Cyberbullying Perpetration and Victimization Among Middle-School Students

Objectives. We examined correlations between gender, race, sexual identity, and technology use, and patterns of cyberbullying experiences and behaviors among middle-school students.Methods. We collected a probability sample of 1285 students alongside the 2012 Youth Risk Behavior Survey in Los Angeles Unified School District middle schools. We used logistic regressions to assess the correlates of being a cyberbully perpetrator, victim, and perpetrator–victim (i.e., bidirectional cyberbullying behavior).Results. In this sample, 6.6% reported being a cyberbully victim, 5.0% reported being a perpetrator, and 4.3% reported being a perpetrator–victim. Cyberbullying behavior frequently occurred on Facebook or via text messaging. Cyberbully perpetrators, victims, and perpetrators–victims all were more likely to report using the Internet for at least 3 hours per day. Sexual-minority students and students who texted at least 50 times per day were more likely to report cyberbullying victimization. Girls were more likely to report being perpetrators–victims.Conclusions. Cyberbullying interventions should account for gender and sexual identity, as well as the possible benefits of educational interventions for intensive Internet users and frequent texters.Cyberbullying is the “willful and repeated harm inflicted [on another] through the use of computers, cell phones, or other electronic devices.”1^(p5) Among 6th- through 10th-grade students nationally, 4% reported being cyberbullying perpetrators, 5% reported being a victim of cyberbullying, and 5% reported being perpetrators–victims (meaning that they have both perpetrated and been victimized by cyberbullying) during the previous 2 months.2 Among middle-school students in the southeastern and northwestern United States, a nonprobability sample of 3767 students by Kowalski and Limber3 found that 11% reported being a victim of cyberbullying, 4% were cyberbullying perpetrators, and 7% were perpetrators–victims during the previous 2 months. Cyberbullying may be more insidious than traditional bullying, because cyberbullying can quickly reach wide audiences (e.g., e-mails sent to an entire school), can be perpetrated anonymously, and is not bound to in-person interactions.4,5 Although cyberbullying has garnered widespread media attention, to our knowledge, no previous study has explored correlates of cyberbullying with a representative probability sample in an urban middle-school sample.Cyberbullying is associated with a host of health and behavioral health consequences. Research has suggested that cyberbullying may have a greater effect on depression and suicidal ideation than traditional offline bullying.6 Both perpetration and victimization are associated with mental health consequences, including lower self-esteem,7 recent depressive symptoms,5,8,9 and suicidal ideation.5,8,10 Cyberbullying perpetrators are more likely to have problems with their behavior, peer relationships, and emotions, and are less likely to be prosocial than their peers who are neither cyberbullying perpetrators nor victims of cyberbullying.11 Specifically, female cyberbullying perpetrators express greater anxiety and depression than their female peers who are not cyberbullying perpetrators.12 Cyberbullying victimization is also strongly associated with substance use, violent behavior, and risky sexual behavior among high-school students.10Cyberbullying disproportionately affects youths who are already vulnerable to mental health and behavioral health disparities, including members of sexual minorities (i.e., gay, lesbian, bisexual), girls, and racial and ethnic minorities. More than half of sexual-minority middle- and high-school students nationally report being a cyberbully victim during the previous year, with almost one fifth reporting often or frequent victimization.13 Female students are significantly more likely to be cyberbully perpetrators–victims than their male peers.9,14 Studies have reported that male students are significantly more likely to be cyberbullying perpetrators2,15 and significantly less likely to be cyberbully victims.2,6,9 Middle-school boys are more likely to cyberbully others because of their race, sexual identity, or both.16 African American students are more likely to be cyberbully perpetrators and Hispanic students are more likely to be cyberbully perpetrators–victims than their White peers.2Cyberbullying may occur across a variety of technology platforms, and the specific qualities of each platform may affect how cyberbullying is perpetrated and experienced. Earlier studies suggested that instant messaging, chat rooms, and message boards were the most common mediums for middle-school students who experienced cyberbullying.3,17 More recently, youths have migrated to social media platforms such as Facebook,18–20 necessitating an examination of cyberbullying across more contemporary and emerging platforms for youth interaction.More frequent use of technology has also been associated with cyberbullying. Students who use the Internet for at least 3 hours per day and those who use instant messaging and Web cams are significantly more likely to have been cyberbully victims at least 7 times during the previous year.17 Frequent Internet users are significantly more likely to be cyberbully perpetrators, victims, and perpetrators–victims.14Research has shown that even though cyberbullying takes place in a virtual space, most cyberbullying perpetrators know their victims and vice versa. Moreover, 73% of victims reported being “pretty sure” or “totally sure” about the identity of their cyberbully, with 51% of cyberbullying perpetrators identified as a classmate, 43% as someone who they only knew online, and 20% as an in-person, nonclassmate relation.17 Cyberbullying perpetrators of middle-school victims were most often a classmate or a stranger; cyberbullying perpetrators most often reported that they cyberbullied classmates, friends, and strangers.3This study expanded previous work with high-school samples2 and nonprobability samples of middle-school students3,17 to explore the role of sexual identity, gender, race, and technology use patterns in a random sample of urban middle-school students in Los Angeles County, California. The study focused on demographic characteristics including sexual identity, patterns of technology use (i.e., frequency of Internet use, texting, parental rules regarding Internet use), and platforms on which middle-school students experience cyberbullying (i.e., Facebook, Twitter, e-mail, text messaging) to inform interventions to disrupt this maladaptive behavior and help protect early adolescents from the consequences of cyberbullying.     

