UCI The Application of AI on Chatbot and Its Relative Concerns Research Paper

  

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All engineering projects have social implications. For this assignment, write on an approved topic in your discipline and explore the social and ethical implications in a 4-6 page paper. Use 1.15 spacing and IEEE format.

Communications in the Professional World
ENGR 190W – Winter 2021
Project 1
The Task
All engineering projects have social implications. For this assignment, write on an approved
topic in your discipline and explore the social and ethical implications in a 4-6 page paper. Use
1.15 spacing and IEEE format.
See Canvas for Updates on Due Dates
Item
Section ​D​ Due
Section ​E ​Due
Initial Topic Selection
1/17
1/17
Topic Proposal
1/19
1/19
Draft for Peer Review
1/21 and 1/28
1/21and 1/28
Final Copy Due:
2/2
2/2
Preparation:
How do you get to know more about the professional writing in your field? You read the papers
produced by experts and analyze them. This is a descriptive landscape paper. ​The goal is to
frame the social and ethical issues that tie to your specific engineering interest area.
Nature of paper:
Consider where key ethical debates occur within topics in your field of study. The paper
will need to identify and describe the technology as well as the debate.​ The debate may
focus on standards, use, design, access, cost/benefit or sustainability. Any of these are viable
areas to explore. Consider meeting with me one-on-one to discuss your paper after you have
started your initial research.
How to tackle the paper:
Research your topic at the library and narrow your focus. Once you have a manageable
research question, provide the technical details, explain the social or ethical issues, and
determine the sides in any debate. The paper will need to identify and describe the technology
as well as the debate.
Research any previous attempts to resolve the ethical dilemma the topic raises, and discover if
any previous research includes measured risks. The debates of your topic may be tied to a
series of unknowns but not always. Sometimes the unknowns are understood, but another level
of social or economic complication must be addressed.
B. Harnick-Shapiro 2021
Communications in the Professional World
ENGR 190W – Winter 2021
Completing Your Midterm Writing Assignment
Assignment Specifications
Audience: assume a scientifically literate audience
You must submit all of the following:
Topic Proposal and Proposal Paragraph
Outline and Draft Paper
Revision feedback and plan
Final Paper
Abstract
Points Available
Topic
10
Proposal Paragraph
20
Outline and Rough Draft Paper
20
Final Published Paper and Abstract
150
Total Points
200
FORM​ – Organization and hierarchy of the information presented in your paper
The paper should contain the following sections:
● Descriptive title, your name, and class time and day
● Abstract – may be written as a stand-alone document – single-spaced text
● Body – contains an introductory statement followed by the main body of text;
appropriately subdivided content using descriptive first and second-level headings as
needed to indicate your chosen hierarchy of information, and end with a brief conclusion
that ties the paper together and brings closure to your selected topic
● List of References – IEEE citation format – should include 4 to 6 sources, with a focus on
peer reviewed journals, white papers and government documents, and preferably not all
web pages – not to be confused with online sources such as electronic copies of books,
journals, or conference proceedings
FORMAT – visual cues and aesthetic appeal
The paper must be set up with the following formatting parameters:
● Body text must be 1.15-spaced and left-justified
● Font size should be between 10-12 point font depending on the style used
● Margins should be approximately one inch (top, bottom, left and right-hand margins)
● Headings should be appropriately sized to indicate first and second-level status
● Pages must be numbered (page one begins on the first page of body text – not the cover
page)
B. Harnick-Shapiro 2021
Communications in the Professional World
ENGR 190W – Winter 2021
STYLE – tone and formality of the writing
The paper should reflect a formal scientific tone (avoiding unnecessary use of first-person
pronouns when possible – I, me, my, we, ours, us) and be written to a scientifically literate
audience.
Audience Considerations
Sufficient technical detail should be included in your paper to meet the expectations of your
engineering-based peer audience. Focus and depth make for a stronger paper. It is best to
provide greater technical detail on fewer points than to provide overgeneralized or oversimplified
information on several points.
