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− | <div class = "container"> <h1 style="text-align:center; font-size: 75px;"><font face= "Poiret One"> Bench-to-Bedside Guideline </font></h1>
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− | <div class="blue">
| + | <!-- MSBT2016 Safety Wiki Page --> |
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− | <p style="text-align:center; font-size:20px;"><font face="verdana">
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− | Human practice in iGEM is about reaching out to the general public and enhancing communication with the science community. On this page, we focus on strengthening the exchange of information for a concrete launch of synthetic biology application. In order to accomplish this goal, we have created the Bench-to-Bedside Guide, which provides individuals with recommendations on how to bring a diagnostic test developed in the lab into the real world. To further supplement this general guide, we created one specifically tailored to our diagnostic test, which uses aptamers and NASBA to detect tuberculosis biomarkers. <br><br> This is an <b> interactive </b> guideline, so please click on the tiles below to expand and learn more!</font></p>
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− | <!--Market Analysis--> | + | |
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− | <h2 style="padding: 0px 0px 10px 0px">Market Analysis</h2>
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− | <!--MA Description-->
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− | <p style="margin-left: 0px; margin-right: 0px; padding: 0px;"><font face="Verdana">
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− | Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis. Around the world, 8 million new tuberculosis cases arise and 2 million lives are taken per year (1). There is not yet an effective point-of-care
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− | diagnostic test and current methods of diagnosis tend to be expensive, not sensitive enough and untimely. Additional challenges arise when attempting to diagnose a disease in developing regions, as many current diagnostic tests require highly trained technicians and laboratory equipment, preventing the tests from being done on-site. </font></p>
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− | <!--MA Demographic Segmentation (I)-->
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− | <h3 style="padding: 0px 0px 10px 20px">I. Demographic Segmentation</h3>
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− | <p><font face="Verdana">The market size of a business needs to be considered when thinking of demographics and segmentation. A common problem is having a market size too large to target for a startup, so a better approach would be to better start at a local level. Segmentation is helpful in narrowing down the focus and the way that the market could be divided. By understanding the demographic background of the entire market, one then uses the relevant information to identify the market to enter first.
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− | When diagnosing a widespread disease like tuberculosis, the market is as large as the entire world and includes all age groups because they could all be affected by the disease. Although only 9,412 of over 10 million new cases in 2014 were in the United States (2), tuberculosis is rampant in less developing parts of the world. Over 95% of TB cases and deaths are in developing countries (3). In 2014, the largest number of new TB cases occurred in South-East Asia and Western Pacific regions, accounting for 58% of new cases worldwide. Africa carries the biggest burden, with 281 cases per 100,000 people(3). The six countries that stand out as having the largest number of incident cases in 2014 were India, Indonesia, Nigeria, Pakistan, People’s Republic of China and South Africa (3).
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− | <!--MA Target Market, Market Need, & Customer Discovery (II)-->
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− | <h3 style="padding: 0px 0px 10px 20px">II. Target Market, Market Need, & Customer Discovery</h3>
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− | <p><font face="Verdana">This section is important as it is where investors are identified!
