Team:Manchester/Human Practices
Human Practices were considered in every aspect of our project:
- Stakeholder interviews with UTI patients, urologists and other healthcare professionals determined our project's focus on catheter coatings instead of wound healing, which was another option our team was considering.
- Human Practices guided research into the materials we would use for our project to find the most sustainable route possible. In our earlier phases of project development, we evaluated and discussed using waste resources firstly from sea creature waste in our chitosan application and later, cellulose tree cutting waste for our final application.
- Social responsibility was at the forefront of our project, guided by literature reviews and research of the HP team. As part of our striving towards inclusivity in science, we contacted stakeholders in low and middle income countries such as Mexico, Pakistan and Uganda to gauge their perspectives on CAUTIs, catheter coatings and our product. We also contacted the Think Tank SYNBIOCHEM to discuss further questions about user acceptability, particularly in using waste materials.
- The HP and Modelling teams worked together to decide on the best hydrogel material to use. We contacted academics within the Material Science Department and the Think Tank SYNBIOCHEM to determine a better biopolymer option than chitosan. Linking technical knowledge of mesh size, porosity and crosslinking with the human-centred design know-how allowed our team to make the right decision in choosing cellulose as our hydrogel biopolymer material.
- More stakeholder interviews presented the problem of the fibrinogen deposition in the inflammatory response that CAUTIs cause. This prompted a collaboration between the HP and Research teams to further research the synthetic biology mechanisms that could act against the fibrinogen response. Later in the design, this led to the incorporation of a urease inhibitor.
- Human Practices shaped our collaborations and entrepreneurship. We brainstormed approaches we could take to increase the sustainability of our product. This included deriving our materials from waste products such as cellulose tree cuttings. Additionally, we collaborated with KCL to broaden our knowledge about the acceptability of novel therapeutics and the gap between research and the clinic.
- We conducted a literature review into care quality, treatment and costs of CAUTIs in low and high income countries. This was done to better understand the care environment of healthcare centres where UriGel's products will be used. We determined that there is disparity in treatments and care quality for CAUTIs both inter- and intra-countries. Some of the main factors improving CAUTI treatment and care quality included well-regulated prevention programmes and keeping a centralised and secure digital health record. UriGel plans to continue its research into the socioeconomic disparities to improve the accessibility of novel treatments in both high and low income countries.
Figure: Timeline of our Integrated Human Practice Activities for iGEM 2021
February 2021
Surface Coating Phase
Our initial project idea was that of an antibacterial surface coating that minimizes the risk of transfer of infection due to pathogens being able to live on surfaces for hours, or even days after being contaminated. The original design was to use a hydrogel substance to coat walls and other hard surfaces, with genetically modified bacteria being incorporated into the design. These bacteria would secrete enzymes that prevented biofilm formation and would also secrete other anti-viral properties.
Researching Countries
The Human Practices team carried out research into global stakeholders that could benefit from our project idea and what materials could make it possible to minimise the manufacturing necessary. The aim was to be able to manufacture the product locally to each stakeholder area both in low and high economically developed countries. From this research, the team made the decision to focus on using chitosan as a hydrogel material, as we saw the opportunity to manufacture our product responsibly using seafood waste.
Chitosan Phase
Chitosan is derived from shellfish waste, thus the team researched NGOs and contacted local fisheries to see whether the production of chitosan for the product would be a viable option. We found that chitosan also has some properties that made it unsuitable for purpose, such as the fact it was antibacterial in our target service environment, so any bacteria that we modified would be killed by the hydrogel itself. We attempted to move forward using Chitin (also another derivative from shellfish waste), but decided to first focus on determining our final application before looking into other materials.
Figure: Underlying Principles for Team:Manchester's Human Practices Activities for iGEM 2021
March 2021
Catheter or Coating Phase
As the design progressed, the team wanted to work on a specific application. Members of the HP team interviewed obstetrics professor Prof. Nick Macklon and urologist Dr Maciej Szwedowski, who gave feedback on two on the teams' two most significant application ideas: wound healing and catheter coating. From all the initial interviews and surveys carried out, it was concluded that catheter coatings received a lot of enthusiastic feedback, as did wound healing coatings-- specifically for groinal injuries. The HP team then looked into catheter usage in hospitals, and noted the link between extended catheter usage and Catheter Acquired Urinary Tract Infections (CAUTIs). We then broadened this approach and interviewed a cardiologist to inquire about other indwelling catheters that could cause infections in other parts of the body, and found that some specialists were enthusiastic about such a product being used in their surgeries.
The take-away from these initial findings was that a catheter coating that prevented CAUTIs would be most useful for medical professionals, and the technology could be applied to different products in the future.