How active are patients in setting goals during rehabilitation after stroke? A qualitative study of clinician perceptions

Purpose: We investigated stroke rehabilitation clinician’s perceptions of the patient as an active partner in setting goals within stroke rehabilitation and factors that influence patient engagement.

Methods: Semi-structured interviews, subject to general inductive analysis with 20 Clinicians’ working in three UK based stroke rehabilitation teams (one in-patient ward and two community based rehabilitation teams).

Results: There were three key themes that impacted on the patients active involvement in setting goals for rehabilitation after stroke: Patient barriers to goal setting (knowledge of the patient and family, who is the patient and the stroke’s impact); How we work as a team (the role of the patient in setting goals, the effect of clinician attributes on goal setting); and How systems impact goal setting (goal-setting practice, home versus hospital, and professional/funder expectations of clinicians’).

Conclusions: Goal setting served a range of different, sometimes conflicting, functions within rehabilitation. Clinicians’ identified the integral nature of goals to engage and motivate patients and to provide direction and purpose for rehabilitation. Further, there was an identified need to consider the impact of prioritizing clinician-derived goals at the expense of patient-identified goals. Lastly the reliance on the SMART goal format requires further consideration, both in terms of the proposed benefits and whether they disempower the patient during rehabilitation.

• Implications for rehabilitation

• Goal setting is often promoted as a relatively simple, straightforward way to structure interactions with patients

• Patient-related factors together with resourcing constraints are significant barriers to patient-centered goal setting, particularly during inpatient rehabilitation

• Clinicians need to have pragmatic tools that can be integrated into practice to ensure that goal-setting practice can be maximized for patients with different intrinsic characteristics

     

Dynamics of the follicle-stimulating hormone (FSH)-inhibin B feedback loop and its role in regulating spermatogenesis in the adult male rhesus monkey (Macaca mulatta) as revealed by unilateral orchidectomy

The purpose of this study was to document the morphological changes in the seminiferous epithelium that underlie the compensatory testicular hypertrophy observed in response to unilateral orchidectomy (UO) in the adult rhesus monkey and to describe the concomitant response in the endocrine feedback loops controlling testicular function in this species. Adult male monkeys were implanted with indwelling venous catheters; seven animals were then subjected to UO (data are presented from six) and three to sham UO. Profiles of circulating concentrations of FSH, LH, testosterone (T), inhibin B, and pro-alpha-C were monitored in 12-h series of sequential blood samples collected before, on the day of UO (day 0), and on days 1, 2, 4, 8, 16, 32, and 42 or 43 after UO. In the UO monkeys, the remaining testis was taken on day 44. Sertoli and germ cells in the removed and remaining testes were counted and expressed either as number per testis or, in the case of the differentiated spermatogonia (B1, B2, B3, and B4), as number per cross-section of the seminiferous tubule. UO was associated with a marked increase in the number of all germ cells more mature than undifferentiated spermatogonia (Ap) in the remaining testis. Sertoli cell number, on the other hand, did not change, and it is therefore reasonable to propose that the primary locus of the spermatogenic compensation was the differentiated spermatogonia. The additional finding that the relationship between the number of Sertoli cells and total germ cells in the remaining testis became robust (r = 0.92; P < 0.01 vs. r = 0.44; P > 0.05 for the removed testis) indicated that in the monkey, spermatogenesis does not normally operate at its ceiling. The increased drive to the seminiferous tubule of the remaining testis is hypothesized to be mediated by the sustained increase in FSH secretion that was observed after UO, although a role for increased testicular T production cannot be excluded. The stimulus for increased FSH secretion was presumably provided by the abrupt, 50% decline in circulating inhibin B levels. Interestingly, inhibin B secretion by the remaining testis was not dramatically affected by UO, and therefore, the deficit in circulating levels of this hormone and thus the error signal to FSH secretion were maintained for the duration of the experiment. In contrast, the changes in circulating LH and T concentrations were only transient, and within 48 h of UO, these hormonal parameters had returned to control values. The mechanisms by which the remaining testis rapidly acquires the capacity to double T production in the face of an unchanging LH drive remains to be determined. The foregoing body of evidence suggests that sperm output by the monkey testis is regulated by the circulating concentration of FSH and that in physiological situations, FSH secretion is insufficient to stimulate spermatogenesis to its ceiling. The results also indicate that FSH secretion is controlled by a feedback system in which the feedforward arm (FSH-inhibin B) is less robust than the feedback loop (inhibin B-FSH). Thus, a decrease in the inhibin B feedback signal results in a sustained increase in FSH secretion that drives the testes toward their spermatogenic ceiling, which is presumably set by Sertoli cell number.     

