AMR Awareness

Overview

One of the most effective methods to positively alter public health policy regarding antimicrobial resistance (AMR) is to raise awareness through education initiatives (Haenssgen et al., 2018). As such, we explored AMR by focusing on public awareness to shape our efforts and learn from the community. The World Health Organization (WHO) reported that only 36% of roughly 10,000 people surveyed in 12 countries were aware of the effects of AMR (WHO, 2015). To truly understand this issue firsthand, we looked to our local community and primary medical care professionals. From our research, we developed a multifaceted approach, including initiatives such as self-publishing a children’s book and hosting synthetic biology and AMR workshops. Moreover, we extended our efforts to introduce AMR to systematically marginalized groups, collaborating with our local neurodivergent community as well as adolescent girls in Afghanistan. Through education initiatives, Lambert iGEM has prioritized community awareness of AMR, while also facilitating increased science literacy.

Addressing Antimicrobial Resistance in Healthcare with Dr. Jesse Jacobs

Figure 1. Dr. Jesse Jacobs

Initially, we met with Dr. Jesse Jacobs (MD), a professor at Emory University in Atlanta, Georgia to learn more about antimicrobial resistance in hospitals. His work focuses on researching hospital procedures that contribute to antimicrobial-resistant bacteria, and the ways hospitals can further address antimicrobial resistance. He emphasized how a lack of education to the public drives resistance, as there is a delicate balance between doctors adhering to procedures and patients pressuring them for unnecessary medication. When bacteria are unnecessarily exposed to these medicines, it accelerates the development of resistance. This led us to focus on education to increase awareness about the consequences of antibiotic overuse and AMR.

Vertical Integration

Insight on Education Initiatives with Dr. Brittney Cantrell

Figure 2. Dr. Brittney Cantrell

Initially, we focused our education efforts on secondary students, planning AMR workshops and educational campaigns. Hence, we reached out to Dr. Brittney Denier Cantrell, the Science Specialist for grades 6-12 in Forsyth County Schools because she has a direct impact on 34,000 students. She offered us insight regarding specific educational standards and introduced our team to a method called vertical integration. Dr. Cantrell defined vertical integration as a method that connects different levels of education—primary, secondary, and post-secondary—ensuring that each level builds upon the knowledge of the previous level. Taking this into account, Lambert iGEM organized our initiatives in a linear format, educating elementary, middle, high school, and post-secondary students (see Fig.3). She further guided us to look past just our local community and expanding our vertical integration to have further impact – ranging from our state, to national, and international levels (see Fig.4).

Figure 3. Vertical Integration Diagram

Figure 4. Scaling our Approach Diagram

Elementary Education

Consulting with Dr. Jacob Harrison on our children’s book

Figure 5. Dr. Jacob Harrison

At the beginning of vertical integration are elementary school students in grades K-5. As our first initiative, we self-published a children’s book, “Benny’s Antibiotic Adventure”. This story follows Benny the Bunny as he faces unexpected challenges, forms new friendships, and learns valuable lessons about the proper use of antibiotics. To improve our book and ensure it would appeal to younger audiences, we contacted Dr. Jacob Harrison, a postdoctoral researcher in the Bhamla Lab at the Georgia Institute of Technology (GT) who specializes in scientific story-telling. At our meeting, Dr. Harrison introduced us to a variety of scientific storytelling techniques, including the Hero’s Journey—a narrative framework involving stages such as the call to adventure, trials, a climax, and a return (see Fig.7). The Hero’s Journey is one that many children enjoy reading, with classic tales such as “Little Red Riding Hood” and “Cinderella” resembling this format. Considering that elementary-aged children already enjoy the Hero’s Journey, we thought it was apt that we framed our book this way as well. This allowed us to craft an engaging story while also simplifying complex scientific concepts to resonate with young minds. After reading the first draft of “Benny’s Antibiotic Adventure” aloud to a panel of science teachers across the state of Georgia, Dr. Jacob Harrison recognized several elements of the “Hero’s Journey” within our children’s book.

With his guidance, we were able to better structure our writing to follow the classic stages of the Hero’s Journey. Specifically, by aligning Benny’s challenges with the trials of the Hero’s Journey, we simplified the concept of antimicrobial resistance, making it easier to comprehend through the use of visual aids and witty dialogue. Additionally, we removed some specific pages that were too complicated to comprehend and added a villain to add to the climactic element of the story.

