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Derivative 22 (der (22)) syndrome and velo-cardio-facial syndrome/DiGeorge syndrome have in common a 1.5-Mb region in chromosome 22q11. Der(22) syndrome is rare. It is associated with a number of congenital irregularities including preauricular skin tags or pits, profound mental retardation, and conotruncal heart defects. It may occur in children of carriers of the constitutional t(11;22)(q23;q11) translocation, the result of a 3:1 meiotic malsegregation event that leads to partial trisomy of chromosomes 22 and 11. The trisomic region on chromosome 22 overlaps the region hemizygously missing in another congenital disorder involving anomalies, that is, velo-cardio-facial syndrome/DiGeorge syndrome (VCFS/DGS). Fluorescence in situ hybridization (FISH) mapping and haplotype analysis were carried out for five patients with der(22) syndrome in a project to identify the interval on 22q11 containing the t(11;22) breakpoint.

Studies examining the link between stressful events and coping with HIV have relied on a between-persons approach focusing on how individuals differ on some characteristics. Although the between-subjects approach has yielded important information, our goal was to use a within-persons approach, making repeated measurements of the same persons over many days, to examine the impact of changing circumstances on the mood states of those with HIV. A second goal was to determine if asking participants to report their daily experiences via a computerized interactive voice system is a viable way to collect such information. This study collected a variety of trait measures for seven HIV patients and subsequently used a computerized telephone system to collect information regarding daily events and mood states over 21 consecutive days. Several daily measures, including self-esteem, optimism, and positive social interactions were significantly related to daily mood states. Trait measures, with the exception of symptom distress, were ineffective in predicting variations in daily mood states. It was concluded that a computerized telephone system is a viable means of collecting information from HIV patients on a daily basis and within-persons methodology may provide useful information about daily events affecting mood states beyond that generated by a between-persons approach. [ABSTRACT FROM AUTHOR]

Abstract Background Altered tryptophan metabolism and indoleamine 2,3-dioxygenase activity are linked to cancer development and progression. In addition, these biological factors have been associated with the development and severity of neuropsychiatric syndromes, including major depressive disorder. However, this biological mechanism associated with both poor disease outcomes and adverse neuropsychiatric symptoms has received little attention in women with breast cancer. Therefore, a pilot study was undertaken to compare levels of tryptophan and other proteins involved in tryptophan degradation in women with breast cancer to women without cancer, and secondarily, to examine levels in women with breast caner over the course of chemotherapy. Findings Blood samples were collected from women with a recent diagnosis of breast cancer (n = 33) before their first cycle of chemotherapy and after their last cycle of chemotherapy. The comparison group (n = 24) provided a blood sample prior to breast biopsy. Plasma concentrations of tryptophan, kynurenine, and tyrosine were determined. The kynurenine to tryptophan ratio (KYN/TRP) was used to estimate indoleamine 2,3-dioxygenase activity. On average, the women with breast cancer had lower levels of tryptophan, elevated levels of kynurenine and tyrosine and an increased KYN/TRP ratio compared to women without breast cancer. There was a statistically significant difference between the two groups in the KYN/TRP ratio (p = 0.036), which remained elevated in women with breast cancer throughout the treatment trajectory. Conclusions The findings of this pilot study suggest that increased tryptophan degradation may occur in women with early-stage breast cancer. Given the multifactorial consequences of increased tryptophan degradation in cancer outcomes and neuropsychiatric symptom manifestation, this biological mechanism deserves broader attention in women with breast cancer.

