Email updates

Keep up to date with the latest news and content from JTM and BioMed Central.

Open Access Research

Challenges facing translational research organizations in China: a qualitative multiple case study

Laixin Zhou1, Ying Li2, Hayden B Bosworth3, John Ehiri4 and Changkun Luo5*

Author Affiliations

1 College of Preventive Medicine, Third Military Medical University, Chongqing, China

2 Department of Social Medicine & Health Service Management, Third Military Medical University, Chongqing, China

3 Department of Medicine / General Internal Medicine, Duke University, Durham, NC, USA

4 Division of Health Promotion Sciences/Global Health Institute, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA

5 Third Military Medical University, No. 30 Gaotanyan Road, Chongqing, Shapingba district 400038, China

For all author emails, please log on.

Journal of Translational Medicine 2013, 11:256  doi:10.1186/1479-5876-11-256

The electronic version of this article is the complete one and can be found online at: http://www.translational-medicine.com/content/11/1/256


Received:18 August 2013
Accepted:7 October 2013
Published:13 October 2013

© 2013 Zhou et al.; licensee BioMed Central Ltd.

This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Translational medicine is attracting much attention worldwide and many translational research organizations (TROs) have been established. In China, translational medicine has developed rapidly, but faces many challenges. This study was aimed at exploring these challenges faced by emerging TROs in China.

Method

A qualitative, multiple case study approach was used to assess the challenges faced by TROs in China. Data were collected between May and August 2012.

Results

Eight cases were identified. Overall, four themes that characterized TROs in China emerged from analyses: 1. objectives, organizer, and funding resources, 2. participating partners and research teams, 3. management, and 4. achievements. All TROs had objectives related to translating basic discovery to clinic treatment and cultivating translational researchers. In terms of organizer and funding resources, 7 out of 8 TROs were launched only by universities and/or hospitals, and funded mostly through research grants. As for participating partners and multidisciplinary research teams, all but one of the TROs only involved biomedical research institutions who were interested in translational research, and characterized as clinical research centers; 7 out of 8 TROs involved only researchers from biomedicine and clinical disciplines and none involved disciplines related to education, ethnicity, and sociology, or engaged the community. Current management of the TROs were generally nested within the traditional research management paradigms, and failed to adapt to the tenets of translational research. Half of the TROs were at developmental stages defined as infrastructure construction and recruitment of translational researchers.

Conclusions

TROs in China face the challenge of attracting sustainable funding sources, widening multidisciplinary cooperation, cultivating multi-disciplinary translational researchers and adapting current research management to translational research. Greater emphasis should be placed on increasing multidisciplinary cooperation, and innovating in education programs to cultivate of translational researchers. Efforts should be made to reform research management in TROs, and establish sustainable funding resources.

Keywords:
Translational medicine; Translational research organization; Translational medical center; Case study

Introduction

Translational medicine/research/science has become an issue of increasing importance to scientists and governments around the world. The history of translational medicine can be traced back to 1966, when the notion of “From bench to bedside” was presented in Bioscience[1]. The concept of “bench to bedside” was further raised in 1992 in the journal of Science[2], and in 1996s, the concept of “translational research” was presented in the Lancet[3]. Dr. Elias Zerhouni, former Director of the United States National Institutes of Health (NIH) defined the term "translational medicine" for the first time in 2003 [4]. Scientists have conducted successful studies in many areas of translational medicine [5-8] and the scope of translational medicine/research/science is evolving and enlarging [9-17]. The overall goals of the “translational” approach are to translate between basic science research and practice in novel diagnostics/prognostics/therapeutics for patients as well as community prevention approaches, regulations and public policies to influence basic research [17,18]. Translation research is a biomedical research translation continuum that includes 4 practical landmarks (basic science discovery, proposed human application, proven clinical application, and clinical practice) which corresponds to the three translation chasms often referred to as T1 (defined as from basic science to clinical science), T2 (defined as from clinical science to clinical practice), and T3 (defined as from clinical science to health improvements) [13]. The complete translation continuum is a complex process and takes an average of 17 years for research evidence to reach clinical practice [11]. Given the time and complexity of translating findings into care, there is a continued need to promote the concept of translational medicine among clinicians, basic science researchers, biotechnologists, politicians, ethicists, sociologists, and investors and to further improve efficiency of these translational processes [19].

The past three decades have witnessed tremendous advances in China in terms of living conditions, food, nutrition, and health systems reform [20]. However, while the economy grows and the society rapidly transforms, the healthcare system still faces multiple problems [20]. Communicable diseases such as hepatitis B virus, tuberculosis, and HIV remain a heavy burden, while at the same time, chronic diseases, including cancer, cardiovascular disease, hypertension, and diabetes mellitus have emerged as leading causes of mortality and disability in China [20]. Along with accelerating economic growth, China is experiencing rapid population aging [21]. Soaring health needs and limited health resources as a result of an aging population, shifts in disease patterns, and failure of the health market indicate that it is urgent for China to develop strong translational medicine programs to move efficacious interventions into the health care delivery system. Fortunately, with the support of governments and scientists, translational medicine in China has been developing rapidly in recent years [20,22-28].