Figure 6. Dr. Jacob Harrison reading aloud Benny’s Antibiotic Adventure

Figure 7. Children’s Book Hero’s Journey

Lambert iGEM published “Benny’s Antibiotic Adventure” on Amazon, making the book available worldwide for the minimum commercial price of $1, letting it be accessible by removing financial barriers. Once published, Lambert iGEM brought our children’s book to our local elementary school, Shiloh Point. There, teachers read “Benny’s Antibiotic Adventure” aloud to their Kindergarten through 2nd grade classes, and introduced the concept of AMR to them.

Figure 8. Shiloh Point read aloud with Benny’s Antibiotic Adventure

Through Benny’s journey, young readers gain a foundational understanding of AMR awareness, setting the stage for more advanced learning in later years.

Middle School Education

Building on our vertical integration efforts, we once again sought guidance from Dr. Cantrell to best target middle school students. Following our discussion, we developed plans to host immersive camps for middle school students. These camps are designed to provide hands-on experience with Lambert iGEM’s 2024 antimicrobial resistance (AMR) project, offering young learners a practical understanding of our work through engaging, application-based activities.

We hosted a Biotechnology Bootcamp at Lambert High School for middle school students across the county. This bootcamp provided these students with an understanding of AMR, while also introducing them to the different aspects of our 2024 iGEM project. Through a weeklong session, members of the Lambert iGEM team led middle school students through several interactive activities:

• AMR Discussion - We introduced our project SHIELD and held discussions on the criticality of AMR

• Banana/Strawberry DNA Extraction - Served as an accessible parallel to our more complex Soil wet-lab procedures. (see Agriculture)

• Central Dogma Lab - Students were able to understand the flow of genetic information in a cell, and understand how transcription and translation work

• CRISPR & Gel Electrophoresis Lab - Allowed students to cut DNA using CRISPR and analyze their results using gel electrophoresis. This lab also gave them the ability to understand how the guide RNA and Cas9 nuclease work together.

• Citizen Soil Science Initiative - Campers brought in soil samples from around Forsyth County to test for AMR in the soil

• Frugal Hardware Gadget Creation - Gave students a glimpse into the field of Frugal Hardware and explained how important accessible equipment is in the field of synthetic biology

• Scientific Communication Activity - Showed students how to effectively communicate complex scientific information in a way that is easily understood

Figure 10. Participants of the bootcamp and their counselors with the Candy DNA Activity

Through these activities, middle school students developed critical hands-on lab skills including micropipetting, gel electrophoresis, lab safety, critical thinking, and scientific communication. Additionally, to integrate our local community into our project, we asked campers to bring in soil samples to contribute to our agricultural initiatives (see Agriculture). This let us show them the prevalence of AMR throughout our county, while also furthering the impact of our agricultural awareness initiative with AMR. Since campers were minors, their parents/guardians signed safety forms of consent to participate in Lambert iGEM’s surveys and activities.

Figure 11. Counselors and participants working on their wetlab skills

The 25 students in this program consisted of a collection of future students at South Forsyth High School and Lambert High School. We intend to concentrate our efforts on the elementary and middle schools that feed into South Forsyth High School (SFHS) in the future to facilitate a STEM pipeline that closely mirrors the one that creates Lambert iGEM. We reached out to the current science teachers and principals of local feeder middle schools of SFHS: South Forsyth Middle School, Piney Grove Middle School, and Lakeside Middle School to develop a standard-aligned synthetic biology workshop curriculum in collaboration with them for future use.

Figure 12. Guest speakers Dr. Tracy Jimerson (left) and Richard Jiang (right)

Lambert iGEM also hosted two different nationwide webinars – an introduction to synthetic biology and a specific session about our project – targeting middle school-aged students. Dr. Cantrell suggested involving guest speakers and professionals in the field to bridge the gap between community literacy and expert knowledge. Our first webinar featured former iGEM member and current Duke undergraduate Ricky Jiang, who gave students an introduction to synthetic biology. Our second webinar featured Dr. Tracy Jimerson, a former pediatrician at Kaiser Permanente who discussed Antimicrobial Resistance in healthcare settings. Our guest speakers, detailed presentations, and interactive games enabled us to more effectively teach students from states including Georgia, New Jersey, Maryland, California, and Texas.