Background: Literature shows that interdisciplinary huddles help promote clear communication and proactive reporting of potential errors., Local Problem: High reliability organization (HRO) and just culture models were implemented, yet fragmented team communication about patient safety remained. Huddles were implemented to identify and address patient safety issues., Methods: A pre/postintervention design was used. Near-miss and actual event safety metrics, patient satisfaction, and employee satisfaction/work group perceptions were measured at 3 time points over 1 year., Interventions: Daily interdisciplinary huddles were implemented to improve communication, reduce errors, and improve patient and employee satisfaction., Results: Near-miss reporting increased across time points. Patient satisfaction with how the staff worked together to provide care significantly increased over time. Employee satisfaction and perception of work group communication, collaboration, and psychological safety scores improved, however, were not statistically significant., Conclusion: Implementing huddles demonstrated improved outcomes in patient safety, patient satisfaction, and employee satisfaction/work group perceptions., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

In selected patients with left ventricular assist device-associated infection or malfunction, pump exchange may become necessary after conservative treatment options fail and heart transplantation is not readily available. We examined the survival and complication rate in patients (⩾19 years of age) who underwent HeartMate II to HeartMate II exchange at our institution from 1 January 2010 to 28 February 2018. Clinical outcomes were analyzed and compared for patients who underwent exchange for pump thrombosis (14 patients), breach of driveline integrity (5 patients), and device-associated infection (2 patients). There were no differences in 30-day mortality (p = 0.58), need for temporary renal replacement therapy (p = 0.58), right ventricular mechanical support (p = 0.11), and postoperative stroke (p = 0.80) among groups. Survival at 1 year was 90% ± 7% for the whole cohort and 85% ± 10% for those who underwent exchange for pump thrombosis. In patients exchanged for device thrombosis, freedom from re-thrombosis and survival free from pump re-thrombosis at 1 year were 49% ± 16% and 42% ± 15%, respectively. No association of demographic and clinical variables with the risk of recurrent pump thrombosis after the first exchange was identified. Survival after left ventricular assist device exchange compares well with published results after primary left ventricular assist device implantation. However, recurrence of thrombosis was common among patients who required a left ventricular assist device exchange due to pump thrombosis. In this sub-group, consideration should be given to alternative strategies to improve the outcomes.

This was a pilot study to examine pre- and postoperative stress experienced by women who were undergoing autologous breast reconstruction and how stress might impact wound healing, specifically examining cytokines and other chemical mediators in the wound environment. A nonexperimental descriptive design over time was utilized. Participants were women who were undergoing autologous abdominal breast reconstruction for breast cancer (N = 20). Data were collected preoperatively and at 24, 48, 72, and 96 hr postsurgery. Complications were monitored intraoperatively and up to 30 days postsurgery. Psychological stress was measured with the 10-item Perceived Stress Scale (PSS), the Impact of Events Scale-Revised (IES-R), and a 100-mm Visual Analog Scale (VAS). Cytokines were assayed using the 27-plex kit with a Bio-Plex Plus. Although breast cancer is considered a stressor, in this sample of women, scores of the PSS, IES-R, and VAS showed that in fact these participants experienced low levels of psychological stress. All measured biochemical mediators in serum and wound fluid were detected and trends were identified. IL-1ra, IL-6, IL-8, G-CSF, IP-10, MCP-1, MIP-1β, RANTES, and VEGF were present in the highest concentrations. Significant changes in levels of cytokines in wound fluid were observed in IL-1β, IL-2, IL-5, IL-6, IL-8, IL-9, IL-10, IL-17, FGF-basic, G-CSF, MIP-1α, PDGF-bb, MIP-1β, RANTES, and TNF-α. The remaining cytokine concentrations stayed stable over time. These findings suggest that although these women were not experiencing high levels of stress, meaningful cytokine patterns were detected.

