approval of the activity will be documented prior to implementation. Any of the mechanisms below can/will be used to resolve conflict of interest:
- Peer review for valid, evidence-based content of all materials associated with an educational activity by the course/program director, editor, and/or Education Content Review Committee or its subgroup.
- Limit content to evidence with no recommendations
- Introduction of a debate format with an unbiased moderator (point-counterpoint)
- Inclusion of moderated panel discussion
- Publication of a parallel or rebuttal article for an article that is felt to be biased
- Limit equipment representatives to providing logistics and operation support only in procedural demonstrations
- Divestiture of the relationship by faculty
Off-label or Unapproved Use of Drugs or Devices
It is the policy of the AUA to require the disclosure of all references to off-label or unapproved uses of drugs or devices prior to the presentation of educational content. The audience is advised that this continuing medical education activity may contain reference(s) to off-label or unapproved uses of drugs or devices. Please consult the prescribing information for full disclosure of approved uses.
Disclaimer
The opinions and recommendations expressed by faculty, authors and other experts whose input is included in this program are their own and do not necessarily represent the viewpoint of the AUA.
Reproduction Permission
Reproduction of written materials developed for this AUA course is prohibited without the written permission from individual authors and the American Urological Association.
Faculty Disclosures
Course Directors:
Tracey Lynn Krupski MD,MPH: Argos: Scientific Study or Trial; NCI- RAZOR: Scientific Study or Trial; Eleven Biotherapeutics ( formally Viventia): Scientific Study or Trial; American Cancer Society: Scientific Study or Trial
Jay D. Raman, MD: American Kidney Stone Management: Investment Interest; Pacific Edge Biotechnology: Consultant or Advisor, Scientific Study or Trial
Course Faculty:
Trinity J Bivalacqua MD: heat biologic: Scientific Study or Trial; photocure: Meeting Participant or Lecturer, Scientific Study or Trial; taris: Scientific Study or Trial
Robert James Evans MD,FACS: allergan: Scientific Study or Trial; urigen: Investment Interest; allergan allergan: Scientific Study or Trial; TARIS: Scientific Study or Trial; aquinox: Consultant or Advisor, Scientific Study or Trial
Patricio C. Gargollo MD: Nothing to disclose
Leonard G. Gomella, MD: Astellas: Consultant or Advisor; Janssen: Consultant or Advisor; Wolters Kluwer: Health Publishing; McGraw Hill: Health Publishing; Merck Manual: Health Publishing; Canadian Journal of Urology: Health Publishing; MDx Health: Consultant or Advisor; Merck Pharmaceuticals: Consultant or Advisor; Bayer: Consultant or Advisor
Mikel L. Gray, PHD: Laborie Medical: Meeting Participant or Lecturer; 3M Inc: Consultant or Advisor
C.D. Anthony Herndon MD,FAAP,: Nothing to disclose
Tracey Lynn Krupski MD,MPH: Argos: Scientific Study or Trial; NCI- RAZOR: Scientific Study or Trial; Eleven Biotherapeutics ( formally Viventia): Scientific Study or Trial; American Cancer Society: Scientific Study or Trial
Alexander Kutikov, MD, FACS: UrologyMatch.com LLC: Leadership Position; Visible Health, Inc: Leadership Position; Genomic Health, Inc: Consultant or Advisor, Meeting Participant or Lecturer; Novartis, Inc: Consultant or Advisor
Richard Kao Lee, MD: Nothing to disclose
W. Marston Linehan, MD: Nothing to disclose
Puneet Masson MD: Nothing to disclose
Victor William Nitti MD: Astellas: Health Publishing, Scientific Study or Trial; Allergan: Health Publishing, Scientific Study or Trial; Serenity Pharmeuticals: Investment Interest; Cook Myosite: Scientific Study or Trial; Medtronic: Scientific Study or Trial
Afshan Ornan, MD: Nothing to disclose
Gladell Paner, MD: Amirsys, Inc.: Health Publishing
Michel Arthur Pontari MD: Lilly: Consultant or Advisor; aquinox: Consultant or Advisor, Scientific Study or Trial
Glenn M. Preminger, MD: Boston Scientific: Consultant or Advisor; Endourological Society: Leadership Position; UpToDate: Health Publishing; Retrophin: Consultant or Advisor, Meeting Participant or Lecturer
Jay D. Raman, MD: American Kidney Stone Management: Investment Interest; Pacific Edge Biotechnology: Consultant or Advisor, Scientific Study or Trial
William Stuart Reynolds MD,MPH: Nothing to disclose
Charles Douglas Scales Jr., M.D.: NIH/National Institute on Aging: Scientific Study or Trial; Society of Urology Chairpersons and Program Directors: Scientific Study or Trial; Filament Biosolutions: Scientific Study or Trial; NIH/National Institute of Diabetes and Digestive and Kidney Diseases: Scientific Study or Trial; Gilead: Consultant or Advisor; Astra-Zeneca: Scientific Study or Trial