To promote translational research, it is required that nations set up translational research organizations (TROs) and integrate them into the larger network of bench to bedside translation continuum [28]. In countries with developed translational medicine, such as the U.S., the government has funded a network of translational science institutes or centers from national to state levels across the country [29]. In China, many TROs have been established or have been in the process of development since 2009. However, translational medicine has met a lot of challenges in China. The aim of this study was to understand the challenges facing translational medicine in China in order to gather information that may inform the creation of more efficient organizational structure, functions, and performance of Chinese TROs.

Method

Case studies have a major function in generating hypotheses and building theory [30]. Usually, better understanding of a phenomenon is gained by conducting multiple case studies [31]. Multiple case studies enable the researcher to explore differences within and between cases in order to deeper insight into phenomena of interest [31,32]. A qualitative multiple case study design was used to examine the construction and performance of TROs in China and was conducted between May and August 2012.

Definition of TROs

In this study, TROs refers to institutes explicitly with the title of 'Translational Medical Center’; these centers have a multidisciplinary research group (basic and clinic researchers, statisticians, psychologists, educators and sociological researchers) who work as a team aimed at translating basic discovery to disease diagnosis, treatment, and prevention, or population health promotion, while simultaneously cultivating translational researchers.

Case selection

TROs were selected if they met the following criteria: (1) had the designation of a translational medical center, translational research center or translational medical research center; (2) had a multidisciplinary research team including representatives from basic medicine, clinic medicine, statistics, psychology, and social sciences; (3) aimed at translating basic discovery to diagnosis, clinic treatment, prevention, or population health promotion, (4) aimed at cultivating translational researchers; (5) had representations from hospitals and/or universities; (6) had representations from a wide economic and geographic spectrum throughout China, and (7) established before January 2012.

Data collection method

Data was triangulated by integrating interviews and review of secondary sources.

(1) Interviews: The purposive sampling technique (based on the afore-mentioned inclusion criteria) was used to select TROs for interview. We used an interview guide to collect data on year of establishment, objectives of TROs, funding resources, research teams (including multidisciplinary and institutional), management teams and approaches, and achievement (platform establishment, translational scientist cultivation, funding, cooperation, and translational research outcomes).

(2) Review of secondary sources: Google, Google Scholar, and PubMed were used to search related literature and reports published up to May 31st, 2012, on Chinese TROs. Search terms included translational research center in China, translational medical research center in China, and translational research institution.

(3) Meeting reports review: We collected mainly documents from the 2012 Sino-American Symposium on Clinical and Translational Medicine (SAS-CTM).

Data analysis

We combined qualitative data from all sources and analyzed them using qualitative content analysis method [30]. The analysis included three phrases: preparation (reviewing the data), organization (coding, categorizing, and triangulating the data), and cross-case synthesis. The main themes that emerged following data coding included date of setup for the TROs, objectives of the TROs, organizer, funding sources, participating partners and multidisciplinary research teams, management (team, project management, cooperation, and funding), and achievements (infrastructure establishment, research team establishment, translational research, service, and outcomes including publications, awards, intellectual properties, products, and international communication) (Additional file 1).

Additional file 1. Summary of themes and related categories.

Format: DOCX Size: 16KB Download fileOpen Data

Results

General information on cases

In total, 8 TROS were identified. They included TROs distributed in the north, south, west, and east of China, in both high and low income regions (Figure 1). Characteristics of the 8 TROs are presented in Table 1. All of the TROs were established between 2008 and 2011: two in 2008 and 2009, respectively, four in 2010, and two in 2011. Among them, one was set up as an independent college (College of Translational Medical Research (CTMR) of the first hospital of Zhejiang province); the rest were set up as Translational (Medical) Research Centers. Four cases were located in teaching hospitals affiliated with universities, three were located in universities, and one was located in a non-teaching hospital (Table 1). Data from CTMR in the Zhejiang province was collected only by interview. In three cases, data was collected by using both interviews and reports. In three cases, data were obtained from reviewing documents from both the 2012 Sino-American Symposium on Clinical and Translational Medicine (SAS-CTM) and published reports; finally, data from Peking Union Medical College Hospital (PUMCH) was collected by a study of literature and a review of reports (Table 1).

thumbnailFigure 1. Distribution of cases in this study. This figure is a description of the distribution of cases in this study.