The 5-HT2C receptor is the primary serotonin receptor located in the corticotrophin releasing hormone (CRH) neurons of the hypothalamus. These neurons initiate the signaling cascade that culminates in cortisol release. Therefore, genetic variation in the 5-HT2C receptor gene (HTR2C) is a prime candidate for affecting cortisol reactivity to stress. Accordingly, we examined the association of a nonsynonymous polymorphism (Cys23Ser; rs6318) in HTR2C with stress reactivity in two Trier Social Stress Tests conducted at separate sites. In both Study 1 (N=128) and Study 2 (N=185), Cys23 homozygous females and hemizygous males had greater cortisol reactivity. There was no relation between this polymorphism and self-reported affective response (Studies 1 and 2) or cardiovascular reactivity (Study 2). Additionally, the short/short genotype of a polymorphism (5-HTTLPR) in the serotonin transporter gene was associated with greater cortisol reactivity in Study 1 as well as in Study 2 (previously reported). The Cys23Ser polymorphism and the 5-HTTLPR were independently associated with cortisol reactivity in both studies. These findings emphasize the important role of genetic variation in the serotonin system on regulating cortisol reactivity to social evaluative stress. Comparison of the present associations with those of prior studies underscores the likely importance of situational and psychological factors in determining the direction and magnitude of the association between genotype and phenotype., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Purpose: Mitochondrial dysfunction is a plausible biological mechanism for cancer-related fatigue. Specific aims of this study were to (1) describe the levels of mitochondrial oxidative phosphorylation complex (MOPC) enzymes, fatigue, and health-related quality of life (HRQOL) before and at completion of external beam radiation therapy (EBRT) in men with nonmetastatic prostate cancer (PC); (2) examine relationships over time among levels of MOPC enzymes, fatigue, and HRQOL; and (3) compare levels of MOPC enzymes in men with clinically significant and nonsignificant fatigue intensification during EBRT., Methods: Fatigue was measured by the revised Piper Fatigue Scale and the Functional Assessment of Cancer Therapy-Fatigue subscale (FACT-F). MOPC enzymes (Complexes I-V) and mitochondrial antioxidant superoxide dismutase 2 were measured in peripheral blood using enzyme-linked immunosorbent assay at baseline and completion of EBRT. Participants were categorized into high or low fatigue (HF vs. LF) intensification groups based on amount of change in FACT-F scores during EBRT., Results: Fatigue reported by the 22 participants with PC significantly worsened and HRQOL significantly declined from baseline to EBRT completion. The HF group comprised 12 men with clinically significant change in fatigue (HF) during EBRT. Although no significant changes were observed in MOPC enzymes from baseline to EBRT completion, there were important differences in the patterns in the levels of MOPC enzymes between HF and LF groups., Conclusion: Distinct patterns of changes in the absorbance of MOPC enzymes delineated fatigue intensification among participants. Further investigation using a larger sample is warranted., (© The Author(s) 2015.)

Objectives: This article reports the cross-studies analysis of projects from the P30 Center of Excellence for Biobehavioral Approaches to Symptom Management. Although the projects investigated diverse populations, a consistent theoretical and empirical approach guided each project., Methods: Common data elements included the following measures of psychobehavioral variables: the PROMIS Short-Form Fatigue Scale, the Center of Epidemiologic Studies Depression Scale, and the Perceived Stress Scale. Plasma cytokines were measured as the shared biological data element., Results: Data were analyzed from 295 participants with fibromyalgia (n = 72), second trimester pregnancy (n = 73), sickle cell anemia (n = 60), and cardiometabolic risk (n = 91). The mean age of participants was 35.4 years, and the most participants were female. Levels of symptoms were generally elevated across samples; the level of fatigue ranged from 18.9 to 24.7, depressive symptoms from 12.5 to 23.4, and perceived stress from 16.5 to 21.8. Intercorrelations among symptom measures and perceived stress were strong across the samples. However, correlations among psychobehavioral variables and cytokines were variable, indicating a separate relationship for the measures with cytokines., Conclusions: Future work in symptom science could benefit from common data elements, including biomarkers, across populations to better develop the taxonomy of symptom profiles across conditions., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Fatigue is often described by patients as a lack of energy, mental or physical tiredness, diminished endurance, and prolonged recovery after physical activity. Etiologic mechanisms underlying fatigue are not well understood; however, fatigue is a hallmark symptom of mitochondrial disease, making mitochondrial dysfunction a putative biological mechanism for fatigue. Therefore, this review examined studies that investigated the association of markers of mitochondrial dysfunction with fatigue and proposes possible research directions to enhance understanding of the role of mitochondrial dysfunction in fatigue. A thorough search using PubMed, Scopus, Web of Science, and Embase databases returned 1,220 articles. After application of inclusion and exclusion criteria, a total of 25 articles meeting eligibility criteria were selected for full review. Dysfunctions in the mitochondrial structure, mitochondrial function (mitochondrial enzymes and oxidative/nitrosative stress), mitochondrial energy metabolism (ATP production and fatty acid metabolism), immune response, and genetics were investigated as potential contributors to fatigue. Carnitine was the most investigated mitochondrial function marker. Dysfunctional levels were reported in all the studies investigating carnitine; however, the specific type of carnitine that was dysfunctional varied. Genetic profiles were the second most studied mitochondrial parameter. Six common pathways were proposed: metabolism, energy production, protein transport, mitochondrial morphology, central nervous system dysfunction and post-viral infection. Coenzyme Q10 was the most commonly investigated mitochondrial enzyme. Low levels of Coenzyme Q10 were consistently associated with fatigue. Potential targets for further investigation were identified as well as gaps in the current literature.