Assignment Review and Submission
Students are encouraged to visit the UCI Center for Excellence in Writing and Communication.
Upload an electronic copy of the paper (both the native application file(s) and a PDF file(s) for
printing) to the ENGR 190W Canvas in the “Assignment Submission” folder for Project 1 by the
published due date.
NOTE: ​Please name the uploaded file using your first and last name and section (e.g., John
Smith_project1_secX.pdf). You do not need to include the title of the paper in the file name.
You may be asked to bring a printed copy of your paper to class.
Grading Criteria – the foundation is the UCI Upper Division Rubric; P
​ roject 1 Rubric
The paper will be graded on its content, form, format, and style. You will receive two grades for
this writing assignment, one for the abstract and one for the paper. As stated in the course
syllabus, Project 1 represents 20% of your course grade. Your writing should reflect the writing
concepts represented by the “4Cs” – clear, concise, complete and correct.
Self-Evaluation: ​0​ Unsatisfactory ​1​ Developing ​2​ Satisfactory
_________Clear statement of purpose
_________Use of ABC format
_________Content included based upon the audience and purpose
_________Clear analysis based on purpose
_________Use of strong, clear sentence structure.
_________ Proper use of font
_________ Proper use of headings
_________ Proper use of subheadings
_________ Proper use of bulleted lists
_________ Use of parallel structure
B. Harnick-Shapiro 2021
Communications in the Professional World
ENGR 190W – Winter 2021
_________ Strong use of active verbs
_________ All sections have a clear statement of purpose
_________ Proper use of images or charts
_________ Edited to remove mechanical errors
_________ Edited to remove grammatical errors
_________ Cite sources appropriately
B. Harnick-Shapiro 2021
1
Evaluating Antimicrobial Surfaces for Medical Implant
Application
By
Abstract—The continued overuse of antibiotics has
led to increase in therapy resistant diseases, this in
turn has necessitated the development of
antimicrobial surfaces. These surfaces act to either
prevent pathogens from sticking to them or by killing
pathogens them on contact. There efficiency in killing
microbes makes them a potential solution for
preventing biofilm formation on medical implants.
The primary focus of this paper will examine the
physically altered antimicrobial surfaces, giving
results on the origins of their design, experimental
development, biocidal mechanisms, and safety
evaluations. An overview of chemically altered
surfaces will be provided, but extensive details will
not be covered. All together this paper seeks to
establish the viability of antimicrobial surface use in
medical implants, and the ethical implications this
technology presents to public health.
I. INTRODUCTION
The overuse of antibiotics and the rapid evolution of
multi-resistant microbial pathogens have led to a crucial
public health crisis which antimicrobial surfaces may be
able to resolve. They are responsible for a significant
increase in therapy resistant diseases. With this
development, traditional techniques used to treat
common diseases are growing less effective, and in
some cases ceasing to work at all as viable treatment
methods. [1,2] These new resistant microbes provide
significant challenges to industrial, commercial, and
medical applications. With a notably increasing concern
among the medical community being issues with these
resistant microbes in biofilm formation on biomedical
implants.
Biofilms are communities of micro-organisms that
connect to one another in a self-produced matrix with an
extracellular polymeric substance acting as protective
barrier for microbial pathogens.[2,3] The formation of a
biofilm on biomedical devices is a high cost issue, which
can lead to infections, implant rejection, and even death.
[4] This is caused by microbial pathogens within the
biofilm infecting surrounding tissues near the implant.
Biofilms may be introduced during operation
procedures, or through patient hospital stays. The
presence of resistant, microbe harboring biofilms has led
to an increasing number of implant-associated
infections. When these pathogen infected devices are
determined to be too great of a risk to patients, the only
option is to undergo corrective surgery. These biofilm
infections have increased risk to patients undergoing
what should be simple procedures. With countries like
the United States experiencing growths in the elderly
populations, greater demand for biomedical implants
will follow. [5,6] So in the interest of the public health,
the risks which antibiotic resistant microbes and biofilms
present must be resolved.