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− | Target market is about identifying and understanding the potential customers, and this is often done by looking at the similar products or services that are already on the market. Market Need serves to highlight the section of the existing products in which specific improvement could be made to satisfy the customers, and this is the key point to be considered for product development and design concept. Sometimes there are no comparable products or services to an invention, then it is necessary to find the potential customers in another way, which is Customer Discovery. </font></p>
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− | Current routine methods for diagnosing TB include acid fast staining of clinical material followed by smear microscopy and M. Tuberculosis culture. However, the former has a poor sensitivity (∼70%) and the latter is costly and an untimely procedure (4). Table 1 from Dorman’s paper “New Diagnostic Tests for Tuberculosis: Bench, Bedside, and Beyond” lists some of the more promising new technologies and tests currently in demonstration or late-stage evaluation phase and those endorsed for use by the World Health Organization which are the ones that seem to be the best. However, in general none of these diagnostic tests are perfect, being either untimely, expensive or not sensitive enough. </font></p>
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− | <img src="https://static.igem.org/mediawiki/2016/7/7f/Current_TB_Tests_Table.png" width="1000" height="700">
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− | <br>
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− | The ideal definition of a TB diagnostic test would be one that is a highly accurate, simple to perform, point-of-care test that test urine or blood, and with ability to detect and predict active TB anywhere in the body, in combination with effective preventive and treatment strategies (4). These are all characteristics we sought for Aptatpaper. </font></p>
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− | <p><font face="Verdana">
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− | Global Biodiagnostics, an Aptapaper competitor, estimates that the demand for a point-of-care TB diagnostic is of 100-200 million tests a year, since not everyone tested will have the disease (5). Based on this information, we expect our customer pool to be quite large and diverse: primarily hospitals, governments, and nonprofit organizations. On-site testing in pharmacies or grocery stores similar to how vaccines and some blood tests are available at pharmacies in the United States, presents further opportunities for sales. In addition, TB testing is required of all health care workers and volunteers in the United States, which provides another market where the test could be priced higher. </font></p>
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− | <p><font face="Verdana">
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− | In 2015, the international community set goals regarding tuberculosis with the endorsement of the Sustainable Development Goals (SDGs) and the World Health Organization’s (WHO) milestones, hoping to culminate in the eradication of TB by 2030 (6). This international endorsement for treatment and diagnosing of TB could increase sales, although at the current rate, this goal would take until 2182 to achieve (6). To eradicate TB, a major shift in how the disease is prevented, diagnosed, and treated will be required. </font></p>
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− | Customer discovery continues to be a main focus area for the team. We have been advised by several people, including our iGEM advisor Professor Marcus Ammerlaan, CEO of Warmilu Grace Hsia, Dr. Krishna Rao and Rama Kannenje, President of the Relief for Africa Foundation. Based on the weakness of competing diagnostic technologies and personal experience, they believe that our tool would be heavily adopted. </font></p>
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− | <h4 style="padding: 0px 0px 10px 20px">Kenya Case Study</h4>
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− | In an interview with Rama Kannenje, President of the Relief for Africa Foundation, we learned that a cheap and easy diagnostic method is the key to save lives in Kenya. Almost 90% of HIV patients have TB and it is not uncommon for 1 in 5 hospitalized patients to have TB. People in remote areas cannot be diagnosed or treated due to the great distance they would have to travel to get tested and treated. There is also a lack of human resources to do the testing; there are very few doctors so clinical officers (doctor assistants) end up treating thousands of patients alone. Patients have to travel between laboratories and hospitals in order to get tested and treated. Doctors often forego diagnostic tests because patients can't afford them, so they blindly treat for what they suspect is TB. (7) </font></p>
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− | <p><font face="Verdana">
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− | When TB is diagnosed early on, patients receive medication and go on with their lives. Despite government hospitals being generally inadequate, when citizens are diagnosed with TB, the Kenyan government does front the cost for medication which is usually in stock. However, with approximately 60% of the population living on one dollar a day, prevention is not a top priority. If the cost of testing, currently at $100 per person in Kenya, could be reduced and made easily accessible to rural communities, thousands of lives would be saved annually. The missing link here is a rapid diagnostic test that would prevent this cascade of unfortunate events. (7)</font></p>