Table 1. General information of cases

Objectives, organizer and funding sources of TROs

All of TROs focused on facilitating translation between clinical and basic researchers (promoting clinic-basic multidisciplinary cooperation) and cultivating translational scientists. However, few TROs explicitly stated any consideration about translating research into health policy and public health (Table 2). Except for one TRO, which was launched through a joint effort of the government and a university (Pudong district and Tongji University), the rest were launched by universities and/or hospitals. As for funding sources, most of the TROs were funded by partners within TROs or through research grants. Only East TMC of Tongji University was supported by the local government but not the central government. CTMR of the Zhejiang province was awarded funds from social services agencies (Table 2). It was notable that no TROs had funding from industry.

Table 2. Objectives, organizer and funding resources of TROs

Organizations of TROs

We collected data about collaborating partners and multidisciplinary research teams involved with the respective TROs. As for partners, East TMC of Tongji University included a university, a hospital (Shanghai East Hospital), and government organizations such as the Pudong New District and Technology Committee and the Pudong New District Health Bureau. The remaining seven TROs were comprised of only research institutes and hospitals. Regarding multidisciplinary research teams, only TMC of Wuhan Union Hospital included public health; the other TROs involved researchers from biomedical and clinical disciplines, with no public health involvement. None of the TROs involved disciplines related to education, behavioral sciences, and sociology, or engaged the community (Table 3).

Table 3. Organization of TROs

Management of TROs

We focused on management teams and research groups, funds, and projects. In terms of management teams, all but one TRO (CTMR of the first affiliated hospital of Zhejiang Province) had a director, vice director, and an administration office. In addition, all TROs had various committees, including a management committee, an academic committee, and a consulting committee (Table 4). Regarding team management, all TROs paid most attention to recruiting researchers, setting up principal investigators (PI), and nurturing translational researchers (through continuing education, joint-cultivation of graduates, training, and academic visits). There was no specific strategy to cultivate multi-disciplinary translational researchers and there were no Master's or PhD degree programs in translational medicine in any of the TROs (Table 5).

Table 4. Management team in TROs

Table 5. Management of TROs

Overall, TROs in China used both internal and external collaborators. As for internal collaboration, one TRO (TMC of Children’s Hospital of Fudan University) had a policy on internal cooperation across institutes and focused on sharing resources and intellectual property, as well as on joint publications. Two TROs (PUMCH-TMC and CTMR of the first affiliated hospital of Zhejiang province) started international cooperation with universities in the U.S. to educate translational researchers. Two TROs (CTMR of the first affiliated hospital of Zhejiang province and TMC of Children’s Hospital of Fudan University) attracted local government funding (Table 5).

Most TROs, however, had no specific strategies for education programs related to cultivation of translational scientists, faculty promotion or performance assessment, promotion of multidisciplinary cooperation inside and outside, or evaluation of outcomes of the different stages across translational continuum. Only the CTMR of the first affiliated hospital of Zhejiang had a policy about performance evaluation, organizing experts locally and abroad to evaluate TRO performance every 3 years according to a list of fixed goals (Table 5).

Achievements of TROs

A majority of TROs are at the beginning stage, few had experienced substantial achievements as TROs. Their main achievements had been predominantly infrastructure construction and recruitment of translational researchers. Three TROs carried out international collaboration. Some TROs had created products such as implantable ventricular assist device (VAD), published papers (Forty-three papers in SCI journals), and/or received awards or patents. Only TRCSR provided a service for training translational researchers in 2012 (Table 6).

Table 6. Achievements of TROs

Discussion

Translational medicine has been supported by the Chinese government. The Chinese government has encouraged integrating industry-academic-research [22]. The 12th Five-year Socio-economic Development Plan (2011–2015) in China emphasized improvement of medical research through developing translational research [20]. The Medium and Long Term Science and Technology [S&T] Development Plan (20122030) issued in 2013 also included emphasis on translational medicine [41]. However, while the Ministry of Science and Technology has just supported a project for building a platform of clinical resources [22], translational medicine in China is still in its early stages. This case study revealed that TROs face many challenges including: 1) They were launched by bio-medical research institutions and are characterized as actual clinic research centers; 2) TROs are not integrated with educational programs that are designed to furnish the TROs with qualified translational researchers; 3) TROs Lacked sustainable funding sources; 4) TROs lacked robust management structures.