Due to recent treatment advances, there have been improvements in the proportion of women surviving a diagnosis of breast cancer (BC). However, many of these survivors report persistent adverse side effects following treatment, such as cognitive dysfunction, depressive symptoms, anxiety, fatigue, sleep disturbances, and pain. Investigators have examined circulating levels of inflammatory markers, particularly serum cytokines, for a potential causal relationship to the development/persistence of these psychoneurological symptoms (PNS). While inflammatory activation, resulting from perceived stress or other factors, may directly contribute to the development of PNS, we offer an alternative hypothesis, suggesting that these symptoms are an early step in a cascade of biological changes leading to epigenetic alterations at the level of deoxyribonucleic acid (DNA) methylation, histone modifications, and/or chromatin structure/chromosomal instability. Given that epigenetic patterns have plasticity, if this conjectured relationship between epigenomic/acquired genomic alterations and the development/persistence of PNS is confirmed, it could provide foundational knowledge for future research leading to the recognition of predictive markers and/or treatments to alleviate PNS in women with BC. In this article, we discuss an evolving theory of the biological basis of PNS, integrating knowledge related to inflammation and DNA repair in the context of genetic and epigenetic science to expand the paradigm for understanding symptom acquisition/persistence following chemotherapy.

The purpose of this article is to introduce a model of neurodevelopmental risk and protection that may explain some of the relationships among biobehavioral risks, environmental risks, and caregiving behaviors that potentially contribute to neurobehavioral and cognitive outcomes. Infants born before 30 weeks of gestation have the poorest developmental prognosis of all infants. These infants have lengthy hospitalization periods in the neonatal intensive care unit (NICU,) an environment that is not always supportive of brain development and long-term developmental needs. The model supports the premise that interventions focused on neuroprotection during the neonatal period have the potential to positively affect long-term developmental outcomes for vulnerable very preterm infants. Finding ways to better understand the complex relationships among NICU-based interventions and long-term outcomes are important to guiding caregiving practices in the NICU.

The purpose of this article is to introduce a model of neurodevelopmental risk and protection that may explain some of the relationships among biobehavioral risks, environmental risks, and caregiving behaviors that potentially contribute to neurobehavioral and cognitive outcomes. Infants born before 30 weeks of gestation have the poorest developmental prognosis of all infants. These infants have lengthy hospitalization periods in the neonatal intensive care unit (NICU,) an environment that is not always supportive of brain development and long-term developmental needs. The model supports the premise that interventions focused on neuroprotection during the neonatal period have the potential to positively affect long-term developmental outcomes for vulnerable very preterm infants. Finding ways to better understand the complex relationships among NICU-based interventions and long-term outcomes are important to guiding caregiving practices in the NICU.