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− | <p><font face="Verdana">
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− | By observing Kenya’s circumstances, the Michigan Synthetic Biology Team (MSBT) thought there was a window of opportunity here to put synthetic biology to use. The wellbeing of thousands of people around the world could be ensured by improving TB diagnostics through the use of paper-based genetic switches. Thus, Aptapaper was born. It is a complex technology fused into simple strip which is storable at room temperature for up to a year. It produces an easy to read colorimetric output in hours, costs just a few cents per test, requires no additional equipment and minimal training. (7)</font></p>
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− | <!--MA Analysis on Barrier to Enter the Market (III)-->
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− | <h3 style="padding: 0px 0px 10px 20px">III. Analysis on Barrier to Enter the Market</h3>
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− | <p><font face="Verdana">In order to make actually launch a product into the market, it is important to consider the potential barriers that could impede this process or the actual success of the product. Such barriers include competition and regulations needed to place the product in the market. </font></p>
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− | Our product falls into the quickly growing biotech industry. Due to the high cost of research and government approval, it is common for biopharmaceutical companies to go over a decade without generating their own revenue only to be highly profitable later on. In comparison, as our company will be a diagnostic company, not a biopharmaceutical, the costs and timeline will be significantly lower and shorter. Biotech is also unique in that large biotech companies frequently outsource both research and manufacturing to smaller companies dubbed Contract Research Organizations (CROs) and Contract Manufacturing Organizations (CMOs). This trend has given rise to numerous biotech start-ups that only perform research, receiving funding first from federal grants, and then more traditional sources (angel investors, VCs, incubators, etc.) and partnerships with larger biotech companies.</font></p>
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− | <p><font face="Verdana">
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− | Alternatively, biotech companies of varying sizes avoid the infrastructure costs associated with developing manufacturing centers by hiring CMOs. CROs allow companies to reduce the risks they incur by only buying or investing in drug/diagnostic candidates that they think will be successful or even those which have already received FDA approval. SImilarly CMOs allow biotech companies to quickly produce drugs for clinical trials without having to build/expand their own manufacturing site.</font></p>
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− | Kenyan regulation on medical devices in limited. An application process involving testing and certifications is required. Medical equipment in Kenya is almost all imported (8). Since Kenya is in great need of a TB diagnostic test and is used to importing medical devices, the application process would likely be easy.</font></p>
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− | Most medical products have access to Kenya as long as they meet the Kenya Bureau of Standards (KEBS) requirements (8). The Kenyan Government, through KEBS, now requires that all consignments of regulated products entering Kenya must obtain a Certificate of Conformity issued by one of two firms: Société Générale de Surveillance S.A. (SGS), or Intertek. The price of this Certificate can be anywhere between $450 and $2,675 usd (9). Medical device product evaluations can be done by the National Public Health Laboratories and typically involve 400 tests at a cost of about $1000 (9).</font></p>
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− | <p><font face="Verdana">Our method is well suited from both humanitarian and business perspectives as it is a common disease, infecting about 10 million new people a year. Since a cure is readily available, governments and nonprofits would be willing to invest in a superior diagnostic tool like ours. The technology would also be easily adapted to diagnose other diseases, massively increasing the potential target market. Our primary customers are hospitals, governments and NGOs, predominantly in sub-Saharan Africa, South-East Asia and Brazil. Aptapaper is affordable, that it is easy to envision on-site TB testing at pharmacies and grocery stores in these countries. The test would be optimal for humanitarian organizations such as Doctors Without Borders, that practice medicine in countries in great need of better healthcare. </font></p>
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− | The next important step is to consider the development of the product in a broad view. This is similar to the scientific method but regarding businesses. There are a set of logical steps to be followed after identifying the target market and doing the market analysis in order to fulfill the process of launching a new product into the market. The steps can be seen in the diagram below.</font></p>
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− | Using the information gathered from the target market and market analysis, it is now time to put scientific knowledge to use to create a tool that can fulfill the need found. The design concept can be simple but informative and must surely be realistic. </font></p>