Most TROs were launched by bio-medical research institutions and are characterized as actual clinic research centers. Although there are some significant translational research occurring outside of government support, such as industries (e.g., pharmaceutical companies, CROs) and foundations/NGOs [42], internationally, governments plays great role in planning, organizing and funding translational research. In the US, National Institutes of Health (NIH) launched the Clinical and Translational Science Awards (CTSA) and established the National Centre for Advancing Translational Sciences (NCATS) [43]. Government establishments such as the Medical Research Council (MRC) in the UK [44,45], the French National Research Agency (ANR) [46], the National Health and Medical Research Council (NHMRC) in Australia [47], and the Canadian Institutes for Health Research (CIHR) [48] guided translational medicine in these countries. In China, the government encouraged construction of TROs, and a number of TROs have been established since 2009 [49]. Many hospitals are setting up translational medicine centers without the necessary infrastructures, robust management systems and government support that characterize TROs in high income countries [22]. China lacks a national systematic plan and a national translational research center to build a roadmap for deployment of effective translational medicine. We found that most Chinese TROs were launched by groups of research institutions without specific government participation in organizing, funding, and coordinating although all of TROs were established in public institutions which have significant government support for their activities. TROs, as multidisciplinary entities, offer the potential to bring together different perspectives to address otherwise intractable problems [50]. Clinical and Translational Science Centers (CTSCs) in the U.S. widely involve institutes and disciplines, and the various CTSA programs throughout that country are all closely linked [51]. The CTSCs incubate multidisciplinary, cooperative programs that include translational technologies, resources, and novel methodologies; biostatistics; study design and research ethics; participant and clinical interaction resources; community engagement, education, regulatory knowledge and support; informatics; and pilot and collaborative studies [51]. However, we report that TROs in China are characterized as clinical research centers. In addition, most TROs just translate basic research outcomes to clinical practice However, very few TROs involved disciplines related to public health, education, ethnicity, and sociology; engaged the community; or provided training for translational researchers.

Current educational programs are not providing qualified translational researchers for TROs

The importance and difficulties of recruiting, mentoring, and retaining an international assembly of qualified clinical and translational scientists has been recognized [52]. Addressing the nurturing of translational investigators, the Association of American Medical Colleges convened its second Clinical Research Task Force (CRTF II) in 2006 and underscored the importance of requiring all future physicians to be educated in the principles and methodologies of translational and clinical research [53]. CRTF II suggested a degree program (Master’s level training at a minimum) [53]. Many CTSC programs provide PhD and Master's degrees [54-56]. In addition, CRTF II suggested start-up support for junior translational investigators, accelerated training, and modifying training (K23 and K24) awards to nurture translational investigators [53].

Translational medicine is likely to have a profound impact on future medical education in China, and the purposeful training of translational research will need to be developed [22]. We report that although most of the TROs had the objective of education, the concept of multidisciplinary researcher cultivation was limited to basic and clinical medicine instead of broader disciplines such as sociology, management, law, public health, and social sciences. What’s more, China has no Master's or PhD degree programs in translational medicine to date.

TROs Lacked sustainable funding sources

Successful translational research will require substantially more money, an important part of which is government funding. For example, CTSAs provided $500 million annually to 60 translational medical centers throughout the U.S. [6]. The MRC UK committed £250 million to deliver this important part of its mission [44]. In addition, CTSCs attract funds from enterprises and social agencies [57]. In China, government increased and is increasing investment to translational research; the National Natural Science Foundation of China approved a budget of 18.27 billion RMB (approximately 2.9 billion USD) for fiscal year 2011 for translational research, which was an 89% increase from 9.65 billion RMB (approximately 1.52 billion USD) from fiscal year 2010. Recently, translational research has been included in certain government projects, such as the National High Technology Research and Development Program (863) and the National Basic Research Program (973) [22]. Projects with potential translational research are strongly encouraged and have priorities over more speculative applications [28,58]. The government is making investments into organizations that focused on translation such as Beijing Genomics Institute (BGI) [59] and Genzyme of Cambridge, Massachusetts and Tianjin International Joint Academy of Biotechnology and Medicine (TJAB)) [60]. However, this study found that in at least these 8 TROs, funds mainly came from research grants or partners of TROs. The government allocated little special funds to TROs construction or researcher cultivation as CTSAs did. Besides, social entrepreneurship is relatively new in China and its concept was first introduced through various symposiums and conferences in 2004. In 2012, 54% of surveyed social enterprises in China are under 3 years old, of which 21% are less than 1 year old, and 38% were older than 5 years. Compared to 2011 survey, the number of mature social enterprises increased from 15% in 2011 to 38% in 2012 [61]. Thus, TROs in China seldom attract funds from social enterprises or donors. Therefore, a sustainable funding mechanism is one major challenge facing translational research in China.