Various solutions to resistant bacteria have been
proposed in recent years, with new types of antibiotics
being a popular [1,2] yet controversial option
considering the use of any new antibiotics would only
develop bacteria resistance further. Another potential
solution exists in the form of engineered antimicrobial
surfaces. These altered surfaces act to inhibit the
attachment of microbes; effectively halting biofilm
formation and preventing any potential of infection of
body tissues. [4] They accomplish this through a variety
of chemical and physical treatments which include
polymer coatings and designed topographical
microstructures. Antimicrobial surface development has
tremendous potential to aid in variety of fields, and it
may provide an ideal alternative to resolving issues
associated with medical implants.
The purpose of this paper is to investigate
antimicrobial surfaces and how they can provide relief to
issues presented by resistant bacteria and biofilms on
medical implants. Additionally, the viability of this
technology for expanded use for medical grade implants
will be evaluated and a discussion of ethical implications
of this technology will be made.
2
II. METHODS
A literature review was performed to find information
pertinent to the guiding ideas of this paper. The process
of this literary review involved searching research and
medical databases such as PubMed for articles on the
primary topics of these piece. From this search
individual journal pieces were selected and utilized to
provide information on the cost of resistant microbes
[2,5], microbial growth [1,3,4], and antimicrobial
surface solutions using chemical [7-13] and physical
[6,14-22] methods. Every source was evaluated to
ensure that it came from an accredited peer reviewed
journal.
III. RESULTS
It is important to provide context to key terms which
will be used throughout this paper. The two most
important of these terms are antibiofouling and
bactericidal. The term ‘antibiofouling’ refers to a surface
that is inherently resistant or can limit the attachment of
microbes. This property results from either an
unfavorable surface architecture for attachment or the
presence of an unattractive surface chemistry for the
attaching microbial species. ‘Bactericidal surfaces’ are
different in that they actively damage bacterial cells
leading to death for those microbes. In addition to
bactericidal, the use biocidal is utilized to show that this
surface effects other cells beyond bacteria.
In general, antimicrobial surfaces fall into one of two
categories. These surfaces are often subdivided by
whether their alterations are largely chemical or
physical. While both these categories of antimicrobial
surfaces are significant to the understanding of the topic,
only an overview of the chemical antimicrobial surfaces
will be provided. This is done to give more priority to
highlighting the opportunities and concerns of physically
altered surfaces.
Chemical Methods for Antimicrobial Surfaces
The chemical approaches to developing antimicrobial
surfaces are vast in number and all highly complex. In
these approaches, the surfaces of materials such as
titanium, silicone, and polymeric materials are
chemically modified, derivatized, functionalized, or
coated. These processes introduce biocidal materials
such as nanoparticles, polymers, and antibiotics onto the
substrates, giving them their antimicrobial abilities. [3,710]
A brief overview of described biocidal chemical
alterations will now be given. To prevent biofilm
formation on critical surfaces, surface coatings are used
to either prevent microbial surface attachment or kill
microbial cells at first contact. The variance in these
coatings are immense, and each of their efficacies are
equally so. Examples of coatings include antibiotics,
biocompatible polymers, and nanoparticles among many
others. [7-10]
Each of these chemical methods provide significant
potential for results but, they each have flaws in their
application. Coating surfaces with biodegradable
antibiotics presents the ability to prevent biofilm
formation at the surface by delivering a steady dose to
kill surface microbes. However, this ability to release
antibiotic agents from the surface is finite and will
eventually be too little to prevent microbe attachment.