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− | Aptapaper is a diagnostic method based on aptamers specific to the proteins secreted by Tuberculosis pathogens. This systems gives a color output visible to the naked eye, which can be freeze-dried onto paper with a cell-free expression system and activated when a liquid biological sample such as blood is applied. Tuberculosis is disease lacking a modern point-of-care detection method that is easy to use and highly specific despite the great need of a detection method of this sort. Aptapaper offers a non-invasive, cheap solution to this problem that could be used by medical professionals across the globe with no need of a laboratory.</font></p>
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− | Regarding IP protection it is important to check the rules regarding IP ownership specific to your university. There is a possibility the inventor might not not own the IP rights to their invention. If the IP rights are owned by the inventor, a provisional patent must be filed with the help of a patent attorney.</font></p>
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− | A provisional patent is very important to have before making any sort of public disclosure about the nature of the product (including but not limited to: social media posts, press releases, and slideshow presentations) in order to ensure you retain patentability not only in the US but internationally. </font></p>
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| + | <div class = "container"> <h1 style="text-align:center; font-size: 75px;"><font face= "Poiret One">Safety</font></h1> |
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− | <h2 style="padding: 0px 0px 10px 0px">SWOT & PEST Analysis</h2>
| + | <p style="text-align:center; font-size:20px;"><font face="verdana"> Safety is, of course, the one of the foremost concerns when designing a sythetic biology system. Addressed here is a wide range of points on the safety of the Michigan Synthetic Biology Team's project in the laboratory and beyond.</font></p> |
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− | <p style="margin-left: 0px; margin-right: 0px; padding: 0px;"><font face="Verdana"> | + | |
− | Some useful tools to visualize all the information that has been gathered are SWOT and PEST analysis. SWOT stands for strengths, weaknesses, opportunities and threats. This analysis helps one to see some opportunities can become threats, some weaknesses can turn into strengths and vice versa. PEST stands for Political, economical, social, technological and provides a holistic analysis into the real details of introducing a product into the market.</font></p>
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− | <p style="margin-left: 0px; margin-right: 0px; padding: 0px;"><font face="Verdana">
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− | [INSERT KENYA SWOT & PEST ANALYSIS CHARTS HERE] </font></p>
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− | <h2 style="padding: 0px 0px 10px 0px">Promotion / Marketing</h2> | + | <h3 style="text-align:center; font-size: 30px;"><font face= "Poiret One">Would any of your project idea raise safety issues in terms of public saftey or environmental safety?</h3><br> |
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| + | <p style="text-align:left; font-size:20px;"><font face="verdana"> Our project is designed to function entirely on a piece of paper; no organism (besides the user) is required to make it work. Our cell-free design is made up mostly of DNA and other components necessary for protein synthesis. Some form of these components exists in every cell of every species, from E. coli to elephants. The in vitro nature of our final product would remove several potential hazards associated with a device utilizing live cells. There is no chassis organism in the final product which can escape into the environment.<br> |
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| + | The DNA used in our design is unlikely to be taken up and expressed by a naturally occurring microorganism because all DNA segments are linear and the T7 promoter driving expression is not transcribed by healthy bacteria. This greatly reduces the risks of using our recombinant DNA outside the lab. Even if the recombinant DNA used in our project were taken up by a natural microorganism, it codes for two fragments of beta galactosidase, an enzyme which is classified as a non-hazardous substance by GHS and HCS (4). The antibiotic resistance plasmids that are used for cloning should never leave a laboratory setting and would not be a part of the final product. Although these precautions alleviate some common concerns regarding the use of recombinant DNA outside the lab, it is important to remember that the project does still utilize recombinant DNA and therefore requires diligent consideration of possible unforeseen environmental effects. <br> |
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| + | The primary safety considerations of the project relate to its use as a diagnostic device. When developing such a device, false negatives and false positives are a major source of concern, and the potential damage of misdiagnosis must be carefully weighed against the benefits of diagnosing the disease correctly and quickly. Although accuracy and reliability have a large effect on a device’s safety, it is difficult to predict these parameters at such an early stage of development. Another potential danger would be the requirement of working with a small quantity of bodily fluid to operate the device. Any bodily fluid must be treated as a potential source of disease transfer between the patient and others. </font><br></p> |
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− | To the extent that is possible, it is a must to make the product and company name known to the market so they can become familiar with the products and company so they can gain trust and purchase the products. In the modern world there are many options in social media which is one of the main ways we communicate news about our group.</font></p>