Chinese TROs lacked appropriate management

The translational continuum is a complicated process, including many steps and involving multidisciplinary research teams that interact with each other across the continuum [62,63]. Management in TROs has the function of obtaining funding, monitoring, guiding and providing shared sources, promoting multidisciplinary collaboration/cooperation for translational research [64]. To meet the needs of translational medicine, current scientific research management teams should adapt to the tenets of translational research [22]. For example, the centralization of CTSCs in the U.S. is one way to remove organizational barriers, and 58% of CTSCs are moving toward administrative centralization [53]. A flexible framework for performance assessment that tracks progress and incentivizes fruitful activities is very important for cost-effective translational research [64]. However, there is no consensus on the methodologies or frameworks for assessing TROs performance [65]. Although we indicated that most TROs in China had established management teams, specific measures in the following areas were still lacking: developing and nurturing researchers, promoting multidisciplinary cooperation, conducting performance assessments, and offering incentives for partners. TROs also lacked mechanisms for profit- and property-sharing, cost-effectiveness assessment systems across different stages in the translational research continuum, and conceptions of “providing service.”

Implications for practice and research

Results of this study had the following implications for future practice in China.

TROs in China need to increase multidisciplinary cooperation

Multidisciplinary research teams in translational research span the life sciences, social sciences, and the physical sciences. The recruitment of sufficient and appropriate participants for translational medicine requires TROs to collaborate with their communities [53]. Furthermore, translational medicine entails not only a “from-bench-to-bedside” approach but also preventive medicine and public policy [17,18]. Community engagement and the broadening of disciplines and research teams in social sciences, physical sciences, health policy, and public health should be emphasized by Chinese TROs.

Medical education needs innovation

Translational researchers must have multidisciplinary knowledge and capability [66].Translational researchers need to have the collaboration skills to allow ensure clinicians and scientists to function in effective inter-professional, multidisciplinary teams [67]. Therefore, current medical education program must be tailored towards training multidisciplinary translational researchers in order to achieve the full benefits and promising applications of translational medicine [68]. China has begun cultivating interdisciplinary talent recently; this cultivation has developed slowly [69]. Although present medical education programs, including 8- and 5-year programs, have the potential to cultivate medical students with both clinical research and basic research [28], they cannot provide multidisciplinary knowledge wider than medical knowledge because, in the traditional Chinese university model, colleges of different disciplines seldom communicate with one another [22]. Therefore, current medical education needs innovation, such as launching Master's or PhD degrees in translational medicine by the Ministry of Education which emphasize professional incubation to generate future-leading, multidisciplinary translational scientists in TROs.

Exploring appropriate management of TROs is of crucial importance

Effective management can ensure the overall excellent performance of TROs [53,70]. Translational research is particularly complex and requires a scalable and adaptive management approach [71]. At the early stages of Chinese TROs, it is particularly important to explore management models that include creating a “culture” of multidisciplinary cooperation in TROs, medical schools and their affiliated teaching hospitals; construct a flexible performance assessment system that considers both translational research and academic recognition in researchers' performance assessments; and explore sustainable funding resources.

Translational research in health policy should be emphasized in China

As in most countries, health research and policy making in China usually operate in separate environments, each with its own professional culture, and most public health research stops at publication [71]. As a result, many public health policies in China are not based on high-quality evidence. A platform using TROs for bilateral communication between researchers and policy makers is needed to improve mutual understanding and to establish an effective and efficient dialogue channel. Translational research in health policy that can promote evidence-based health policies [18,71] should be underscored in China.

Strengths and limitations

A major strength of the case study approach is the opportunity to use multiple sources of evidence such as interviews and document reviews [32]. The main limitation is that we collected data about some cases indirectly through conferences, reports, and literature, some of which may have been incomplete. A qualitative multiple case study method was used to collect data, which as a form of qualitative descriptive research, looks intensely at an individual or small participant pool, drawing conclusions only about that participant or group and only in that specific context. In this case, we did not focus on the discovery of a universal, generalizable truth, nor did we look for cause-effect relationships; instead, we placed emphasis on exploration and description [72].

Conclusions

Establishing TROs is an important approach in promoting tranlationational medicine. TROs should be cooperative platforms, centers for human resource cultivation (translational researchers) and agencies of social services (consulting and training) and translational research. Translational medicine in China is developing quickly, and many TROs have been established throughout the country. However, while these TROs maintain key staff (academic, program and administration, technical, and research), headquarters and office accommodation, and suitable experimental research facilities, they still face many challenges. Therefore, it is of paramount importance to strengthen the government's role in widening multidisciplinary cooperation, promoting translational researcher cultivation, and designing management approaches that foster an open culture of cooperation.