Shifting the balance between in-patient and out-patient care for tuberculosis results in economic savings.

SETTING: Although hospitalisation is not always necessary for the treatment of tuberculosis (TB), in Australia 90% of TB patients have treatment initiated in hospital. OBJECTIVE: To calculate and compare the costs of in-patient and out-patient tuberculosis treatment, and to measure the impact of shifting care from in-patient to out-patient settings. METHODS: In a costing study performed in Victoria, Australia, the proportion of all notified TB cases who were hospitalised was calculated by matching coded state hospital morbidity data with the Victoria Notifiable Diseases database for the financial year 1994-1995. In-patient and out-patient costs were calculated using data obtained from a number of sources. The effect on health care costs of varying the proportion of TB cases treated as in-patients and out-patients was calculated using Excel. RESULTS: Nearly 90% (239/269) of notified TB cases received hospitalised care in 1994-1995. The cost of treatment for hospitalised patients (mean length of stay 2 weeks) was AU$5447 per patient, with a total cost of $1,301,833. Hospitalisation comprised 60% of the total cost of treatment. The cost of out-patient treatment was $2260 per patient. If 90% of patients were treated on an out-patient basis, the total cost would be $693,670. We estimated that it would be feasible to treat at least 55% of TB patients as out-patients, reducing costs by nearly 30%. CONCLUSIONS: Routine hospitalisation for patients with uncomplicated TB is not necessary, but is often used in industrialised countries. More cost-effective use of resources can be achieved by giving initial TB treatment on an out-patient basis rather than in hospital for a greater proportion of cases.     

Hypoxia drives murine neutrophil protein scavenging to maintain central carbon metabolism

Limiting dysfunctional neutrophilic inflammation while preserving effective immunity requires a better understanding of the processes that dictate neutrophil function in the tissues. Quantitative mass-spectrometry identified how inflammatory murine neutrophils regulated expression of cell surface receptors, signal transduction networks, and metabolic machinery to shape neutrophil phenotypes in response to hypoxia. Through the tracing of labeled amino acids into metabolic enzymes, proinflammatory mediators, and granule proteins, we demonstrated that ongoing protein synthesis shapes the neutrophil proteome. To maintain energy supplies in the tissues, neutrophils consumed extracellular proteins to fuel central carbon metabolism. The physiological stresses of hypoxia and hypoglycemia, characteristic of inflamed tissues, promoted this extracellular protein scavenging with activation of the lysosomal compartment, further driving exploitation of the protein-rich inflammatory milieu. This study provides a comprehensive map of neutrophil proteomes, analysis of which has led to the identification of active catabolic and anabolic pathways that enable neutrophils to sustain synthetic and effector functions in the tissues.     

Web-based self-management support training for health professionals: A pilot study

Objective

To evaluate a web-based self-management training for health professionals. Patients spend 99% of their time outside the healthcare system. Thus self-management support from health professionals is central to optimal care. Our objective was to teach health professionals the skills to provide this support.

Methods

Primary care residents and practicing providers enrolled in six groups. Each group received four web-based interactive training sessions derived from self-efficacy theory. Retrospective-pre/post assessed changes in self-management beliefs and confidence. Wilcoxon signed-rank tests with Bonferroni correction compared responses. Focus groups solicited qualitative feedback.

Results

Fifty-seven residents and providers across the United States enrolled. Residents demonstrated positive changes on all belief questions (P 0.001–0.012). Practicing providers had a non-significant positive change on one and significant changes on the remainder (P 0.001–0.018). Both types of participants demonstrated significant increases on confidence questions regarding their ability to support self-management (P < 0.01 for all). Participants described learned techniques as being useful, reducing burnout, and increasing acceptance of patient involvement in care planning.