[9] The concentration of the antibodies can also be
problematic causing acute tissue toxicity to host
cells.[11] Polymer coatings can act as physical barriers
which resist adhesion, or act to exterminate microbes
when given microbiocidal effects on their surfaces.[8]
Yet these polymer coatings are also limited by their
biocompatibility, meaning in they struggle to perform in
application[12] Finally nanomaterials derived from
materials such as silver [13], are usually suspended in a
polymer matrix and slowly release antimicrobial agents
to prevent biofilm formation. Though nanoparticles are
ideal in that microbes are unlikely to develop resistance
to them, but they too have an issue over tissue toxicity in
humans. Despite the effectiveness these antimicrobial
substrates show in biofilm prevention, their flaws are
equally significant to consider.
Physical Methods for Antimicrobial Surfaces
With the details and problems of chemical approaches
to antimicrobial surfaces considered, the next step is
evaluating the efficacy and viability of physical
approaches. To begin it is important to understand where
many of the common approaches to physical designs of
antimicrobial materials come from.
The
Nature Inspires Design
designs used to create many
physical
3
antimicrobial surfaces are inspired by examples from
nature. With microorganism having had millions of
years to adapt to conquer abiotic environments,
researchers chose to examine other organism which
adapted to develop their own methods to protect against
these microbes. These natural surfaces feature complex
micro and nanostructures with varying topographies that
give them properties including the ability to self-clean,
super hydrophobicity, and antibiofouling properties.
[3,14,15] These natural surfaces appear on the wings of
creatures like dragonflies and most famously with lotus
leaves. [14] Though initially the antibiofouling
properties of these surfaces was thought to be a product
of their super hydrophobicity, it was discovered in more
recent papers that it was the high aspect ratio topological
features which are responsible for any antibiofouling or
biocidal activity. [16] From the work of many
researchers on this topic, a general theory of how
nanoscale topographies produce bactericidal affects was
generated. It described that the fine surface features
induced a greater strain on bacterial membranes, a strain
which if significant enough could rupture the membrane
and kill the bacteria. [16,17,19,20] This theory would
serve as guiding principle to designing synthetically
generated surfaces.
Development from Design
When the first studies into the creation of synthetic
physical antimicrobial systems began, researchers aimed
to use the high aspect-ratio nanostructures to prevent
biofilm formation. One of the first examples of the
development of a physically altered antimicrobial
surface is in the work of Ivanova et al. [18] In their
study, they created silicon substrates incorporating high
aspect ratio nano-protrusions modeled after those found
on a species of dragonfly. The synthetic protrusions
were sharper and more discretely arranged than their
natural counterparts. These nano-pillars had diameters
on the scale of ~20 nm and heights of ~ 500 nm.
Scanning electron microscope (SEM) images of the
designed structures and dragonfly used for inspiration
can be seen in figure 1. The silicon substrate created by
the researchers was later labeled as ‘black silicon’ or bSi
for short. During the primary investigation, the bSi
substrate was found to be highly bactericidal, exhibiting
killing rates up to ~450,000 cells min-1cm-2.[18] These
results demonstrated that the synthetic substrate had
greater killing rates and higher efficiencies than that of
the natural designs. This study also demonstrated the
effectiveness of this approach to preventing biofilm
formation through alterations to nano-topography.
Figure 1; (a) bSi and (b) dragonfly forewings at 35,000
magnification demonstrate the surface patterns of the two samples.
Scale bars, 200 nm. Micrographs tilted at an angle of 53 (inset)
show sharper nanopillars of black silicon distinct from one another
and approximately twice the height of those of the dragonfly wing.
[18]
This early work has led to further expansion into the
field of physically designed antimicrobial surfaces.
