Team:elan vital korea/Integrated Human Practice

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HUMAN PRACTICE
-Integrated Human Practice-

Threat of Antibiotics-Resistance and Countermeasures: Korea and US

The spread of antibiotic-resistant bacteria is a global health problem that affects nations across borders and boundaries and rapidly spreads throughout the world. These nightmare bacteria pose catastrophic threat to people everywhere in the world.

Our project is Early Detection of Antibiotic Resistant Bacteria using Quorum Sensing. It is closed related to the surveillance and containment of the pathogens. With the understanding, we have conducted case study of Korea and the US on the current status of antibiotic resistant bacteria infection and the countermeasures. We have gathered data on the spread of antibiotic-resistant bacteria and countermeasures taken as well as contemplated in Korea and the US. For this, we have relied on various materials and documentations, and some of them are translated from Korean.

Introduction

On November 11, 1945, Alexander Fleming delivered his Nobel Prize speech. This great man who discovered penicillin warned that bacteria could become resistant to these remarkable drugs. Indeed, the development of each new antibacterial drug has been followed by the detection of resistance to it. The development of resistance is a normal evolutionary process for microorganisms, but it is accelerated by the selective pressure exerted by widespread use of antibacterial drugs. Resistant strains are able to propagate and spread where there is non-compliance with infection prevention and control measures.

Even considering regional discrepancy in the data quality as well as quantity, resistance patterns for the bacteria of public health importance is sufficient to alarm the world. For example, the proportion resistant of S.aureus to commonly used specific antibiotic drugs exceeded 50% in many countries. Furthermore, there are limitations in effective oral treatment options for some common community-acquired infections in several countries, and that there remain few, if any, treatment options for some common severe and health-care associated infections in many places.

High rates of MRSA imply that treatment for suspected or verified severe S. aureus infections, such as common skin and wound infections, must rely on secondline drugs in many countries, and that standard prophylaxis with first-line drugs for orthopaedic and other surgical procedures will have limited effect in many settings. Second-line drugs for S. aureus are more expensive; also, they have severe side-effects for which monitoring during treatment is advisable, increasing costs even further.

Unfortunately, there is at present no global consensus on methodology and data collection for Antibiotic Resistant Bacteria surveillance. Routine surveillance in most countries is often based on samples taken from patients with severe infections – particularly infections associated with health care, and those in which first-line treatment has failed. Community-acquired infections are almost certainly underrepresented among samples, leading to gaps in coverage of important patient groups.

It is urgent to develop effective implementation strategies in order to curtail the emergence and spread of AR, and to evaluate the effect of interventions.

Antibiotic resistance has a significant adverse impact on clinical outcomes and leads to higher costs due to consumption of health-care resources. Patients with infections caused by bacteria resistant to a specific antibacterial drug generally have an increased risk of worse clinical outcomes and death, and consume more healthcare resources, than patients infected with the same bacteria not demonstrating the resistance pattern in question.

Although surveillance on antibiotic resistant bacteria has been undertaken for many years in a number of high-income countries, there are still large gaps in knowledge about the status of surveillance capacities worldwide, particularly in resource-limited settings.

Available data are insufficient to estimate the wider societal impact and economic implications when effective treatment for an infection is completely lost as a result of resistance to all available drugs. The overall health and economic burden resulting from acquired antibiotic resistant bacteria cannot be fully assessed with the presently available data; new methodologies are needed to more precisely assess the total impact of resistance, to better inform health policies and to prioritize the deployment of resources. However, even admitting the lack of reliable information on the financials, the overall cost is highly burden to all nations, even further to the less developed countries. For example, the yearly cost to the US health system alone has been estimated at US $21 to $34 billion dollars, accompanied by more than 8 million additional days in hospital. Because antibiotic resistant bacteria has effects far beyond the health sector, it was projected, nearly 10 years ago, to cause a fall in real gross domestic product (GDP) of 0.4% to 1.6%, which translates into many billions of today’s dollars globally.

2. On-booth Experiment Sessions and DNA-Related Activities

For 3 days, we taught more than 500 visitors about conducting DNA extraction experiments and assembling DNA models.

(1) Broccoli DNA Extraction Experiment

We have explained the DNA structure while students were conducting the experiments. Following pictures had been used to make visitors understand better.