Conclusion

The web-based self-management support training for health professionals was feasible and changed beliefs and confidence.

Practice implications

The program may maximize patient self-management by increasing provider self-efficacy and skill for self-management support.     

Age-dependent neurological phenotypes in a mouse model of PRRT2-related diseases

Paroxysmal kinesigenic dyskinesia is an episodic movement disorder caused by dominant mutations in the proline-rich transmembrane protein PRRT2, with onset in childhood and typically with improvement or resolution by middle age. Mutations in the same gene may also cause benign infantile seizures, which begin in the first year of life and typically remit by the age of 2 years. Many details of PRRT2 function at the synapse, and the effects of mutations on neuronal excitability in the pathophysiology of epilepsy and dyskinesia, have emerged through the work of several groups over the last decade. However, the age dependence of the phenotypes has not been explored in detail in transgenic models. Here, we report our findings in heterozygous and homozygous Prrt2 knockout mice that recapitulate the age dependence of dyskinesia seen in the human disease. We show that Prrt2 deletion reduces the levels of synaptic proteins in a dose-dependent manner that is most pronounced at postnatal day 5 (P5), attenuates at P60, and disappears by P180. In a test for foot slippage while crossing a balance beam, transient loss of coordination was most pronounced at P60 and less prominent at age extremes. Slower traverse time was noted in homozygous knockout mice only, consistent with the ataxia seen in rare individuals with biallelic loss of function mutations in Prrt2. We thus identify three age-dependent phenotypic windows in the mouse model, which recapitulate the pattern seen in humans with PRRT2-related diseases.

     

Recent advances in the management of cutaneous malignant melanoma: our case cohort

Decades of research into the management of cutaneous malignant melanoma have proven it to be a ‘tough nut to crack’, and its incidence has continued to increase over the last 30 years. Surgery remains a gold standard for early-stage melanoma with five-year survival of 98% for stage I disease, and 90% for stage II. Nonetheless, patients with stage III disease are at a higher risk, resulting in local recurrence as well as distant metastasis. Research regarding the control of metastatic malignant melanoma of the head and neck has evolved. Currently the search is on to understand metastatic malignant melanoma as a heterogeneous disease both at the molecular and clinical level. This paper focuses on the latest systemic therapy for metastatic disease of the head and neck, including cytotoxic chemotherapy, immunotherapy, and target therapy. The new eighth edition of tumour staging, and the sequelae for malignant melanoma, sentinel lymph node biopsy (SLNB), surgical intervention, and its benefits and shortfalls, are discussed. Also, the outcome of our cohort series of patients with metastatic cutaneous malignant melanoma who were treated with systemic combination therapy in Dorset is presented.     

Regulation of erythropoietin production in a human hepatoblastoma cell line

Production of immuno and biologically active erythropoietin was documented to occur in the human hepatoblastoma cell line HepG-2. The expression of the erythropoietin gene was further verified by Northern blot analysis using a single stranded RNA probe. In vitro studies showed that erythropoietin production by these cells was not stimulated by hypoxia or cobalt chloride, but was related to the proliferative activity of the cells in culture. In addition it was found that the secretion of erythropoietin was almost completely abrogated by tunicamycin, an inhibitor of N-linked glycosylation. This effect of tunicamycin was also observed in a permanently transfected cell line that secretes erythropoietin in large quantities.     

An alternative extrinsic pathway of human blood coagulation

To study the interrelationships of the major human coagulation pathways, factor X activation in normal and various deficient human plasmas was evaluated when clotting was triggered by dilute rabbit or human thromboplastin. Various dilutions of thromboplastin were added to plasma samples containing 3H-labeled factor X, and the time course of factor X activation was determined. At a 1/250 dilution of rabbit brain thromboplastin the rate of factor X activation in factor VIII or factor IX deficient plasma was only 10% of the activation rate seen for normal or factor XI deficient plasma. Reconstitution of the deficient plasmas with factors VIII or IX, respectively, restored normal factor X activation. Similar results were obtained when various dilutions of human thromboplastin replaced the rabbit thromboplastin. From these experiments, it is inferred that normal activation of factor X in plasma due to dilute thromboplastin requires factors VII, IX and VIII. An alternative extrinsic pathway that involves factors VII, IX, and VIII may be a major physiologic extrinsic pathway, and this pathway may help to explain the clinical observations of bleeding diatheses in patients deficient in factors IX or VIII.