These expanded studies have explored various systems
with differing to nanostructures, substrate materials, and
other variables. [21,22] With the expansion into new
materials such as Titanium and Titania, a whole host of
production methods have been utilized to produce
nanostructured surfaces. Examples of these techniques
include reactive-ion beam etching (RIE), nanotemplating, plasma chemical vapor deposition, and laser
ablation among many others. [18,21,22] Though many
of techniques are highly complex, they are preferred due
to the detailed surface features they can create. For
example, in the work of Ivanova et al, the nanoscale
4
features were created using RIE. This is a plasma
etching technique normally used in the semiconductor
industry. The material is usually placed on a quartz or
graphite plate. Gas is then injected into the process
chamber and a radio frequency plasma source is applied
which determines both the ion density and energy for
etching. RIE is normally used to etch surface textures
with depth < 1 µm. This high degree control of topography exemplifies the most desired trait to any production method. Mechanism of Bactericidal Effects With the effectiveness and implementation established, it is important to clarify the mechanism by which these antimicrobial surfaces act to eradicate bacteria. Not only because it will provide a more complete understanding, but also because it is important to some of ethical concerns of this technology. While the exact nature of this mechanism is not agreed upon, with several theories existing which try to explain the biocidal phenomena, this paper will present one of the most popular explanations for synthetic biocidal activity. This theory was previously discussed and works off the principal of the nanostructures destroy bacteria cells by imposing stresses which are too great for the bacterial cell membranes. [3, 16,17,19,20] To clarify, the surface structures are not themselves puncturing the cell membrane of the bacteria. Instead their designs simply force the bacteria deform. This deformation induces a membrane stress and can then lead cell rupture. [3,1922] Through this process, the surfaces can kill cells that encounter them at varying rates of efficiency. Notably the biocidal effect described by this mechanism does not differentiate between cells. If the criteria for rupture of cell membrane is satisfied, the surface will kill any cell it is in contact with. Despite the growth in research in this field several questions on this mechanism and they biocidal activity are still undefined. For example, researchers still lack enough systematic data to define an optimum microstructure for producing the most efficient biocidal effects. This is due in part to complex variables which determine biocidal effectiveness. Notably these are not limited to the surface topography and surface chemistry alone but instead include variables associated with microbes themselves. Questions over these variables still need to be investigated in future work, in order to generate a complete understanding of this mechanism and its effects. Concerns for Human Implants Despite success in demonstrating effectiveness, the nature of the bactericidal mechanism was a cause for concern for the community of researchers studying physical antimicrobial surfaces. The question of whether the bactericidal nature of these surfaces would pose a risk to eukaryotic (human) cells, became a critical issue. If these surfaces had the same effect on eukaryotic cells as they did on bacteria, the viability of using these modified surfaces in any medical application was in doubt. The answer came in two forms, giving both positive and negative results. For the negative results several studies demonstrated how nanostructured surfaces interacted with cells other than bacteria. [22,23] In the case of Hasan et al [23], their team investigated the effects of nanostructures on mammalian bone matrix cells. Their work found that nanopillars which covered the surface acted lethally against the mammalian cells, with only 12% of incubated cells showing viability for surviving. Other studies have also found that different forms of nanostructures with different mammalian cells have also demonstrated this lethal effect.[22] Despite these negative results fueling fires of concern, other studies have shown more positive results. Building off the work done by Ivanova, the study of Pham et al [6] found that in implant studies performed on monkeys, the silicon substrates demonstrated high levels of biocompatibility. The animals used as subjects demonstrated no inflammatory issues, and the researchers found that while bacteria were exterminated, the animal cells were able to proliferate over the surface.