Aim of the Study: This pilot study was designed to examine the relationships among spirituality and psychosocial factors in a sample of 52 adult males living with human immunodeficiency virus (HIV) disease and to determine the most reliable spirituality measure for a proposed longitudinal study., Background: HIV disease is among the most devastating of illnesses, having multiple and profound effects upon all aspects of the biopsychosocial and spiritual being. Although research has suggested relationships among various psychosocial and spiritual factors, symptomatology and physical health, much more research is needed to document their potential influences on immune function, as well as health status, disease progression, and quality of life among persons with HIV disease., Methods: This descriptive correlational study explored the relationships of spirituality and psychosocial measures. Spirituality was measured in terms of spiritual perspective, well-being and health using three tools: the Spiritual Perspective Scale, the Spiritual Well-Being Scale, and the Spiritual Health Inventory. Five psychosocial instruments were used to measure aspects of stress and coping: the Mishel Uncertainty in Illness Scale, Dealing with Illness Scale, Social Provisions Scale, Impact of Events Scale, and Functional Assessment of HIV Infection Scale. The sample was recruited as part of an ongoing funded study. The procedures from the larger study were well-defined and followed in this pilot study. Correlational analyses were done to determine the relationship between spirituality and the psychosocial measures., Findings: The findings indicate that spirituality as measured by the existential well-being (EWB) subscale of the Spiritual Well-Being Scale was positively related to quality of life, social support, effective coping strategies and negatively related to perceived stress, uncertainty, psychological distress and emotional-focused coping. The other spirituality measures had less significant or non significant relationships with the psychological measures., Conclusions: The study findings support the inclusion of spirituality as a variable for consideration when examining the psychosocial factors and the quality of life of persons living with HIV disease. The spiritual measure that best captures these relationships is the EWB subscale of the Spiritual Well-Being Scale.

Disclosure or nondisclosure of self-as-lesbian to family is a difficult task. Eleven lesbians aged 25-47 years old described their experiences of disclosure or nondisclosure to family. The primary source of data collection was focus groups. Family disclosure was preceded by recognition of self-as-lesbian. Five story patterns of lesbians and their families related to disclosure or nondisclosure were derived from text analysis. The participants also described missing sociocultural landmarks and symbols for lesbian lives. Implications are included for lesbians who are contemplating disclosure and their health care providers.

The Roman Jewish community has been historically continuous in Rome since pre-Christian times and may have been progenitor to the Ashkenazi Jewish community. Despite a history of endogamy over the past 2000 yr, the historical record suggests that there was admixture with Ashkenazi and Sephardic Jews during the Middle Ages. To determine whether Roman and Ashkenazi Jews shared common signature mutations, we tested a group of 107 Roman Jews, representing 176 haploid sets of chromosomes. No mutations were found for Bloom syndrome, BRCA1, BRCA2, Canavan disease, Fanconi anemia complementation group C, or Tay-Sachs disease. Two unrelated individuals were positive for the 3849 + 10C->T cystic fibrosis mutation; one carried the N370S Gaucher disease mutation, and one carried the connexin 26 167delT mutation. Each of these was shown to be associated with the same haplotype of tightly linked microsatellite markers as that found among Ashkenazi Jews. In addition, 14 individuals had mutations in the familial Mediterranean fever gene and three unrelated individuals carried the factor XI type III mutation previously observed exclusively among Ashkenazi Jews. These findings suggest that the Gaucher, connexin 26, and familial Mediterranean fever mutations are over 2000 yr old, that the cystic fibrosis 3849 + 10kb C->T and factor XI type III mutations had a common origin in Ashkenazi and Roman Jews, and that other mutations prevalent among Ashkenazi Jews are of more recent origin.

Synthesizing the neurologic mechanisms of psychoneuroimmunology (PNI) into a schematic model serves as a basis to enhance understanding of the complex interactions within the PNI framework. The examination of current research in physiology, neurotransmission, hormonal mechanisms, immunologic function and stress allows for the creation of a neurological model to depict hypothetical interactions of these systems. This model of neurological mechanisms in PNI can serve as the basis for integrating PNI in nursing practice. It is hoped that the model will serve as a bridge to understanding the neuroscience component of PNI and stimulate further research.

