A Candida auris Outbreak and Its Control in an Intensive Care Setting.

BACKGROUND: Candida auris is an emerging and multidrug-resistant pathogen. Here we report the epidemiology of a hospital outbreak of C. auris colonization and infection. METHODS: After identification of a cluster of C. auris infections in the neurosciences intensive care unit (ICU) of the Oxford University Hospitals, United Kingdom, we instituted an intensive patient and environmental screening program and package of interventions. Multivariable logistic regression was used to identify predictors of C. auris colonization and infection. Isolates from patients and from the environment were analyzed by whole-genome sequencing. RESULTS: A total of 70 patients were identified as being colonized or infected with C. auris between February 2, 2015, and August 31, 2017; of these patients, 66 (94%) had been admitted to the neurosciences ICU before diagnosis. Invasive C. auris infections developed in 7 patients. When length of stay in the neurosciences ICU and patient vital signs and laboratory results were controlled for, the predictors of C. auris colonization or infection included the use of reusable skin-surface axillary temperature probes (multivariable odds ratio, 6.80; 95% confidence interval [CI], 2.96 to 15.63; P<0.001) and systemic fluconazole exposure (multivariable odds ratio, 10.34; 95% CI, 1.64 to 65.18; P=0.01). C. auris was rarely detected in the general environment. However, it was detected in isolates from reusable equipment, including multiple axillary skin-surface temperature probes. Despite a bundle of infection-control interventions, the incidence of new cases was reduced only after removal of the temperature probes. All outbreak sequences formed a single genetic cluster within the C. auris South African clade. The sequenced isolates from reusable equipment were genetically related to isolates from the patients. CONCLUSIONS: The transmission of C. auris in this hospital outbreak was found to be linked to reusable axillary temperature probes, indicating that this emerging pathogen can persist in the environment and be transmitted in health care settings. (Funded by the National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Oxford University and others.).

Using Student Engagement to Relocate Ethics to the Core of the Engineering Curriculum.

One of the core problems with engineering ethics education is perceptual. Although ethics is meant to be a central component of today's engineering curriculum, it is often perceived as a marginal requirement that must be fulfilled. In addition, there is a mismatch between faculty and student perceptions of ethics. While faculty aim to communicate the nuances and complexity of engineering ethics, students perceive ethics as laws, rules, and codes that must be memorized. This paper provides some historical context to better understand these perceptual differences, and suggests that curriculum constraints are important contributing factors. Drawing on the growing scholarship of student engagement approaches to pedagogy, the paper explores how students can be empowered to effect change in the broader engineering curriculum through engineering ethics. The paper describes a student engagement approach to pedagogy that includes students as active participants in curriculum design-a role that enables them to critically reflect about why ethics is a requirement. Including students in the process of curriculum design leads students to reframe ethics as an integrative tool with the capacity to bring together different engineering departments and build bridges to non-engineering fields. This paper argues that students can and should play an active and important role in relocating ethics from the periphery to the core of the engineering curriculum.

Reengineering Biomedical Translational Research with Engineering Ethics.

It is widely accepted that translational research practitioners need to acquire special skills and knowledge that will enable them to anticipate, analyze, and manage a range of ethical issues. While there is a small but growing literature that addresses the ethics of translational research, there is a dearth of scholarship regarding how this might apply to engineers. In this paper we examine engineers as key translators and argue that they are well positioned to ask transformative ethical questions. Asking engineers to both broaden and deepen their consideration of ethics in their work, however, requires a shift in the way ethics is often portrayed and perceived in science and engineering communities. Rather than interpreting ethics as a roadblock to the success of translational research, we suggest that engineers should be encouraged to ask questions about the socio-ethical dimensions of their work. This requires expanding the conceptual framework of engineering beyond its traditional focus on "how" and "what" questions to also include "why" and "who" questions to facilitate the gathering of normative, socially-situated information. Empowering engineers to ask "why" and "who" questions should spur the development of technologies and practices that contribute to improving health outcomes.

Taking emotion seriously: meeting students where they are.

Emotions are often portrayed as subjective judgments that pose a threat to rationality and morality, but there is a growing literature across many disciplines that emphasizes the centrality of emotion to moral reasoning. For engineers, however, being rational usually means sequestering emotions that might bias analyses-good reasoning is tied to quantitative data, math, and science. This paper brings a new pedagogical perspective that strengthens the case for incorporating emotions into engineering ethics. Building on the widely established success of active and collaborative learning environments, in particular the problem-based learning (PBL) philosophy and methodology, the paper articulates new strategies for incorporating emotion into engineering ethics education. An ethics education pilot study is analyzed to explore how PBL can engage students' emotions. Evidence suggests that PBL empowers students to cultivate value for engineering ethics and social responsibility, and in doing so, redefine the societal role of the engineer. Taking students' emotions seriously in engineering ethics offers an effective strategy to meaningfully engage students in ethical learning.

The ethos and ethics of translational research.

Calls for the "translation" of research from bench to bedside are increasingly demanding. What is translation, and why does it matter? We sketch the recent history of outcome-oriented translational research in the United States, with a particular focus on the Roadmap Initiative of the National Institutes of Health (Bethesda, MD). Our main example of contemporary translational research is stem cell research, which has superseded genomics as the translational object of choice. We explore the nature of and obstacles to translational research and assess the ethical and biomedical challenges of embracing a translational ethos.

Modernizing Natural History: Berkeley's Museum of Vertebrate Zoology in Transition.