[6] With this, the researchers demonstrated that these surfaces could provide a level of biocidal selectivity. After this result, researchers like Pham began searching for explanations to the biocidal selectivity. There conclusion found that this feature depended on the cell structure, cell size, and rigidity. They found that due to the larger size of eukaryotic cells and special protrusions known as filopodia in the case of Pham, they could distribute cell mass across a larger surface. This gave a greater ability for eukaryotic cell membranes to distort and form themselves along surface nanostructures 5 without damaging themselves [6] This effect is not limited to this paper and system as other researchers such as Diu have found similar biocidal selectivity present in Titania nanostructures. [21] IV. DISCUSSION Taking in the information presented in the results section of this paper, a conclusion can be that antimicrobial surfaces can act effectively to eliminate bacteria and biofilm growth on several different sorts of substrates. With both chemical and physical methods, these surfaces either prevent bacteria from attaching to the surface or kill those bacteria which they come into contact. The numerous journal articles utilized to form the results section of this piece also all act as evidence to support this conclusion. With this the basic goal of this paper is answered in that antimicrobial surfaces can act to reduce or eliminate resistant bacteria and biofilm growth on implants. Moving onto the second and arguably more fascinating goal of this paper, to evaluate the viability of antimicrobial surfaces in expanded applications for medical implants. With their effectiveness established there are now two areas of concern for which the viability of antimicrobial surfaces comes under question. These are the ethical concerns prompted by the safety of this technology, and the feasibility of scaling up production. Concerns of Safety Beginning with the safety of antimicrobial surfaces, the results of this piece gave information regarding the nature of biocidal mechanism brought on by the designed nanostructures. The ethical dilemma here comes from the fact that despite offering a tremendous potential in combating biofilm formation on medical implants, there is some risks with the technology which pose an equally significant risk. Given the nature of the biocidal mechanism, which acts to put significant stresses on cells to force them to rupture, there are some concerns over use of this technology in human implants. It was established earlier that these surfaces can pose a threat to human beings as the work of Hasan [23] demonstrated. Effects of this magnitude raise concerns that antimicrobial surfaces cannot yet be made to guarantee patient safety if used in implant. If this statement is in fact true than it would morally wrong to support their use in implants. In fact, the idea of promoting antimicrobial surfaces despite the hazards they possess would violate the first cannon of the National Society of Professional Engineers’ code of ethics. This code acts as the standard which are engineers held accountable. The cannon states that engineers must hold the safety, health, and welfare of the public paramount above all else.[25] In this case, the danger presented by biocidal effects targeting host cells would serve as enough of reason for engineers to prevent this technology from being as implant materials. However, evidence was also presented to support the idea that these surfaces can be generated to produce selective biocidal activity in the work of Pham and Diu. This selectivity could help ensure the safety of the user while still guaranteeing the effectiveness of surface. Now to say that this safe result is guaranteed in every combination of nanostructure, substrate, and host cell is false. There is still a need for additional research to evaluate potential precautions needed for application in medical implants. Too many unknowns exist with this technology, with variables guiding biocidal efficiency being some of the greatest unknowns. With the presence of uncertainty there is still a notable risk to public safety. This leads to the conclusion that based on concerns for public health and safety, antimicrobial surfaces are not yet viable for use for implants. Despite this, it would be in the greater interest of the public for this technology to be investigated further, and for steps to be taken to begin small scale human tests. This would serve as the first steppingstone to truly opening this technology to widespread use in medical implants. Manufacturing effect on Viability The production of these nanostructured antimicrobial surfaces presents additional concerns for the viability of this technology for medical implants. Issues with manufacturing can be seen in the work of Ivanova et al [18] where a reactive ion beam etching (RIE) was used to generate the nanostructures for the experiment. While laboratory techniques such as RIE are effective in creating the nano-features needed to generate biocidal effects, they are both costly and lack scalability.