Academic institutions continue to be challenged to enhance their productivity in the face of diminishing resources. Escalating demands on full-time faculty must come from a fundamental transformation in the focus and, hence, design of that work. This article presents a model of a mission transformed from the current representation of the tripartite activities involved with teaching, research, and service to a new representation of the inherent holism of that work. This transformation moves the academy's mission to a single, integrative focus on knowledge work. When the essence of the academy's unique mission is expressed as knowledge work, the unity of knowledge development, dissemination, and application can be actualized in the work lives of a community of scholars. A fuller realization of the inherently holistic nature of this knowledge work is seen as a transformation to coherence at the levels of university, unit, and scholar. Coherence within the academic lives of individuals, the collective community of scholars, and the broader organization is the essential feature for the long-term success of the institution and the career of a scholar.

HIV-related symptomatology represents both an indirect measure of immune functioning and a clinically significant indicator of disease progression. The most widely used classification system for HIV-related symptomatology is the Center for Disease Control (CDC) system. Although the CDC scale has widely recognized clinical utility, it provides only nominal-level measurement, which may be problematic for both clinicians and researchers. This article describes the revision and validation of the HIV Center Medical Staging Scale (rHCMSS), and ordinal-level physical illness scale that provides a means of independently measuring the progression of HIV-disease symptomatology and immunological decline. Concurrent use of the rHCMSS, the CDC classification system, and T-lymphocyte and viral load data will provide a more comprehensive indication of HIV-disease progression for clinical and research purposes.

Sadness as a developmental phenomenon in young women was discovered in a study designed to identify developmental transitions and the relationship of these transitions to mental health. Sadness is conceptualized as a pervasive feeling of disillusionment and unhappiness that influences the meaning of life events and decision-making. Field research and interpretive analysis techniques were used to observe, describe and analyse the life experiences of 25 volunteer participants. For most women in the study, sadness was found to be time-limited and perhaps had beneficial effects. Some women, however, were unable to resolve sadness and became depressed. Sadness can be an antecedent to depression. Sadness that is recognized and validated may facilitate reshaping of a woman's expectations, a form of cognitive restructuring. The transitional nature of sadness has important implications for women's mental health.

A pretest-posttest design (with a 6-week wait-list control and a 6-month comparison group) was used to compare the effectiveness of a 6-week stress management training program with standard outpatient care for 45 men with HIV disease. Outcomes included stress levels, coping patterns, quality of life, psychological distress, illness-related uncertainty, and CD4+ T-lymphocyte levels. At 6 weeks, intervention was associated with increases in the emotional well-being dimension of quality of life. After 6 months, the intervention group had a relative decline in HIV-related intrusive thinking, indicating that stress management training may have buffered illness-related psychological distress over time.

Psychoneuroimmunology (PNI) is concerned with the mechanisms of bidirectional communication between the neuroendocrine and immune systems. Investigators in other disciplines have used this framework to guide the examination of possible relationships between behavioural factors and the progression of immunologically mediated illnesses and to evaluate the role of immune products in central nervous system disturbances. Nurse scientists have an opportunity to make unique contributions to the growing field of PNI. Unlike basic science research, which has as its goal the generation of fundamental knowledge concerning biological or behavioural processes, nursing research is driven by the need to promote excellence in nursing science as a guide for nursing practice. Although a few nurse scientists have conducted PNI research to date, additional studies are needed to generate new knowledge concerning mind-body interactions in health and illness and to develop strategies that promote mental and physical well-being in persons at risk for immune dysfunction. This paper highlights the few recently conducted nursing studies grounded in a PNI framework to illustrate the utility of PNI in advancing nursing science.

This review, based upon scientific literature, evaluates a number of immunological and virological markers for their usefulness as prognostic indicators for progression of HIV disease. The most widely studied marker, the CD4 positive T lymphocyte count, is perhaps the best single indicator of stage of illness. Serum factors such as neopterin and beta-2 microglobulin, alone and in combination with CD4 cell counts, have been shown to have good predictive value. Measurement of viral burden by quantification of viral RNA levels in plasma and immune cells also holds promise for following disease progression. It is recommended that a combination of these factors be monitored in evaluating stage of illness and responses to therapy in HIV-infected persons.