Throughout the twentieth century calls to modernize natural history motivated a range of responses. It was unclear how research in natural history museums would participate in the significant technological and conceptual changes that were occurring in the life sciences. By the 1960s, the Museum of Vertebrate Zoology at the University of California, Berkeley, was among the few university-based natural history museums that were able to maintain their specimen collections and support active research. The MVZ therefore provides a window to the modernization of natural history. This paper concentrates on the directorial transitions that occurred at the MVZ between 1965 and 1971. During this period, the MVZ had four directors: Alden H. Miller (Director 1940-1965), an ornithologist; Aldo Starker Leopold (Acting Director 1965-1966), a conservationist and wildlife biologist; Oliver P. Pearson (Director 1966-1971), a physiologist and mammalogist; and David B. Wake (Director 1971-1998), a morphologist, developmental biologist, and herpetologist. The paper explores how a diversity of overlapping modernization strategies, including hiring new faculty, building infrastructure to study live animals, establishing new kinds of collections, and building modern laboratories combined to maintain collections at the MVZ's core. The paper examines the tensions between the different modernization strategies to inform an analysis of how and why some changes were institutionalized while others were short-lived. By exploring the modernization of collections-based research, this paper emphasizes the importance of collections in the transformation of the life sciences.

Computerizing natural history collections.

Computers are ubiquitous in the life sciences and are associated with many of the practical and conceptual changes that characterize biology's twentieth-century transformation. Yet comparatively little has been written about how scientists use computers. Despite this relative lack of scholarly attention, the claim that computers revolutionized the life sciences by making the impossible possible is widespread, and relatively unchallenged. How did the introduction of computers into research programs shape scientific practice? The Museum of Vertebrate Zoology (MVZ) at the University of California, Berkeley provides a tractable way into this under-examined question because it is possible to follow the computerization of data in the context of long-term research programs.

Collections-Based Research at Berkeley's Museum of Vertebrate Zoology.

UNLABELLED: [[ KEYWORDS: Alden Holmes Miller, natural history, collections, museum, ornithology, evolution, fieldwork, Berkeley, collections-based research, Museum of Vertebrate Zoology ]] Recognizing natural history collections as dynamic scientific tools that enable unique forms of comparative analysis, theorizing, and questioning offers a new perspective on the history of the life sciences in the twentieth century that emphasizes the important role that collections played in the transformation of biology. To build an understanding of "collections-based research," this paper focuses on the career of Alden Holmes Miller, who led the Museum of Vertebrate Zoology at the University of California, Berkeley through significant institutional, disciplinary, and technological changes (1940­1965). This paper examines how Miller's efforts as researcher, administrator, and teacher enabled him to foster collections-based research. Miller's own research into speciation and reproductive physiology are examples of collectionsbased work, incorporating concepts, theories, practices, and tools from the laboratory, museum, and field.

Morphogenesis, Dictyostelium, and the search for shared developmental processes.

In the 1930s John Tyler Bonner began studying the slime mold, Dictyostelium discoideum, as a way to investigate how organisms develop. With a life cycle that includes periods of unicellularity and multicellularity, Dictyostelium raises questions fundamental to development and evolution. In Morphogenesis: An Essay on Development (1952), Bonner built on his work with Dictyostelium to inform developmental theory and practice. By exploring how Bonner's early work with Dictyostelium motivated his synthetic approach in Morphogenesis, this paper presents an example of how those who studied development sought ways to gain traction in the rapidly changing life sciences. While a biochemical viewpoint of development became dominant, morphogenesis provided a way to reintroduce and emphasize biological organization at the organismal level. Bonner's early work offers a window to mid-twentieth century studies of development, an understudied area in the history of science, and shows that it was a time when growing experimental evidence enabled new ways of thinking about the relationship between ontogeny and evolution, and more broadly, about how the parts of nature might fit together.

Regeneration: Thomas Hunt Morgan's window into development.

Early in his career Thomas Hunt Morgan was interested in embryology and dedicated his research to studying organisms that could regenerate. Widely regarded as a regeneration expert, Morgan was invited to deliver a series of lectures on the topic that he developed into a book, Regeneration (1901). In addition to presenting experimental work that he had conducted and supervised, Morgan also synthesized and critiqued a great deal of work by his peers and predecessors. This essay probes into the history of regeneration studies by looking in depth at Regeneration and evaluating Morgan's contribution. Although famous for his work with fruit fly genetics, studying Regeneration illuminates Morgan's earlier scientific approach which emphasized the importance of studying a diversity of organisms. Surveying a broad range of regenerative phenomena allowed Morgan to institute a standard scientific terminology that continues to inform regeneration studies today. Most importantly, Morgan argued that regeneration was a fundamental aspect of the growth process and therefore should be accounted for within developmental theory. Establishing important similarities between regeneration and development allowed Morgan to make the case that regeneration could act as a model of development. The nature of the relationship between embryogenesis and regeneration remains an active area of research.

The proliferation and expansion of retinal stem cells require functional Pax6.

Retinal stem cells (RSCs) exist as rare pigmented ciliary epithelial cells in adult mammalian eyes. We hypothesized that RSCs are at the top of the retinal cell lineage. Thus, genes expressed early in embryonic development to establish the retinal field in forebrain neuroectoderm may play important roles in RSCs. Pax6, a paired domain and homeodomain-containing transcription factor, is one of the earliest genes expressed in the eye field and is considered a master control gene for retinal and eye development. Here, we demonstrate that Pax6 is enriched in RSCs. Inactivation of Pax6 in vivo results in loss of competent RSCs as assayed by the failure to form clonal RSC spheres from the optic vesicles of conventional Pax6 knockout embryos and from the ciliary epithelial cells of adult Pax6 conditional knockout mice. In vitro clonal inactivation of Pax6 in adult RSCs results in a serious proliferation defect, suggesting that Pax6 is required for the proliferation and expansion of RSCs.