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− | <p style="margin-left: 0px; margin-right: 0px; padding: 0px;"><font face="Verdana"> | + | |
− | Check out the <a href="https://www.facebook.com/MSBT2015/?fref=ts"><u>MSBT Facebook Page</u></a>to see how we utilized social media to spread the word about our project and our <a href="https://experiment.com/projects/developing-a-simple-to-use-and-affordable-solution-for-detecting-pathogens"><u>Experiment.com Campaign Page</u></a>to learn about one of the ways we raised money to fund our project. </font></p>
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− | <!--Financial Analysis-->
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− | <h2 style="padding: 0px 0px 10px 0px">Financial Analysis</h2>
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− | <p style="margin-left: 0px; margin-right: 0px; padding: 0px;"><font face="Verdana"> | + | <h3 style="text-align:center; font-size: 30px;"><font face= "Poiret One">Do any of the new Biobrick parts (or devices) that you made this year raise any safety issues?</h3><br> |
− | Financial Analysis is crucial for the survival of a start-up, and the plan could be separated into 2 parts: R&D Stage and Production stage. The R&D stages is equivalent to the seeding stage in Business. It is where a start-up looks for funding and resources to develop its product and/or deliver its service. The first table below summarizes the financial situation of Michigan team in 2016 when they were developing a diagnostic device, and such table and categorization of costs could be used for other teams. The second table is build on assumption of massive production after the R&D is done. It is when the start-up launches its product/ service in the target market. </font></p>
| + | <p style="text-align:left; font-size:20px;"><font face="verdana"> The LacZ omega fragment Biobrick that we submitted is a commonly used reporter in synthetic biology. It encodes a version of beta galactosidase which is only functional when paired with the beta galactosidase alpha fragment. The full beta galactosidase enzyme is classified as a non-hazardous substance under GHS and HCS standards (4). </font><br><hr></p> |
− | <p style="margin-left: 0px; margin-right: 0px; padding: 0px;"><font face="Verdana"> | + | |
− | [INSERT Current Budget at R&D Stage Chart HERE] </font></p>
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− | <h4><font face="Verdana"> Estimated Project Budget </font></h4>
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− | Initial investment includes lab supplies needed to produce the dual-aptamer system used to detect the chosen TB biomarker. Creation of the DNA system only needs to be completed once per chosen biomarker.</font></p>
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− | [INSERT Budget Chart HERE] </font></p>
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− | The predicted cost of producing an Aptapaper diagnostic is very cheap. The cell-free circuit breadboard costs approximately 1.05 cents per uL for materials, including the labor cost of preparing the reaction components, it costs approximately 2.64 cents. This is significantly cheaper than most rapid diagnostic tests (RDTs) which would generally cost between $0.45 to $1.40 for a single reaction. For the reagents of PCR, a between $1.50 to $4.00 is estimated (11).</font></p>
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− | <!--Growth Plan-->
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− | <h2 style="padding: 0px 0px 10px 0px">Growth Plan</h2> | + | <h3 style="text-align:center; font-size: 30px;"><font face= "Poiret One">Is there a local biosafety group, committee, or review board at your institution? If yes, what does your local biosafety group think about your project?</h3><br> |
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| + | <p style="text-align:left; font-size:20px;"><font face="verdana"> There is no body specifically focused on overseeing biosafety hazards. The University of Michigan’s Department of Occupational Safety and Environmental Health reviewed the team’s laboratory and practices multiple times, and found that our lab space met their requirements for safety. Before our team started doing lab work, all our members were trained in laboratory safety and instrument handling in accordance with University of Michigan requirements. </font><br></p> |
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− | It is also ideal to have a growth plan for the project in order to continue to make it grow as it becomes more successful. This keeps the company up to date and in the market as time passes by. Ideas could include expansion, additional services and improvement of management and quality control.</font></p>
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− | <b>Operation</b> will scale up as we introduce this diagnostic test to other countries where prevalence rate is high and obtaining a test is inconvenience, and this would be the first expansion.</font></p>
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− | <b>Product Development</b> is in the growth plan, new diagnostic tests could be designed and made, by switching the aptamers in our design in order to detect other biomarkers that are currently found by ELISA.</font></p>
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− | <b>Additional Cervices</b> would be detecting several diseases using single paper strip, and this could be achieved by freeze drying multiple gene circuits on the diagnostic paper. </font></p>
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− | <b>Management and Quality Control</b> would be detecting several diseases using single paper strip, and this could be achieved by freeze drying multiple gene circuits on the diagnostic paper.