A group of 53 men with HIV disease participated in this correlational study of the relationships among psychological distress, quality of life, uncertainty, coping patterns, stress, and CD4+ T-lymphocyte levels. Meaningful correlations (r > .40, p < .01) indicated that higher levels of negative-impact stressful experiences were associated with more frequent use of emotion-focused coping; both higher levels of negative stress and more frequent use of emotion-focused coping were associated with lower quality of life, higher psychological distress, and more uncertainty; lower quality of life was associated with higher psychological distress and more uncertainty; and lower CD4+ counts were associated with higher levels of positive-impact stressful experiences.

Nurses who specialize in mental health routinely deal with stress and coping as priority issues. Yet there has been no consensus on an overriding framework for organizing and interpreting knowledge concerning the influences of stress on health and well-being. In addition, stress-management interventions have often been piecemeal. This article surveys traditional and emerging conceptualizations of stress and stress management, with a special focus on the transactional model and psychoneuroimmunology as complementary integrative frameworks. The authors recommend a comprehensive approach for stress management that includes behavioral, cognitive, and combination strategies for active coping as well as cognitive-behavioral techniques for relaxation.

The complex biopsychosocial aspects of nursing care for persons infected with the human immunodeficiency virus (HIV) present formidable challenges for nursing research. Suggestions for clinical nursing research related to physiological aspects of HIV care recently were addressed by Zeller, Swanson, and Cohen (1993). The authors highlight the research priorities related to psychosocial aspects of nursing care in HIV disease, as identified for the 1990-1994 National Nursing Research Agenda by the National Center for Nursing Research (NCNR) (1990). The authors conclude that the NCNR's 1990 recommendations remain relevant priorities for research concerning the psychosocial aspects of nursing care for persons with HIV disease.

People diagnosed with HIV disease experience multiple and severe stressors; however, little is known about these stressors and coping among this population. This phenomenological study was undertaken to (1) gain an understanding of the informants' lived experiences of coping with HIV disease and (2) develop a disease-specific instrument to measure stress and coping. The study involved interviews with 36 people with HIV disease. The interviews were analyzed and synthesized to (1) derive the structure of the experience through phenomenological analysis and (2) identify stress and coping themes through content analysis. Only the findings from the phenomenological analysis are reported here. The structure of the lived experience of coping with HIV disease unfolds from the initial diagnosis of being HIV-seropositive through the diagnosis of AIDS to impending death. The processes involved in this structure were labeled Living with Dying, Fighting the Sickness, and Getting Worn Out.

The Nurse's Professional Orientation Scale and Schwirian's Six-Dimension Scale of Nursing Performance (Six-D Scale) were used in a five-year, longitudinal study of the professional socialization of the Registered Nurse/Bachelor of Nursing Science (RN/BSN) (n = 30) and generic baccalaureate students (n = 193) in a nursing program in the Southeast United States. Program exit socialization scores between RN/BSN and generic graduates were not significantly different. Using an ANCOVA, significantly higher socialization scores were found for the generic graduates. The scores for the RN/BSN graduates were significantly higher than the generic students at graduation on the teaching/collaboration, planning/evaluation and interpersonal communication subscales of the Six-D scale. When program entry Six-D subscales score were controlled, only the professional development subscale differentiated between RN/BSN and generic graduates. The program impact on the RN/BSN student/graduate as well as the means by which this process can be studied are questioned.

The study was designed to test the Cohen (1981) model of professional socialization, which proposes that nursing students progress through four developmental stages of unilateral dependence, negative/independence, dependence/ mutuality, and interdependence as they advance through an educational program. The Professional Socialization Staging Scale (PS3), consisting of four subscale scores representative of the stages, was administered to 422 students enrolled in eight clinical nursing courses. Instrument revision was accomplished using a cross-validation design, and the study hypotheses were tested with 214 subjects in the cross-validation subsample. Significant findings (p less than .05) were the beginning students were more dependent than were graduating students, that older students were less dependent and more highly interdependent than were younger students, and that students with concurrent work experience in nursing-related fields were more highly interdependent than were students without concurrent work experience. With all groups of students evidencing the interdependence stage, no relationship was found between the sequential developmental stages and level of enrollment. Thus results of the study failed to support the Cohen model (McCain, 1984).