[22] Though medical implants can be small in scale, the designs used for research level applications are often produced to an even smaller scale. So, there is obvious need to scale up production, but using the wrong 6 technique would only increase costs. This limits antimicrobial surfaces’ potential for application purposes as it drives the price of objects utilizing this technology to be too high. In order to improve the overall viability of physical antimicrobial surfaces, greater work must focus on optimizing methods which can produce these surfaces with precision on a larger scale. By increasing the cost effectiveness and scale of this technology, the viability of using antimicrobial surfaces for medical implants can improve enormously. By using techniques such as template electrodeposition, hydrothermal synthesis, and anodization, larger scale production can be achieved at lower costs. [22,25] An example of work supporting an alternative production method is presented by Wu et al. In their research they utilized electrodeposition as method to create gold nanopillars on a tungsten substrate. The template electrodeposition technique is not cost effective on the small scale but holds great potential for manufacturing on much larger scale. [25] Techniques such as these should thus be the priority going forward, to promote development of antimicrobial surfaces which be used of medical implants. Ethics of Antimicrobial Surface Implementation Overall, when looking at antimicrobial surfaces from an ethical perspective, we see can see a utilitarian dilemma emerge. Utilitarianism is a consequentialist ethical theory that is viable for engineers to follow because it promotes a comprehensive assessment of right from wrong by balancing the cost and benefits of an action.[26] In this case the benefits that antimicrobial surface could bring to medical implant patients is tremendous. In a perfect world it would reduce medical costs for thousands of patients and save much need time and energy for physicians to assess other patients. Yet the issues of safety and insufficient production methods means that the use of antimicrobial surfaces for implants would come at cost of public safety and wellbeing. These concerns of safety and inefficient production techniques highlight that this technology is still in its’ early stages of development and is not yet ready for application. When weighing the costs against the benefits further, an argument could be made that because this could be such a crucial solution, that the benefits would hold a greater weight. Yet the flaws are too great to overcome. Without further testing, antimicrobial surfaces present an expensive solution that has the potential to harm patients more than helping them. This would notably also go against standards established by the NSPE code of ethics; as it would be irresponsible for engineers to create a product of such a high price that had such a high risk to a user. This current risk damages their current viability as it would not be a responsible choice for these surfaces to be used in medical implants. So, when considering antimicrobial surfaces from an ethical perspective, this technology is not yet ready for medical uses. Though antimicrobial surfaces may not yet currently ready for use in medical implants, its’ potential to aid the public make it a necessary subject for future research and development. Even with the high costs associated with greater research and development of high scale production methods; this technology could provide tremendous benefits to state of public health and should be treated as priority for the health industry to invest in. V. CONCLUSION This paper set out to explore the possibilities that antimicrobial surfaces could provide in application in medical implants. Information was provided to generate basic understanding of both categories of antimicrobial surfaces, chemical and physical, and greater overview to the inspiration, synthetic experimentation, mechanisms, and safety concerns of physical methods were explored. From the results of this overview several key conclusions were made. First that antimicrobial surfaces can be effective in eliminating resistant bacteria and biofilm formation on medical implants. Second that the viability of antimicrobial surfaces in medical implants was not yet ready when considering the safety and manufacturing practices. These issues of viability also resonate with the larger ethical concerns surrounding antimicrobial surface use in medical implants. With the current state of antimicrobial surface production being only able to high cost and potentially unsafe materials, it would be in the best interest of public health and safety to avoid their use in medical implants. This claim is made with considerations to NSPE code of ethics, and the utilitarian ethical theory. 7 Works Cited [1] Bush, K., Courvalin, P., Dantas, G., Davies, J., Eisenstein, B., Huovinen, P., ... & Lerner, S. A. (2011). Tackling antibiotic resistance. Nature Reviews Microbiology, 9(12), 894. [2] Spellberg, B., Guidos, R., Gilbert, D., Bradley, J., Boucher, H. W., Scheld, W. M., ... & Infectious Diseases Society of America. (2008). The epidemic of antibioticresistant infections: a call to action for the medical community from the Infectious Diseases Society of America. Clinical infectious diseases, 46(2), 155-164. [3] Hasan, J., Crawford, R. J., & Ivanova, E. P. (2013). Antibacterial surfaces: the quest for a new generation of biomaterials. Trends in biotechnology, 31(5), 295-304. [4] Desrousseaux, C., Sautou, V., Descamps, S., & Traoré, O. (2013). Modification of the surfaces of medical devices to prevent microbial adhesion and biofilm formation. Journal of hospital Infection, 85(2), 87-93. [5] Mutters, N. T., Günther, F., Heininger, A., & Frank, U. (2014). Device-related infections in long-term healthcare facilities: the challenge of prevention. Future microbiology, 9(4), 487-495. [6] Pham, V. T., Truong, V. 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