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− | <ol>
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− | <li>The fundamental quality control:
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− | <ol type="a">
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− | <li>Step-by-step instructions for consumers to use the product appropriately.</li>
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− | <li>As the diagnostic component is sensitive to storage condition, extra attention and effort is needed to provide instruction when the test is used by people of different places and countries. </li>
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− | <li>Another necessary control is the provision of a signal to show the strip maintains its functionality, and at the same time, it is a standard to indicate the test result. </li></ol></li>
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− | <li>Safety control would be the most crucial challenge for a biotech company to overcome. Specifically to our project, we have designed a <a href= "https://2016.igem.org/Team:Michigan/Safety"><u>A Transformation Failsafe</u></a></li>
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− | <li>Managerial control are rules of a company to organize, to plan, to direct and it can be identified in few general steps:
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− | <ol type="a">
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− | <li>Set standards for both the product and employees
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− | Example: product has to function as expected and all employees are capable of accomplishing the wet lab work with full understanding of the knowledge related to the lab work. </li>
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− | <li>Measurement of performance</li>
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− | <li>Evaluation of the standard according to actual performance</li>
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− | <li>Review and audit the standards to develop the program</li></ol></li>
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− | <li>Management Control are needed across all department of a company, and the the key aspects for a start-up biotech organizations are the followings:
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− | <li>Financial Resources
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− | <li>Fundraise for non-profit, and the check and balance should be done on a regular basis, so is evaluation to update rules.</li>
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− | <li>Otherwise, maximizing the profit and lower the cost is the goal</li></ol></li>
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− | <li>Human and Machine Control
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− | <ol type="i">
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− | <li>Human - Members joined and stay as a team by sharing the same common goal, and the goal of the company as well as the learning objectives should be clearly identified. Responsibility and positions of each person need to be recognized by all members</li>
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− | <li>Machine - Regular audition of the environment and calibration of equipment should be part of the rules and standards.</li></ol></li></ol></li></ol>
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− | <p style="margin-left: 0px; margin-right: 0px; padding: 0px;"><font face="Verdana"> | + | <h3 style="text-align:center; font-size: 30px;"><font face= "Poiret One">How could parts, devices and systems be made even safer through biosafety engineering? Do you have any other ideas how to deal with safety issues that could be useful for future iGEM competitions?</h3><br> |
− | Some useful tools to visualize all the information that has been gathered are SWOT and PEST analysis. SWOT stands for strengths, weaknesses, opportunities and threats. This analysis helps one to see some opportunities can become threats, some weaknesses can turn into strengths and vice versa. PEST stands for Political, economical, social, technological and provides a holistic analysis into the real details of introducing a product into the market.</font></p>
| + | <p style="text-align:left; font-size:20px;"><font face="verdana"> With a mass produced product that is based on exposed synthetic genes, there is a small chance of natural transformation by environmental bacteria. The products that would come from these genes’ expression are harmless, but to prevent mutation and spreading of these genes a simple failsafe was designed. Inspired by The Chinese University of Hong Kong’s 2012 project that featured a safety component that targets DNA using CRISPR (1). Our design is more simplistic; it relies on the weak expression of DNase I. University Oxford’s 2015 project included a part for DNase I and the necessary chaperone peptide (DbsA) (2). Using a weak promoter to slowly build up the enzymes concentration should not destroy the main template until after it has finished expression. The University of California, Berkeley 2006 iGEM documented a list of promoters and their relative strength and submitted them as parts (3). If it is decided to use this system, several different promoters could be tested with the DNase part in order to find the right level of expression.<br> |
− | <p style="margin-left: 0px; margin-right: 0px; padding: 0px;"><font face="Verdana"> | + | <br><hr> |
− | [INSERT KENYA SWOT & PEST ANALYSIS CHARTS HERE] </font></p>
| + | <p><img src="https://static.igem.org/mediawiki/2016/f/fb/Kill_Switch%281%29.jpg" width="675" height="300" style="margin-left: 250px"></p> |
| + | <p style="text-align:left; font-size:20px;"><font face="verdana">A DNase-based suicide gene has applications with any cell-free synthetic gene network. It is almost every organism that comes in contact with it, and bacterial the do transform the suicide gene into itself will not survive long enough to spread gene further. It will also efficiently wipe away any DNA that was used and leave only short oligonucleotides behind.</font><br></p> |
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