At a 2005 national meeting on Enhancing the Discipline of Clinical and Translational Sciences, the NIH expanded on that directive by saying that translational research must include disease-oriented research, patient-oriented research, clinical trials, epidemiology, and disease prevention.

Clinical and translational sciences must convert discoveries made in the lab into practical applications; accelerate and strengthen the clinical and translational research process; improve the clinical research enterprise; and bridge the gap between discovery and clinical testing so that more efficient translation of promising discoveries may take place.

"Research teams of the future are really what translational medicine and research facilities are all about," says Robert DeGenova, laboratory planner at Hillier Architecture. "It is really combining the wealth of knowledge and expertise from basic researchers, clinicians, and M.D. Ph.D.s, into one facility where state-of-the-art patient care is taking place. The focus is to re-engineer the clinical research enterprise."

That plays out in many forms, the most important of which is that scientists collaborate with physicians who also serve patients, all in one building. This helps to facilitate and accelerate the movement of medical discoveries from laboratory bench to bedside, and improves the patients' understanding of research and the healing process.

"We are not doing research for the sake of research," says DeGenova. "A researcher in Newark said the building would really change how and what he does. You do get motivated when you see the people who are very ill."

This collaborative approach also captures the interest of potential funding sources, such as government agencies, pharmaceutical companies, and philanthropists.

Designing an "Academic Home"

The NIH's directive requires architects to rethink the way they design facilities to combine state-of-the-art research laboratories, graduate-degree granting academic institutions, and clinical healthcare centers under one roof.

"As an architect, we have a new mission and a new initiative," says DeGenova. "We see new building types that foster relationships."

The NIH calls this concept an "academic home," with the primary investigator, typically a person with M.D./Ph.D. degrees, organizing the basic research and developing the protocols. These facilities, in turn, need to be part of large medical campuses that include private enterprise and funding sources, and which are accessible to the community.

"Traditionally we feel that there have been physical and cultural barriers set up between the healthcare parts of campus and the medical school campus," says Steven Gifford, managing and planning principal at Hillier Architecture. "We are seeing the need for significant master planning to figure out a more sophisticated view of how all these buildings and program elements are integrated on one campus."

The physical barrier is simply the segregation of three distinct areas: the healthcare campus, with a hospital, an ambulatory care center, and a medical office building; and the medical school's two campuses, with academic buildings and a library on one side, and research laboratory space with a vivarium on the other.

Cultural barriers include competitiveness, trademark concerns, and intellectual property rights, all the results of programmatic and disciplinary silos that have been the traditional mainstay of research and, therefore, building design.

These issues begin to resolve themselves when multiple institutions partner on a building together, says Gifford.

DeGenova and Gifford list several key program elements to include in the new facilities:

• Research Laboratories
• Vivaria
• Clinical Exam / Treatment Areas
• Clinical Trial Facilities
• Display and Learning Centers
• Patient / Family Resource Center
• Healing Gardens
• Academic / Offices
• Conference and Classroom Facilities
• Formal Integration
• Communication Spine
• Informal Integration—"Social Glue"

Translational Medicine Facilities in Progress

The University of Medicine & Dentistry of New Jersey, for example, has a large campus in New Brunswick which is book-ended by the Cancer Institute of New Jersey to the north and the Child Health Institute on the south end. A spine connects various facilities through the main hospital and the children's hospital.

In the southern part of the campus, a Children's Hospital has been constructed and a Children's Specialized Hospital is planned, which would be clustered around a quadrangle with the Child Health Institute.

"This is an exciting idea," says Gifford. "This would be quite a concentrated focus on childhood diseases."

Another example is the University of South Alabama, which was planned as a fairly small medical complex—long-term care, a hospital, and a cancer center—on a large parcel of land. Future plans may include expanding into other centers of excellence and adding a biotech park, hotel, ambulatory care, a conference center, and a wellness center.

As important as where buildings are located on a campus is where the elements are located within the building itself. The building designs are categorized as either vertical or horizontal, each with its owns benefits. Vertical orientations are more common because of the price and shortage of land, and they are easier to secure because the ground-floor area most accessible to the public is smaller. Coincidentally, those designs are typically found in urban settings where security is more of an issue. In rural settings, where there is not the heightened need for security, there also is plenty of room, so the designs tend to be more horizontal.

Aside from the cost of the land, building horizontally is generally less expensive, and the elements are easier to integrate, says Gifford. But there needs to be a balance between the vertical walking distance and the horizontal walking distance within the building.

At the University of South Alabama's Cancer Center, land was not as big an issue, so the layout is very horizontal, with one wing for research laboratories and another for clinical space, joined by an atrium through which everyone passes. Faculty offices, which do not need to be accessible to the public, are located on the upper floors.

"The patients enter the atrium and are invited to literally look into the laboratories," says Gifford.

The Cancer Institute of New Jersey in New Brunswick is a combination of horizontal and vertical because it was built in phases. The more vertical 90,000-sf administrative and clinical space came first. A 120,000-sf building for clinical and research specialties grew horizontally in the second phase.

The Child Health Institute at the Robert Wood Johnson Medical School in New Brunswick and the University Hospital Cancer Center at the New Jersey Medical School in Newark are vertical organizations, with the academic and research floors stacked on opposite sides of the building, and the clinical floors closest to ground level.

University Hospital contains two atriums—a three-story one on the patient floor and a two-story one on the research floor—which physically and visually link the elements of the building. Including spaces like an atrium is important in creating interactions between the various users of the facility.

"Labs are very secure facilities, and yet the goal is to make them synergistic and force interactions between patients, doctors, and researchers," says DeGenova. "We're trying to get everyone to cross paths."

The Child Health Institute successfully organizes core elements and accommodates programs of dramatically different configurations and space needs within one footprint. It contains a courtyard at the lower level, which is accessible to the public. The academic facility is somewhat secure but still open to the public, as is the ambulatory care center.

As you rise up through the building, the clinical research facilities are more secure, and the vivarium (below grade) is even more so.

At the University Hospital Cancer Center, the vivarium is on the top floor.

Gifford says the most common place for a vivarium is below grade, but if it needs to be above ground level, "the higher the better. It keeps it further away from the public consciousness and the venting and mechanicals are cheaper." But that scenario also requires an extra, dedicated elevator for vivarium use.

While it is difficult to generalize, benchmarking has revealed some standards to keep in mind. A viviarium, for example, averages 20 to 25 percent of the overall research space. A vivarium below 15,000 sf is not particularly cost-effective. Building footprints should be 25,000 to 30,000 sf. Anything larger than that creates such large horizontal distances that it discourages collaboration.

One feature that was left out of many of these buildings for budgetary reasons is large academic meeting spaces. Large auditorium spaces are uncommon in these buildings, though they are available in other buildings on campus.

The Future of Translational Medicine

These collaborative environments can be expanded even further into national networks, making IT, biostatistics, and bioinformatics even more critical to the process, says DeGenova. A tissue and tumor bank at the Cancer Institute, for example, will generate the kind of information other researchers can use.

Translational medicine facilities in the future also may combine ambulatory care beds, clinical trial beds, and research in one building.

The NIH has begun an initiative to mentor a new generation of translational researchers. A principal investigator at the Cancer Center received a large grant specifically to train new researchers in these methods.

By Lisa Wesel

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