Abbreviations

HIV: Human immunodeficiency virus; ICTM: International Conference on Translational Medicine; U.S.: The United States; SAS-CTM: Sino-American Symposium on Clinical and Translational Medicine; TROs: Translational research organization; PUMCH: Peking Union Medical College Hospital; TMC: Translational medical center; CTMR: College of Translational Medical Research; TRCSR: Translational Research Center of Stem Cell and Regenerative Medicine; NIH: National Institute of Health; CTSA: Clinical and Translational Science Awards; NCATS: National Centre for Advancing Translational Sciences; MRC: Medical Research Council; ANR: National Research Agency; NHMRC: National Health and Medical Research Council; CIHR: Canadian Institutes for Health Research; MDRTs: Multidisciplinary research teams; STSI: Scripps Translational Science Institute; CRTF II: Second Clinical Research Task Force.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

CL designed the study. LZ and YL designed the data collection instrument and collected. LZ and YL analyzed the data. YL drafted the manuscript. HB commented, edited and revised the final draft. JE provided guidance on design and analysis, provided critical review, edited, and revised the manuscript. All authors read and approved the final manuscript.

Acknowledgement

The authors would like to thank all of the participants of interviews. The authors also thank Professor Shenglan Tang of Duke University Medical School, Durham, NC, USA, for his comments on draft of this paper.

References

  1. Mckinney GR, Stavely HE: From bench to bedside: the biologist in drug development.

    Bioscience 1966, 16:683-687. Publisher Full Text OpenURL

  2. Choi DW: Bench to bedside: the glutamate connection.

    Science 1992, 258(5080):241-243. PubMed Abstract | Publisher Full Text OpenURL

  3. Geraghty J: Adenomatous polyposis coli and translational medicine.

    Lancet 1996, 17:348-422. OpenURL

  4. Zerhouni E: The NIH Roadmap.

    Science 2003, 302:63-72. PubMed Abstract | Publisher Full Text OpenURL

  5. Planas AM, Traystman RJ: Advances in translational medicine 2010.

    Stroke 2011, 42:283-284. PubMed Abstract | Publisher Full Text OpenURL

  6. Moskowitz MA, Lo EH, Iadecola C: The science of stroke: mechanisms in search of treatments.

    Neuron 2010, 67:181-198. PubMed Abstract | Publisher Full Text | PubMed Central Full Text OpenURL

  7. Schwartz M, Shechter R: Systemic inflammatory cells fight off neurodegenerative disease.

    Nat Rev Neurol 2010, 6:405-410. PubMed Abstract | Publisher Full Text OpenURL

  8. Abe T, Shimamura M, Jackman K, Kurinami H, Anrather J, Zhou P, Iadecola C: Key role of CD36 in Toll-like receptor 2 signaling in cerebralischemia.

    Stroke 2010, 41:898-904. PubMed Abstract | Publisher Full Text | PubMed Central Full Text OpenURL

  9. Sung NS, Crowley WF Jr, Genel M, Salber P, Sandy L, Sherwood LM, Johnson SB, Catanese V, Tilson H, Getz K, Larson EL, Scheinberg D, Reece EA, Slavkin H, Dobs A, Grebb J, Martinez RA, Korn A, Rimoin D: Central challenges facing the national clinical research enterprise.

    JAMA 2003, 289:1278-1287. PubMed Abstract | Publisher Full Text OpenURL

  10. Woolf SH: The meaning of translational research and why it matters.

    JAMA 2008, 299:211-213. PubMed Abstract | Publisher Full Text OpenURL

  11. Westfall JM, Mold J, Fagnan L: Practice-based research–"Blue Highways" on the NIH roadmap.

    JAMA 2007, 297:403-406. PubMed Abstract | Publisher Full Text OpenURL

  12. Dougherty D, Conway PH: The "3T's" road map to transform US health care: the "how" of high-quality care.

    JAMA 2008, 299:2319-2321. PubMed Abstract | Publisher Full Text OpenURL

  13. Drolet BC, Lorenzi NM: Translational research: understanding the continuum from bench to bedside.

    Transl Res 2011, 157:1-5. PubMed Abstract | Publisher Full Text OpenURL

  14. About Harvard Catalyst.

    http://catalyst.harvard.edu/ webcite

    OpenURL

  15. Tufts CTSI.

    http://www.tuftsctsi.org/ webcite

    OpenURL

  16. Khoury MJ, Gwinn M, Yoon PW: The continuum of translation research in genomic medicine: how can we accelerate the appropriate integration of human genome discoveries into health care and disease prevention.

    Genet Med 2007, 9:665-674. PubMed Abstract | Publisher Full Text OpenURL

  17. Jiang F, Zhang J, Wang X, Shen X: Important steps to improve translation from medical research to health policy.

    J Transl Med 2013, 11:33. PubMed Abstract | BioMed Central Full Text | PubMed Central Full Text OpenURL

  18. Wu X, Marincola FM, Liebman MN, Wang X: A global resource to translational medicine: the International Park of Translational Medicine and BioMedicine (IPTBM).

    J Transl Med 2013, 11:8. PubMed Abstract | BioMed Central Full Text | PubMed Central Full Text OpenURL

  19. Littman BH, Di Mario L, Plebani M, Marincola FM: What’s next in translational medicine?

    Clin Sci (Lond) 2007, 112:217-227. PubMed Abstract | Publisher Full Text OpenURL

  20. Chen Z, Zhou GB: Translational medicine should translate medical science and technology into health care for everyone in China.