1. Grind broccoli using the blender.
2. For 25g of broccoli, put 2g of salt and 7g of surfactant (liquid detergent) into 150ml of distilled water, then stir until it is completed melted, and wait for 5-10 minutes. The detergent captures the proteins and liquids of the cell membranes.

3. Pour the grinded broccoli through a strainer into another container.
4. Pour the mixture into test tubes (or small glass containers).

5. Tilt the test tube and slowly pour rubbing alcohol (70-95% isopropyl or ethyl
alcohol) into the tube down the side so that it forms a layer of the broccoli mixture.
6. DNA will rise into the alcohol layer from the broccoli layer. Use a glass stirring rod (or wooden stick) to draw the DNA into the alcohol.

3. Information Seminar on Synthetic Biology

Elan Vital Korea has organized an information seminar on synthetic biology during the Korea Youth Expo. For the seminar,
we have invited Mr. Damon Tighe as our lecturer, who conducted the lecture in the English language, which was
simultaneously translated into the Korean language. We have invited college students and professors as well as high school students visiting the expo.
We also held an introduction session on iGEM. The entire session was video recorded, and offered to various institutions.

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4. On-Booth Discussions and Talks on Synthetic Biology

We explained to the visitors of our booth what is the synthetic biology, and what benefits and risks are inherent in the new field
full of great potential and possibility. We began our discussions with visitors of our booth by asking them to express their opinions on
the synthetic biology. This way, we were able to customize the level of information we share based on their answers and feedbacks.
In the process of the discussions, we showed them various displays, including various pictures, videos,
information brochures and the glow fish on display in our booth to explain the synthetic biology.

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To The Top

Click here to see the Questionnaire

We have conducted surveys by designing questionnaires, distributing them to the visitors to our booth, then gathering their responses. The questionnaire
is designed to solicit information on the level of public awareness of the topics and issues related to the synthetic biology.
The survey results, which are summarized below, will give us better understanding of the public awareness of the synthetic biology and tools
to better plan our promotional, human practice activities in the future.

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Most of the respondents belong to the age group of 10-18 years old. In fact, more than 80% of respondents belong to that age group.
The result is expected, considering that the survey was conducted at the Youth Expo. Male respondents are tree times larger than female.
The largest age group is high school students, followed by under and over graduates. Since program providers
are mostly high school and college club members, the result is expected.

B. Public Awareness of Synthetic Biology

In general, the younger the respondent is, less likely that they knew what the synthetic biology meant, or ever heard about it. Respondents aged between 10 and 15,
174 out of 222 (about 78.83%) answered that they have never heard of the synthetic biology. Respondents belonging to the age group 16-18 showed
similar results: 75% (147 out of 196) have never been exposed to the definition of the synthetic biology. As ages increase, more people
answered that they have at least heard about it, or know what it is. About 66.67% of people aged between 19 and 25 (52 out of 78)
responded that they have heard about the synthetic biology. For older age groups, more than 55% of age group between 26 and 40 and 83% of
age group between 41 and 50 respectively understood what synthetic biology means. The result, however, is not reliable because the
total number of sample belonging to these age groups are very few (only 15 out of 511). Furthermore, that they are aware of the subject is rather expected,
considering that they visited the Youth Expo at all, visited our booth and volunteered to participate in the survey. The results seem to suggest
that the synthetic biology is not well understood or accepted among school age teenagers.

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Comparing the result we got with the results obtained by the Team Oxford in 2014 iGEM and and UCL London 2010 (see the charts above),
general public in Korean including high school and college students show higher percentage of people
who have been informed of and/or interested in synthetic biology.

But comparing the results with those obtained in Hong Kong, Korea’s Asian neighbor, the level of public awareness of the synthetic biology
among Korean population are substantially lower than residents of Hong Kong. It is rather surprising considering that
the Korean government has demonstrated that it has a strong desire to drive growth in the synthetic biology-related industries.
In August 2011, the Korean government has selected the synthetic biology as one of the ‘Global Frontier Businesses’ and established
the Intelligent Synthetic Biology Center later the same year, in order to support the research and business development
in the field. The Center (including 11 universities and more than 200 researchers) leads the development of the synthetic biology
in Korea. In short, the government’s strong drive for the synthetic biology did not result in heightened public awareness
of the field. The observation is supported by the level of participation in iGEM, which is quite low compared to the government’s and
the industry’s
drive and efforts to make the industry thriving. The result seem to suggest that as a further study, we need to look deeper into the
actual works performed by the government, academics and the industry to promote the synthetic biology, and identify the challenges and issues
that hinder the development of the synthetic biology despite government’s and industry’s resolution and drive.

