Background: Cyberbullying describes bullying using mobile phones and the internet. Most previous studies have focused on the prevalence of text message and email bullying. Methods: Two surveys with pupils aged 11-16 years: (1) 92 pupils from 14 schools, supplemented by focus groups; (2) 533 pupils from 5 schools, to assess the generalisability of findings from the first study, and investigate relationships of cyberbullying to general internet use. Both studies differentiated cyberbullying inside and outside of school, and 7 media of cyberbullying. Results: Both studies found cyberbullying less frequent than traditional bullying, but appreciable, and reported more outside of school than inside. Phone call and text message bullying were most prevalent, with instant messaging bullying in the second study; their impact was perceived as comparable to traditional bullying. Mobile phone/video clip bullying, while rarer, was perceived to have more negative impact. Age and gender differences varied between the two studies. Study 1 found that most cyberbullying was done by one or a few students, usually from the same year group. It often just lasted about a week, but sometimes much longer. The second study found that being a cybervictim, but not a cyberbully, correlated with internet use; many cybervictims were traditional 'bully-victims'. Pupils recommended blocking/avoiding messages, and telling someone, as the best coping strategies; but many cybervictims had told nobody about it. Conclusions: Cyberbullying is an important new kind of bullying, with some different characteristics from traditional bullying. Much happens outside school. Implications for research and practical action are discussed.

Cyberbullying has recently emerged as a new form of bullying and harassment. 360 adolescents (12-20 years), were surveyed to examine the nature and extent of cyberbullying in Swedish schools. Four categories of cyberbullying (by text message, email, phone call and picture/video clip) were examined in relation to age and gender, perceived impact, telling others, and perception of adults becoming aware of such bullying. There was a significant incidence of cyberbullying in lower secondary schools, less in sixth-form colleges. Gender differences were few. The impact of cyberbullying was perceived as highly negative for picture/video clip bullying. Cybervictims most often chose to either tell their friends or no one at all about the cyberbullying, so adults may not be aware of cyberbullying, and (apart from picture/video clip bullying) this is how it was perceived by pupils. Findings are discussed in relation to similarities and differences between cyberbullying and the more traditional forms of bullying.

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BACKGROUND In a randomized trial comparing mitral-valve repair with mitral-valve replacement in patients with severe ischemic mitral regurgitation, we found no significant difference in the left ventricular end-systolic volume index (LVESVI), survival, or adverse events at 1 year after surgery. However, patients in the repair group had significantly more recurrences of moderate or severe mitral regurgitation. We now report the 2-year out-comes of this trial. METHODS We randomly assigned 251 patients to mitral-valve repair or replacement. Patients were followed for 2 years, and clinical and echocardiographic outcomes were assessed. RESULTS Among surviving patients, the mean (±SD) 2-year LVESVI was 52.6±27.7 ml per square meter of body-surface area with mitral-valve repair and 60.6±39.0 ml per square meter with mitral-valve replacement (mean changes from baseline, −9.0 ml per square meter and −6.5 ml per square meter, respectively). Two-year mortality was 19.0% in the repair group and 23.2% in the replacement group (hazard ratio in the repair group, 0.79; 95% confidence interval, 0.46 to 1.35; P = 0.39). The rank-based assessment of LVESVI at 2 years (incorporating deaths) showed no significant between-group difference (z score = −1.32, P = 0.19). The rate of recurrence of moderate or severe mitral regurgitation over 2 years was higher in the repair group than in the replacement group (58.8% vs. 3.8%, P<0.001). There were no significant between-group differences in rates of serious adverse events and overall readmissions, but patients in the repair group had more serious adverse events related to heart failure (P = 0.05) and cardiovascular readmissions (P = 0.01). On the Minnesota Living with Heart Failure questionnaire, there was a trend toward greater improvement in the replacement group (P=0.07). CONCLUSIONS In patients undergoing mitral-valve repair or replacement for severe ischemic mitral regurgitation, we observed no significant between-group difference in left ventricular reverse remodeling or survival at 2 years. Mitral regurgitation recurred more frequently in the repair group, resulting in more heart-failure–related adverse events and cardiovascular admissions.

The study of school bullying has recently assumed an international dimension, but is faced with difficulties in finding terms in different languages to correspond to the English word bullying. To investigate the meanings given to various terms, a set of 25 stick-figure cartoons was devised, covering a range of social situations between peers. These cartoons were shown to samples of 8- and 14-year-old pupils (N = 1,245; n = 604 at 8 years, n = 641 at 14 years) in schools in 14 different countries, who judged whether various native terms cognate to bullying, applied to them. Terms from 10 Indo-European languages and three Asian languages were sampled. Multidimensional scaling showed that 8-year-olds primarily discriminated nonaggressive and aggressive cartoon situations; however, 14-year-olds discriminated fighting from physical bullying, and also discriminated verbal bullying and social exclusion. Gender differences were less appreciable than age differences. Based on the 14-year-old data, profiles of 67 words were then constructed across the five major cartoon clusters. The main types of terms used fell into six groups: bullying (of all kinds), verbal plus physical bullying, solely verbal bullying, social exclusion, solely physical aggression, and mainly physical aggression. The findings are discussed in relation to developmental trends in how children understand bullying, the inferences that can be made from cross-national studies, and the design of such studies.

Background Ischemic mitral regurgitation is associated with a substantial risk of death. Practice guidelines recommend surgery for patients with a severe form of this condition but acknowledge that the supporting evidence for repair or replacement is limited. Methods We randomly assigned 251 patients with severe ischemic mitral regurgitation to undergo either mitral-valve repair or chordal-sparing replacement in order to evaluate efficacy and safety. The primary end point was the left ventricular end-systolic volume index (LVESVI) at 12 months, as assessed with the use of a Wilcoxon rank-sum test in which deaths were categorized below the lowest LVESVI rank. Results At 12 months, the mean LVESVI among surviving patients was 54.6±25.0 ml per square meter of body-surface area in the repair group and 60.7±31.5 ml per square meter in the replacement group (mean change from baseline, −6.6 and −6.8 ml per square meter, respectively). The rate of death was 14.3% in the repair group and 17.6% in the replacement group (hazard ratio with repair, 0.79; 95% confidence interval, 0.42 to 1.47; P = 0.45 by the log-rank test). There was no significant between-group difference in LVESVI after adjustment for death (z score, 1.33; P = 0.18). The rate of moderate or severe recurrence of mitral regurgitation at 12 months was higher in the repair group than in the replacement group (32.6% vs. 2.3%, P<0.001). There were no significant between-group differences in the rate of a composite of major adverse cardiac or cerebrovascular events, in functional status, or in quality of life at 12 months. Conclusions We observed no significant difference in left ventricular reverse remodeling or survival at 12 months between patients who underwent mitral-valve repair and those who underwent mitral-valve replacement. Replacement provided a more durable correction of mitral regurgitation, but there was no significant between-group difference in clinical outcomes. (Funded by the National Institutes of Health and the Canadian Institutes of Health; ClinicalTrials.gov number, NCT00807040.)

In contrast to the popular stereotype and research tradition of the ‘oafish’ bully lacking in social skills and understanding, the bully may be a cold, manipulative expert in social situations, organizing gangs and using subtle, indirect methods. Performance on a set of stories designed to assess understanding of cognitions and emotions was investigated in 193 7‐10‐year‐olds in relation to role in bullying. Ringleader bullies scored higher than ‘follower’ bullies (those who helped or supported the bully), victims and defenders of the victim. Results are discussed in terms of the need for further research into cognitive skills and emotion understanding in children who bully, the possible developmental pathway of social cognition in bullying and important implications for intervention strategies.