An instrument to measure the stigma perceived by people with HIV was developed based on the literature on stigma and psychosocial aspects of having HIV. Items surviving two rounds of content review were assembled in a booklet and distributed through HIV-related organizations across the United States. Psychometric analysis was performed on 318 questionnaires returned by people with HIV (19% women, 21% African American, 8% Hispanic). Four factors emerged from exploratory factor analysis: personalized stigma, disclosure concerns, negative self-image, and concern with public attitudes toward people with HIV. Extraction of one higher-order factor provided evidence of a single overall construct. Construct validity also was supported by relationships with related constructs: self-esteem, depression, social support, and social conflict. Coefficient alphas between .90 and .93 for the subscales and .96 for the 40-item instrument provided evidence of internal consistency reliability. The HIV Stigma Scale was reliable and valid with a large, diverse sample of people with HIV.

Simulation, in its many forms, has been a part of nursing education and practice for many years. The use of games, computer-assisted instruction, standardized patients, virtual reality, and low-fidelity to high-fidelity mannequins have appeared in the past 40 years, whereas anatomical models, partial task trainers, and role playing were used earlier. A historical examination of these many forms of simulation in nursing is presented, followed by a discussion of the roles of simulation in both nursing education and practice. A viewpoint concerning the future of simulation in nursing concludes this article.T hroughout time, nursing educators have sought effective ways to help students to become competent nurses. Since learning takes place through cognitive, psychomotor, and affective domains, nursing education has taken place in the lecture room, the psychomotor laboratory, and in the health care delivery setting. To enhance theoretical learning, simulation, in its many forms, has been added. The types of simulation used in nursing education include anatomical models, task trainers, role playing, games, computer-assisted instruction (CAI), standardized patients, virtual reality, and low-fidelity to high-fidelity mannequins. For the most part, these types of simulation, with the exception of anatomical models, task trainers, and role playing, have been introduced to nursing education in the past 40 years, which coincides with the 40th anniversary of this journal. With increasing numbers of nursing students and decreasing numbers of available clinical sites and nursing faculty, the use of simulation has become an integral part of nursing education. In this article, each of these types of simulation and their use in nursing education is discussed. This is followed by a description of the roles of simulation in both nursing education

Professional competency will be a critical performance outcome in the years ahead. Current investigations have found an alarming increase in the morbidity and morality rates of individuals in hospitals across the United States. With such findings, the competency levels of health care professionals, including nurses, are under scrutiny. The use of human patient simulators (adult and pediatric) in baccalaureate and graduate nursing education provides an excellent, objective tool by which to measure competency in the application of knowledge and technical skills. Emphasis is placed on educational, research, and evaluative applications of the simulators for nursing education. Critical Incident Nursing Management is further described as an instructional framework for the use of this technology. Last, administrative considerations will be addressed.

Distal symmetrical peripheral neuropathy (DSPN) is a particularly distressing pain syndrome associated with human immunodeficiency virus (HIV) disease. Capsaicin has been found to be effective in relieving pain associated with other neuropathic pain syndromes, and is mentioned as a possible topical adjuvant analgesic for the relief of DSPN. This multicenter, controlled, randomized, double-masked clinical trial studied patients with HIV-associated DSPN and compared measures of pain intensity, pain relief, sensory perception, quality of life, mood, and function for patients who received topical capsaicin to the corresponding measures for patients who received the vehicle only. Twenty-six subjects were enrolled in the study. At the end of 1 week, subjects receiving capsaicin tended to report higher current pain scores than did subjects receiving the vehicle (Mann-Whitney test; P = 0.042). The dropout rate was higher for the capsaicin group (67%) than for the vehicle group (18%) (chi 2 test of association; P = 0.014). There were no other statistically significant differences between the capsaicin and vehicle groups with respect to current pain, worst pain, pain relief, sensory perception, quality of life, mood, or function at study entry or at any time during the 4-week trial. These results suggest capsaicin is ineffective in relieving pain associated with HIV-associated DSPN.

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ISSUES AND PURPOSE. The stigma of HIV infection creates barriers to disclosure. The purpose of this study was to identify to whom biological and foster mothers disclose the diagnosis of HIV infection, discuss their rationale, and describe the recipient's reactions. DESIGN AND METHODS. A descriptive, qualitative study included biological (n = 9) and foster (n = 11) mothers of children with HIV infection. RESULTS. Three themes emerged from the data: Telling for support, determining who should know, and telling children. These themes were present for both biological and foster mothers. PRACTICE IMPLICATIONS. It is important for nurses to realize that parental disclosure of the diagnosis of HIV infection is a long‐term, age‐appropriate process that will take place over many discussions and time, and should have the support of the interdisciplinary team. Additional psychological support also should be available.

Evidence for the reciprocal role of the immune system in sleep is growing. Sleep disturbances are believed to be both a cause and a consequence of various immune and autoimmune conditions.

We live in an ever more connected global village linked through international travel, politics, economics, culture and human-human and human-animal interactions. The realization that the concept of globalization includes global exposure to disease-causing agents that were formerly confined to small, remote areas and that infectious disease outbreaks can have political, economic and social roots and effects is becoming more apparent. Novel infectious disease microbes continue to be discovered because they are new or newly recognized, have expanded their geographic range, have been shown to cause a new disease spectrum, have jumped the species barrier from animals to humans, have become resistant to antimicrobial agents, have increased in incidence or have become more virulent. These emerging infectious disease microbes may have the potential for use as agents of bioterrorism. Factors involved in the emergence of infectious diseases are complex and interrelated and involve all classifications of organisms transmitted in a variety of ways. In 2003, outbreaks of interest included severe acute respiratory syndrome, monkeypox and avian influenza. Information from the human genome project applied to microbial organisms and their hosts will provide new opportunities for detection, diagnosis, treatment, prevention, control and prognosis. New technology related not only to genetics but also to satellite and monitoring systems will play a role in weather, climate and the approach to environmental manipulations that influence factors contributing to infectious disease emergence and control. Approaches to combating emerging infectious diseases include many disciplines, such as animal studies, epidemiology, immunology, ecology, environmental studies, microbiology, pharmacology, other sciences, health, medicine, public health, nursing, cultural, political and social studies, all of which must work together. Appropriate financial support of the public health infrastructure including surveillance, prevention, communication, adherence techniques and the like will be needed to support efforts to address emerging infectious disease threats.