    Sci China Life 2011, 54:1074-1076. Publisher Full Text OpenURL

  21. Peng X: China's demographic history and future challenges.

    Science 2011, 333:581-587. PubMed Abstract | Publisher Full Text OpenURL

  22. Guan J, Chen J: Translational research and its effects on medicine in China.

    Chin Med J (Engl) 2011, 124:3170-3175. PubMed Abstract | Publisher Full Text OpenURL

  23. Leng FW: Build a two-way road for health industry: the current circumstance of translational medicine in China.

    Sci China Life Sci 2012, 55:931-932. PubMed Abstract | Publisher Full Text OpenURL

  24. Wang X, Wang E, Marincola FM: Translational Medicine is developing in China: a new venue for collaboration.

    J Transl Med 2011, 9:3. PubMed Abstract | BioMed Central Full Text | PubMed Central Full Text OpenURL

  25. Sino-American Symposium on Clinical and Translational Research. 2010.

    http://www.chinacts.org webcite

    OpenURL

  26. Chen X, Andersson R, Cho WC, Christiani D, Coico R, Drazen J, Ege M, Fehniger T, Gao H, Jin K, Liebman MN, Lopez E, Marraro G, Marko-Varga G, Marincola FM, Popescu LM, Spada C, Shahzad A, Wang E, Wang W, Wang X, Wang YX, Xia J, Qu J: The international effort: building the bridge for translational medicine: report of the 1st International Conference of Translational Medicine (ICTM).

    Clin Transl Med 2012, 1:15. PubMed Abstract | BioMed Central Full Text | PubMed Central Full Text OpenURL

  27. Zhou J, Wu D, Liu X, Yuan S, Yang X, Wang X: Translational medicine as a permanent glue and force of clinical medicine and public health: perspectives (1) from 2012 Sino-American symposium on clinical and translational medicine.

    Clin Transl Med 2012, 1:21. PubMed Abstract | BioMed Central Full Text | PubMed Central Full Text OpenURL

  28. Zhang ZQ, Chen HZ, Liu DP: Translational research: lessons from past research, growing up nowadays, and development goal in future.

    Sci China Life Sci 2011, 54:1085-1088. PubMed Abstract | Publisher Full Text OpenURL

  29. Collins F:

    The NIH National Center for Advancing Translational Sciences: How Will It Work?. 2011.

    https://www.dtmi.duke.edu/websiteadministration/files/Collins%20NCATS%20slides.pdf webcite

    OpenURL

  30. Kohlbacher F: The use of qualitative content analysis in case study research [89 paragraphs].

    Forum Qualitative Sozialforschung / Forum: Qualitative Social Research 2005., 7(1)

    Art. 21. http://nbn-resolving.de/urn:nbn:de:0114-fqs0601211 webcite

    OpenURL

  31. Baxter P, Jack S: Article qualitative case study methodology: study design and implementation for novice researchers.

    Qual Rep 2008, 13:544-559. OpenURL

  32. Yin RK: Case Study Research: Design and Methods. Applied Social Research Methods. Vol. 5. 3rd edition. Thousand Oak, CA: Sage Publications; 2003. OpenURL

  33. Xu J, Liu S, Yu X: Bridging the translation gap and building the translation platform: translational medicine at Peking Union Medical College Hospital.

    Sci China Life Sci 2012.

    Epub ahead of print]

    OpenURL

  34. Peking Union Medical College Hospital (PUMCH):

    cooperation with universities in US in translational research.