Eric Alan Singer, MD, MA: Nothing to disclose
Ryan P. Smith MD: Nothing to disclose
Necole M Streeper MD: Nothing to disclose
Duong D. Tu, MD: Nothing to disclose
Michael B. Williams MD,MS: Astellas: Scientific Study or Trial; Jannsen: Scientific Study or Trial; Pacific Edge Diagnostics: Consultant or Advisor
Planner Disclosures
Education Council
Timothy Charles Brand, M.D.: Nothing to disclose
Anthony A. Caldamone MD: Nothing to disclose
Peter Robert Carroll, MD, MPH: NIH: Scientific Study or Trial; Department of Defense: Scientific Study or Trial; AUA Update: Leadership Position; Genomic Health: Scientific Study or Trial
Matthew S. Christman MD: Nothing to disclose
Jody Donaldson: Nothing to disclose
Shelby Englert: Nothing to disclose
Matthew Thomas Gettman, MD: Nothing to disclose
Inderbir Singh Gill ,MD, M.Ch.: Nothing to disclose
Howard B. Goldman, MD: allergan: Consultant or Advisor; astellas: Consultant or Advisor; Medtronic: Consultant or Advisor, Meeting Participant or Lecturer, Scientific Study or Trial; Cook: Scientific Study or Trial; Nuvectra: Consultant or Advisor; Axonics: Consultant or Advisor
William C. Huang, MD: Photocure: Scientific Study or Trial; Karl Storz: Scientific Study or Trial
William C. Hulbert Jr. MD: Nothing to disclose
Brant Inman, M.D., MS, FRCSC: Dendreon: Scientific Study or Trial; Abbott Laboratories: Scientific Study or Trial; Genentech Inc: Scientific Study or Trial; Combat Medical: Consultant or Advisor; FKD Therapies: Consultant or Advisor; AstraZeneca: Consultant or Advisor; Taris Biomedical: Consultant or Advisor
Mark L. Jordan MD,FACS: Nothing to disclose
Hari K. Koul, MSC,PHD: Novartis Pharmaceuticals: Consultant or Advisor; Urologic Research: Leadership Position; PLOS one: Leadership Position; OMICS group: Leadership Position; Open Access Publishing: Leadership Position, Health Publishing
Martin A. Koyle MD: Nothing to disclose
Yair Lotan ,MD: abbott: Scientific Study or Trial; Cepheid: Consultant or Advisor, Scientific Study or Trial; Pacific Edge: Scientific Study or Trial; FKD: Scientific Study or Trial; MDxHealth: Consultant or Advisor, Scientific Study or Trial; biocancell: Scientific Study or Trial; Genomic Health: Scientific Study or Trial; GenomeDx Biosciences Inc: Scientific Study or Trial; photocure: Consultant or Advisor, Scientific Study or Trial
Nicole Lara Miller ,MD: Present: Boston Scientific Corporation: Consultant or Advisor, Meeting Participant or Lecturer; Practical Reviews In Urology: Health Publishing
Manoj Monga, MD, FACS: Fortec: Other; endourology society: Leadership Position
Victor William Nitti MD: Astellas: Health Publishing, Scientific Study or Trial; Allergan: Health Publishing, Scientific Study or Trial; Serenity Pharmeuticals: Investment Interest; Cook Myosite: Scientific Study or Trial; Medtronic: Scientific Study or Trial
Christopher Porter, MD: Nothing to disclose
Ganesh V. Raj MD, PhD: Ptares: Owner, Product Development; C-diagnostics corp: Consultant or Advisor, Investment Interest; amgen: Meeting Participant or Lecturer; Johnson and Johnson: Consultant or Advisor, Owner, Product Development; Astellas: Meeting Participant or Lecturer; ASTELLAS: Consultant or Advisor, Meeting Participant or Lecturer; Janssen: Owner, Product Development; BAYER: Consultant or Advisor, Meeting Participant or Lecturer; SANOFI: Consultant or Advisor, Meeting Participant or Lecturer; Gaudium: Leadership Position, Investment Interest, Owner, Product Development; Medivation: Consultant or Advisor, Meeting Participant or Lecturer, Scientific Study or Trial
Jay D. Raman, MD: American Kidney Stone Management: Investment Interest; Pacific Edge Biotechnology: Consultant or Advisor, Scientific Study or Trial
Heather Schultz, NP: SUNA: Meeting Participant or Lecturer
Karl-Dietrich Sievert ,MD, PhD: AMS: Meeting Participant or Lecturer; Medtronics: Meeting Participant or Lecturer, Scientific Study or Trial; Allergen: Consultant or Advisor, Meeting Participant or Lecturer, Scientific Study or Trial; Neotract: Meeting Participant or Lecturer; Stimguard: Meeting Participant or Lecturer, Scientific Study or Trial
Joseph A. Smith Jr.,MD: Nothing to disclose
Ryan Patrick Terlecki, MD, FACS: American Medical Systems: Consultant or Advisor, Other; Allergan: Scientific Study or Trial
Edouard John Trabulsi, MD: Nothing to disclose
AUA Privacy and Confidentiality Policy
www.auanet.org/education/confidentiality-statement.cfm
Contact Information
American Urological Association
Office of Education
1000 Corporate Blvd.
Linthicum, MD 21090
Toll Free (U.S. only): 1-866-RING AUA (1-866-746-4282)
Phone: 410-689-3700
Fax: 410-689-3800
CME Information
For all inquiries regarding CME credit email: cme@AUAnet.org