c. Public Attitude Toward Specific Area of Synthetic Biology/Genetic Engineering

Answers on Question 5 shows interesting observation: The phrase we use to solicit answer leads to extremely different responses.
Respondents expressed their concerns and generally responded negatively if the question includes the phrase “gene modification,
gene alteration, etc.,” but answered more positively if the question is about the “genetic engineering.”
The contrasting results seem to suggest that people do not understand what genetic engineering means, or what kind of works are
done in the field. Also, people were more understanding and forgiving if given more generic, comprehensive
phrases such as “genetic engineering” rather than specific works such as “gene modification or alteration.” The result also
seems to show that the public attitude is largely decided based on the particular phrase used, (verbal and nonverbal)
nuances and cultural contexts in which the phrase appears.

Absolute majority of respondents (about 65%) thought that the genetic engineering should be permitted only
when justified by clear reasons and right purposes. About 17% said that the genetic engineering is very dangerous, and prohibited at any cost.
About 10% answered that the genetic engineering should be permitted, even though it may pose dangers and concerns.
And, another 9% of the respondents thought that the genetic engineering should be allowed for the welfare of the humanity.

About 10% answered that the genetic engineering should be permitted, even though it may pose dangers and concerns.
And, another 9% of the respondents thought that the genetic engineering should be allowed for the welfare of the humanity.

D. Concerns About Synthetic Biology

When asked what comes to their mind first about the danger of the synthetic biology and gene modification, many respondents did not articulate
their answers, but substantial portion of people (about 20-30 percent) answered the danger of human as well as animal cloning.

Comparing the responses we got with the responses of US, it seems that the Korean people do nothave sufficient knowledge on how
the synthetic biology is actually used. It is possible such result is due to the fact we conducted our survey
for mostly younger generations (aged between 10 and 25).

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6. Follow-up Activities at the Korea Science Festival

As follow-up activities, we have supported a few science clubs that are selected program roviders at the Korea Science Festival
held from 27th of July to 3rd of August. We were not eligible for operating a booth at the event, because Elan Vital Korea is not a school
science club but an interschool club comprising different school students. We had conducted subsequent survey for 141 program providers.
Our initial expectation was that they must have had interests and knowledge on the synthetic biology, as they are members of science clubs
in schools. However, the result showed otherwise.

7. Observations

During the process of our education and public awareness-related human practice at Korea Youth Expo and the Korea Science Fair, we have become
keenly aware of the need for educating students and young generation about the synthetic biology. As our survey result and our
on-site interview show, very few youngsters knew about synthetic biology, and none heard about iGEM before.
Against the background, we have adopted a few strategies to facilitate our efforts to educate general public particularly focusing on
younger generation about synthetic biology and iGEM. First, we have decided to establish an extensive network with teachers and education
institutions in the field. After searching multiple options and reaching out possibilities, we were able to establish a
cooperative network with the National Association for Science Teachers(http://k-sta.or.kr/), a nonprofit
organization established in March 2003 with the purpose of encouraging science teachers of primary and secondary institutions to enhance
expertise in the cutting edge technology and of motivating them to provide better science education. We have sent our information brochure,
DNA extraction experiment equipment and videos that can be used for the science teacher to work with their students in the field.
We have created Youtube videos explaining synthetic biology and MRSA, which was the starting point of our project and still has urgent
need to teach school aged children what is MRSA and how to protect themselves from getting infected by the
antibiotics-resistant bacteria. In addition, we have made public our blog which had been used only internally to store data and resources until then.
We have committed to provide basic education on synthetic biology whenever requested. We believe that making full use of existing network
of YMCA would be very much beneficial to promote public awareness initiative, because YMCA has extensive network comprising all ages
from high school students to senior citizens. Our role there is to provide information including brochures and video and, if requested,
to visit nursing homes and long term care centers for senior citizens to inform them of the dangers of antibiotics-resistance
and of the measure that should be taken to reduce the infection.