Figure 13. Webinar 1

Figure 15. Webinar 2

Webinar 1 - Introduction to Synthetic Biology with Richard Jiang, an undergraduate biology researcher attending Duke University to speak about his experience and passion for synthetic biology

Webinar 2 - Antimicrobial Resistance (AMR) from the perspective of a medical professional with Dr. Tracy Jimerson, a former pediatrician at Kaiser Permanente

High School Education

Over the summer, Lambert iGEM was given the opportunity to participate in the Frugal Science Academy (FSA) program, which allowed us to utilize the facilities of the Bhamla Lab at the Georgia Institute of Technology (GT).

We also invited several high schoolers from across the state of Georgia to shadow the Lambert iGEM team on campus. This program helped expose these students to advanced research and fundamental synthetic biology skills such as PCR, gel electrophoresis, and hardware components, providing them with direct exposure to the iGEM environment.

Figure 17. Lambert iGEM team at Georgia Institute of Technology with our high school and teacher shadows

To build upon our initiatives with the feeder schools of South Forsyth High School, Lambert iGEM also collaborated directly with the school. We contacted the administrative staff as well as the biotechnology teachers, Mrs. Pam Seeley and Mrs. Jennifer Clendenen, to develop a detailed workshop curriculum plan for future implementation. Additionally, we conducted 5 guest speaking sessions at the school to introduce students to the Biobuilder and iGEM programs, detailing our personal experiences as well as our journey to the team.

There is currently a “lack of social research… on antibiotic-related awareness in a low-income… context” (Haenssgen et al., 2018). Recognizing this, Lambert iGEM wanted to ensure that we were inclusive in our initiatives. As we were researching, we learned about an initiative called the One Health Approach- an educational AMR awareness campaign that prioritizes underserved communities in their initiatives (Marvasi et al., 2021). Inspired, Lambert iGEM also wanted to consider underrepresented communities in our approaches, collaborating with our local neurodivergent community, and extending our efforts internationally with Flowers for the Future, a female STEM education initiative in Kabul, Afghanistan.

Collaborating with the Local Neurodivergent Community

To better understand how to best introduce AMR and synthetic biology to the neurodivergent community, Lambert iGEM collaborated with Mrs. Mary Nicoletti, the head of special education at Lambert High School.

Figure 18. Mrs. Mary Nicolleti

Mrs. Nicolletti helped us develop and implement a series of customized, yet standard-aligned lesson plans. Based on these conversations, Lambert iGEM iterated upon our lesson plans, taking into consideration the fine motor skills of students, individual strengths, and varying sensitivity levels. By incorporating their feedback into our lesson plans, we were able to ensure a more inclusive and effective educational experience. Throughout a span of 6 months, our team worked with Lambert High School’s neurodivergent classes by holding multiple learning sessions. These sessions not only introduced key concepts in synthetic biology but also allowed us to teach them about antimicrobial resistance.

Flowers For the Future

We also continued our collaboration from 2023 with Flowers for the Future (FFF), a female STEM education initiative in Kabul, Afghanistan.

Lambert iGEM conversed with Flowers for the Future regarding the further integration of biotechnology into their curriculum. The organization cited consistency as one of their key factors in successfully ensuring retention with the girls. Hence, rather than employing periodic lessons, we held a month-long intensive focusing on synthetic biology to best cater to the students.

We created a synthetic biology curriculum consisting of lessons about the basics of biotechnology, an introduction to cells, and equipment in science labs. Lambert iGEM contributed to FFF’s original curriculum by adding synthetic biology lessons and standards to allow these girls to explore their passions while also obtaining fundamental science skills. We aim to combat the limited access to education of female students in Afghanistan, given their restrictive political environment.

Below is a comprehensive overview of our lesson plans:

Along with English, we translated all the presentations into their language Dari to increase the ease of comprehension. In order to maintain safety and confidentiality for our students and partners, Flowers For the Future makes no mention of any names, locations, and/or specificities anywhere on websites, social media, or the internet (e.g. “learning academy,” not “[name] school”) to avoid any risks. The organization also fundraises to provide the girls with laptops and wifi so they can learn from home and not be seen or have their safety undermined. They also do not publicize the organizations they work with, and make sure that any and all released video lessons are put on the Flowers for the Future YouTube channel, with no other information given than the instructional topics being presented (Lambert-iGEM 2023).

Post-Graduate Collaboration and Workforce Education

The final step in our vertical integration strategy focuses on our initiatives with postgraduates and the workforce. Our research experience at GT extended beyond independent work, evolving into a mentorship program between undergraduates and Lambert iGEM team members that significantly enhanced our project. We implemented their critiques and feedback into our project to better refine SHIELD.