April 2021
Materials Phase
One of our team members arranged an interview with Dr. Christopher Blanford (Senior Lecturer in Biomaterials at the University of Manchester) to discuss the specificities of the hydrogel. It was suggested in this interview to perhaps use cellulose rather than chitin or chitosan. The necessity for the porosity of the hydrogel to suit bacterial functions was discussed, as well as the feasibility of our hydrogel material selection. Chitin or chitosan requires harsh, corrosive chemicals to process and quality control is challenging. Due to these concerns, we moved to an alternative biopolymer as the matrix of our engineered bacteria.
Input from SYNBIOCHEM
This decision was then backed following a meeting with Professor Phil Shapira from SYNBIOCHEM, where the team discussed issues the product could potentially face if we were to produce it using “waste-derived” products such as chitin or chitosan. It was also debated whether or not we could label the product as “waste-derived” due to inappropriate data collection in shellfish producing companies, and labelling a material that is being reused as waste. This discussion also further raised concerns regarding allergic reactions to potential allergens that could contaminate the chitin or chitosan extracted from shellfish waste.
Chitin Feasibility Study
The HP team then researched whether it would be feasible to use chitin due to the number of people globally with shellfish allergies (0.5-2.5% of the global population), and the team found that shellfish allergies in particular can range in severity. “Hypoallergenic” chitin-based polymers were also researched, but the methods to synthesise these polymers were high-cost and multistep to ensure a maximal chitin purity, however, this then would limit our product to high-income providers. With all the direction we had been given in the interviews, we decided to use cellulose derivatives (NaCMC and HPMC) and began our modelling work.
May 2021
Patient Phase
As the team now had a more in-depth idea of what materials we were going to use for the catheter-coating, specific stakeholder feedback was required in order to help to influence the design and purpose of the product further. Three further interviews were carried out: first with a chronic UTI patient, second with a urologist, and finally with a GP senior partner in order to gain further insight as to how Urigel could potentially benefit both doctors and UTI patients. From the interviews, we found that inflammation associated with CAUTIs is often the aspect of the infection that patients suffer the most from-- and so it was suggested that instead of just preventing UTIs, the team include an anti-inflammatory aspect within the design. The HP team also evaluated the consequences of inflammation on a patient, and found that inflammation often leads to infections, and requires increased use of anti-inflammatory drugs and painkillers. There is also increased risk of chronic infections, stricture formations and chronic pain.
June 2021
Inclusivity and Collaboration
The team prepared a literature review study to investigate the difference in adopting new medical technologies in low and high income countries, how are resources managed for medical device technologies, would medical staff use new medical devices when given accessibility to the appropriate equipment, how do the behaviours of patients differ between state-sponsored or self-purchased novel medical devices. We decided to keep this for our collaboration and to narrow our research questions to focus more on our design for UriGel.
The Collaboration
After the KCL-organised UK virtual meetup, we began our collaboration with the King’s College London team. We started forming a mentorship and had bi-weekly meetings to discuss our projects and troubleshoot specific research, modelling and other problems.
July 2021
Inclusivity(continued)
We started to write a literature review on the costs, treatment and care quality outcomes for CAUTI patients in low and high income countries. This was done to better understand the institutional environment our project would be used in. In particular, it was important to understand the different factors influencing care quality and how it could be incorporated into UriGel design.
Inclusivity for All
In planning to make an accessible and inclusive Wiki, we contacted the Disabled Society and Rosalind Bell to get recommendations and feedback. The outcome of the interview was that websites should be designed with accessibility in mind upfront. However, to make sure all the governmental guidelines are addressed, we planned to make our wiki customisable so that the user can change the font size, font style and background colour.
August 2021
Expanding our Collaboration
We expanded our collaboration into the human practices realm. We each collaborated through our team presenting a lecture on synthetic biology and the environment for KCL's Biologix competition. We used this as an opportunity for improving our interactive presentation techniques and to advertise our podcast, The Living Revolution, which we invited KCL on.
September 2021
Collaboration and Literature Review
Alongside KCL, we were interested in whether or not there was a gap in communication between researchers and practicing healthcare professionals regarding novel therapies, and so we investigated this. We designed a questionnaire collaboratively, and interviewed a doctor who works at a hospital with a Research and Innovation department to gather opinions on whether this was indeed an issue that limited the use of novel therapies. From this interaction we learned about how the researcher-healthcare practitioner communication could be streamlined to provide a more integrated person-centered healthcare, something which we will take into consideration in our future entrepreneurship strategies.
From our literature review, we were able to demonstrate the key differences in care quality both between and within high and low income countries. These disparities originated from policy, procedures, lack of resources as well as factors in how digital health data was used to aid treatment of CAUTIs. This raised future considerations for the team in how we might incorporate digital healthcare and recording keeping into the design. Additionally, it presented a significant need for a point-of-care approach to our design.
You can find a PDF copy of the review here.