Protecting Patient Data Is the New Scope of Practice: A Recommended Cybersecurity Curricula for Healthcare Students to Prepare for this Challenge.

Protection of patient data has become a critical part of the scope of practice of all healthcare professionals. Routine data breaches underscore the importance of training clinical employees in protecting these data. However, beyond exposure to HIPAA regulations, little is done to educate the healthcare student about the risks and vulnerabilities of the online environment as it pertains to health data. Most individuals receive training upon employment, and compliance with regulations and policies is problematic. This article supports the belief that educating the student prior to entering into the profession may result in improved compliance with state and federal regulations and local policies, thus providing better protections to their patients. We propose a curriculum for both undergraduate and graduate healthcare students to prepare them for understanding and complying with institutional policies once they begin their clinical rotations or are hired as employees. This curriculum addresses the roles of information technology and health information management personnel in securing patient data, local and federal legislation, and the limitation of technical security measures. This curriculum should prepare future clinicians to use their own judgment and to better understand the role of intuitional policies in protecting patient data.

Transforming Preprofessional Health Education Through Relationship-Centered Care and Narrative Medicine.

ISSUE: The Institute of Medicine identified health care education reform as a key to improving the error prone, costly, and unsatisfying U.S. health care system. It called for health care education that no longer focuses exclusively on the mastery of technical skills but teaches students the human dimensions of care and develops their ability to collaborate with patients and colleagues to alleviate suffering and improve health. When should this educational reform begin, by what frameworks should it be guided, and which methods should it employ are important questions to explore. EVIDENCE: There is increasing evidence that practitioners' relational skills, such as empathy and reflection, improve patients' health outcomes. Efforts to shift education toward patient-centered care in interprofessional teams have been made at the professional level, most notably in medical schools. However, reform must begin at the preprofessional level, to start cultivation of the habits that support humane care as early as possible and protect against empathic decline and the development of counterproductive attitudes to collaboration. The conceptual basis for reform is offered by relationship-centered care (RCC), a framework that goes beyond patient-centered care and interprofessional teamwork to focus on the reciprocal human interactions at the micro, mezzo, and macro levels of care. RCC identifies practitioners' relationships with patients, colleagues, community, and self as the critical interpersonal dimensions of healthcare and describes a foundation of values, knowledge, and skills required for teaching each dimension. The teaching of these foundations can be facilitated with techniques from narrative medicine, a compatible care model that conceptualizes health care as a context in which humans exchange stories and thus require narrative competence. IMPLICATIONS: We suggest beginning the educational reform at the preprofessional level with the implementation of a formal curriculum based on the 4 RCC dimensions with students expected to gain beginner levels of competency on these dimensions in addition to evidence-based principles of health sciences. This requires interprofessional collaboration among health professions, social science, and liberal arts faculty and training of health professions faculty in narrative medicine. Next, we suggest engaging in incremental change in the organizational culture with professional development and team-building activities. Although we need systematic research on the efficacy of the components of the transformation, their impact on students' learning, and their costs, it is important to engage in efforts to prepare professionals who are able to respond to the complex health needs of individuals and society in the 21st century.

Integrating Investigative Research into the Classroom: Foundational Experiences for Both Science Majors and Pre-Professional Healthcare Students.

Few students at institutions that do not have scholarly research as central to their mission have the opportunity to explore experimental design and data analysis through investigative research. Laboratory courses are often the only opportunities to apply scientific knowledge, but traditionally rely on "cookbook" labs that often only demonstrate concepts. Much of the discussion regarding the need for research experiences in undergraduate education has focused on the impact on encouraging science students into research careers. However, it is clear that the need for opportunities in investigative research is just as critical for pre-health professional students as it is for students entering into primarily research careers, for future evidence-based practice and translating research to practice. Thus, healthcare pre-professionals need exposure to experimental methodologies prior to their professional education, as a foundation for their coursework and eventual practice. The challenge is to provide such experiences at community colleges and primarily undergraduate institutions. To assist faculty in implementing research into their undergraduate curriculum and to expand the discussion, we propose models for implementing research into the curriculum-course contained; multi-semester experience; research paired; course adjunctive; and independent study/club activity-and provide case studies used in courses taken by science majors and pre-health professionals.

The Eaf3/5/7 Subcomplex Stimulates NuA4 Interaction with Methylated Histone H3 Lys-36 and RNA Polymerase II.

NuA4 is the only essential lysine acetyltransferase complex in Saccharomyces cerevisiae, where it has been shown to stimulate transcription initiation and elongation. Interaction with nucleosomes is stimulated by histone H3 Lys-4 and Lys-36 methylation, but the mechanism of this interaction is unknown. Eaf3, Eaf5, and Eaf7 form a subcomplex within NuA4 that may also function independently of the lysine acetyltransferase complex. The Eaf3/5/7 complex and the Rpd3C(S) histone deacetylase complex have both been shown to bind di- and trimethylated histone H3 Lys-36 stimulated by Eaf3. We investigated the role of the Eaf3/5/7 subcomplex in NuA4 binding to nucleosomes. Different phenotypes of eaf3/5/7Δ mutants support functions for the complex as both part of and independent of NuA4. Further evidence for Eaf3/5/7 within NuA4 came from mutations in the subcomplex leading to ∼40% reductions in H4 acetylation in bulk histones, probably caused by binding defects to both nucleosomes and RNA polymerase II. In vitro binding assays showed that Eaf3/5/7 specifically stimulates NuA4 binding to di- and trimethylated histone H3 Lys-36 and that this binding is important for NuA4 occupancy in transcribed ORFs. Consistent with the role of NuA4 in stimulating transcription elongation, loss of EAF5 or EAF7 resulted in a processivity defect. Overall, these results reveal the function of Eaf3/5/7 within NuA4 to be important for both NuA4 and RNA polymerase II binding.

The capacity to form H-DNA cannot substitute for GAGA factor binding to a (CT)n*(GA)n regulatory site.

Previous studies of the Drosophila melanogaster hsp26 gene promoter have demonstrated the importance of a homopurine*homopyrimidine segment [primarily (CT)n*(GA)n] for chromatin structure formation and gene activation. (CT)n regions are known to bind GAGA factor, a dominant enhancer of PEV thought to play a role in generating an accessible chromatin structure. The (CT)n region can also form an H-DNA structure in vitro under acidic pH and negative supercoiling; a detailed map of that structure is reported here. To test whether the (CT)n sequence can function through H-DNA in vivo, we have analyzed a series of hsp26-lacZ transgenes with altered sequences in this region. The results indicate that a 25 bp mirror repeat within the homopurine.homopyrimidine region, while adequate for H-DNA formation, is neither necessary nor sufficient for positive regulation of hsp26 when GAGA factor-binding sites have been eliminated. The ability to form H-DNA cannot substitute for GAGA factor binding to the (CT)n sequence.