Furthermore, Lambert iGEM participated in a poster session at GT where we presented various aspects of our 2024 project to numerous undergraduates, professors, researchers, post-doctorates, and education department members.

Figure 21. Lambert iGEM team members presenting to GT poster presentation attendees

Figure 22. Lambert iGEM team members presenting to GT poster presentation attendees

Our project underwent a crucial phase of refinement during this poster session. As part of this interactive process, attendees were encouraged to provide constructive feedback. Using this, we identified specific areas for improvement, such as incorporating more visual aids to enhance understanding.

Figure 23. Feedback received from GT poster session

In the figure above, several sticky notes were given to us for feedback. The majority of this feedback focused on organizational and visual representation. Through this method, Lambert iGEM not only was able to involve our research community in our scientific process, but we were also able to spread AMR awareness to our workforce. For example, session attendees reported font readability, logical organization, and increased quantification as factors of improvement in our project. Taking this into account, we focused on the aesthetic component of our project, prioritizing ease of comprehension in our technical writing.

Post-secondary students were able to understand the importance of high school research opportunities, and expressed curiosity about Lambert iGEM’s initiatives, praising its uniqueness. Specifically, attendees took an interest in our children’s book, reading it in detail, and reported that they would also like to implement something similar in the future. Through our post-graduate collaboration and education initiatives, Lambert iGEM was not only able to receive feedback on our approaches, but we were also able to share our ideas of scientific communication, ultimately aiming to build a larger scientific community.

Figure 24. Lambert iGEM team members with mentors, high school shadowees, and teacher shadowees, at the GT poster presentation

During our summer participating in the Frugal Science Academy at the Bhamla Lab, we recognized that to properly support the spread of AMR awareness to a larger population of high schoolers, we would need to mentor teachers in addition to students, as they would have a greater overall impact – with each teacher, on average, instructing over 150 students. Therefore, we also invited seven head science teachers from across the state to shadow the Lambert iGEM team. We equipped teachers with the knowledge, skills, and resources necessary to introduce and integrate AMR awareness through synthetic biology education into their classrooms. Likewise, Lambert iGEM was also able to gain feedback from teachers on how to improve educational methods to raise awareness of AMR. With this back-and-forth exchange of commentary and advice, we refined our approach and developed more effective ways to engage students and promote understanding of antimicrobial resistance. By supporting our trained educators, Lambert iGEM aims to contribute to the future workforce of STEM and create a lasting impact beyond the immediate scope of our project. Understanding that current students are the future of AMR research, Lambert iGEM’s primary goal with our vertical integration approach was to foster a future workforce that will be well-informed of public health issues through increasing interest in and engagement with these scientific concepts.

Proof of Concept

After implementing our education initiatives, we wanted to evaluate the efficacy of our vertical integration approach. To do this, we once again contacted Dr. Cantrell, who recommended identifying an existing successful “model” of vertical integration for effective comparison with our AMR awareness education approach.

As we reflected, many Lambert iGEM team members found they had personally experienced a similar vertical integration method with the Lambert iGEM pipeline. They recalled their synthetic biology journey starting at workshops and camps they had attended in middle school, sparking their initial interest, and eventually leading them to pursue the biotechnology pathway in high school. After recognizing their passion, they joined Lambert iGEM’s preliminary seminar team, where they honed the skills necessary to eventually become members of our Lambert iGEM competition team (see Fig.25)

Figure 25. Lambert iGEM as a model

To quantify the impact of Lambert iGEM’s vertical integration model, we obtained a decade’s worth of Lambert iGEM alumni data from Dr. Brittney Denier Cantrell and Mrs. Janet Standeven (past Lambert iGEM advisors). To determine the model’s success, we analyzed this data to determine the proportion of Lambert iGEM members who joined and graduated with STEM degrees after pursuing a STEM degree at the university level (see Fig.26).

Figure 26. STEM matriculation data

While the matriculation of STEM degrees of Lambert iGEM members cannot be directly compared to the national average due to confounding factors, Lambert iGEM greatly outperforms the national average of 34.2% in 2021 (NCES, 2022) by 41.3%. While correlation isn’t indicative of causation, based on the data, it is seen that a vertical integration approach positively impacts STEM interest and matriculation. Lambert iGEM hopes to replicate a similar pipeline with our future initiatives at South Forsyth High School.

References