    http://news.xinhuanet.com/health/2013-01/29/c_124294489.htm webcite

    OpenURL

  35. TMC of Children’s hospital of Fudan University.

    http://ch.shmu.edu.cn/content.asp?ArticleID=2815 webcite

    OpenURL

  36. TRCSR in Shanghai Ninth hospital.

    http://www.transmed.org.cn/news-info.asp?id=28&sortid=6&subid=&thid= webcite

    OpenURL

  37. TMC of North East of China.

    http://www.transmed.org.cn/news-info.asp?id=36&sortid=6&subid=&thid= webcite

    OpenURL

  38. East TMC of Tongji University.

    http://www.transmed.org.cn/news-info.asp?id=31&sortid=6&subid=&thid= webcite

    OpenURL

  39. TMC of Wuhan Union Hospital.

    http://news.hustonline.net/html/2011-8-31/79192.shtml webcite

    OpenURL

  40. TMC of West China Hospital.

    http://www.biocro.net/html/news/2013/0509/595.html webcite

    OpenURL

  41. Zhang FZ, Cooke P, Wu FL: State-sponsored Research and development: a case study of China’s biotechnology.

    Reg Stud 2011, 5:575-595. OpenURL

  42. O'Connell D, Roblin D: Translational research in the pharmaceutical industry: from bench to bedside.

    Drug Discov Today 2006, 17–18:833-838. OpenURL

  43. Mirvis DM: From research to public policy: an essential extension of the translation research agenda.

    Clin Transl Sci 2009, 2:379-381. PubMed Abstract | Publisher Full Text OpenURL

  44. NIH establishes National Center for Advancing Translational Sciences.

    http://www.ncats.nih.gov/ webcite

    OpenURL

  45. MRC translational research.

    http://www.mrc.ac.uk/Ourresearch/ResearchInitiatives/Translationalresearch/index.htm webcite

    OpenURL

  46. Medical Research Council: MRC’s translational research strategy. 2010.

    http://www.mrc.ac.uk/consumption/groups/public/documents/content/mrc004551.pdf webcite

    OpenURL

  47. Translational Research in Health (PRTS).

    http://www.agence-nationale-recherche.fr/en/research-programmes/aap-en/translational-research-in-health-prts-2013/ webcite

    OpenURL

  48. Health and Ageing Portfolio Agency:

    National Health and Medical Research 703 Council.

    http://www.health.gov.au/internet/budget/publishing.nsf/Content/2013-2014_Health_PBS_sup3/$File/2013-14_DoHA_PBS_4.14_NHMRC.pdf webcite

    OpenURL

  49. Canadian Institutes of Health Research:

    Strategy for Patient-Oriented Research: A discussion paper for a 10-year plan to change health care using the levers of research.

    http://medicine.ucalgary.ca/files/med/Patient_Oriented_Research_Strategy_EN_Feb24FINAL.pdf webcite

    OpenURL

  50. Progress of Translational medicine in China: construction of translational research organizations.

    http://meeting.dxy.cn/translation2012/article/i17583.html webcite

    OpenURL

  51. Haythornthwaite C: Learning and knowledge networks in interdisciplinary collaborations.

    J Am Soc Inf Sci Technol 2006, 57:1079-1092. Publisher Full Text OpenURL

  52. Zerhouni EA: Translational and clinical science — time for a New vision.

    N Engl J Med 2005, 353:1621-1623. PubMed Abstract | Publisher Full Text OpenURL

  53. Pozen R, Kline H: Defining success for translational research organizations.

    Sci Transl Med 2011, 3(94):94.

    94cm20

    OpenURL

  54. Master’s in Clinical and Translational Investigation.

    http://www.stsiweb.org/index.php/education_training/masters/ webcite

    OpenURL

  55. Research Education Programs supported by the CTSC in The University of New Mexico.

    http://hsc.unm.edu/research/ctsc/education.shtml webcite

    OpenURL

  56. Clinical and Translational Science Graduate Program.

    http://sackler.tufts.edu/Academics/Degree-Programs/MS-Programs/Clinical-and-Translational-Science webcite

    OpenURL

  57. NIH launches national consortium to transform clinical research. Washington DC: NIH News release; 2006.

    http://whb.news365.com.cn/jkw/201206/t20120629_497266.html webcite

    OpenURL

  58. Duke Translational Research Institute:

    Duke Translational Research Institute.

    https://www.dtmi.duke.edu/about-us/organization/duke-translational-research-institute webcite

    OpenURL

  59. Beijing Genomics Institute.

    http://en.wikipedia.org/wiki/Beijing_Genomics_Institute webcite

    OpenURL

  60. Rohn J: Genzyme partners TJAB.

    Nat Biotechnol 2010, 28:637. OpenURL

  61. FYSE 2012 China Social Enterprise Report.

    http://www.bsr.org/reports/FYSE_China_Social_Enterprise_Report_2012.PDF webcite

    OpenURL

  62. Berglund L, Tarantal A: Strategies for innovation and interdisciplinary translational research: removal of barriers through the CTSA mechanism.

    J Investig Med 2009, 57:474-476. PubMed Abstract | Publisher Full Text OpenURL

  63. Trochim W, Kane C, Graham MJ, Pincus HA: Evaluating translational research: a process marker model.

    Clin Transl Sci 2011, 4:153-162. PubMed Abstract | Publisher Full Text | PubMed Central Full Text OpenURL

  64. Keramaris NC, Kanakaris NK, Tzioupis C, Kontakis G, Giannoudis PV: Translational research: from benchside to bedside.

    Injury 2008, 3:643-650. OpenURL

  65. Dickler HB, Korn D, Gabbe SG: Promoting translational and clinical science: the critical role of medical schools and teaching hospitals.

    PLoS Med 2006, 3:e378. PubMed Abstract | Publisher Full Text | PubMed Central Full Text OpenURL

  66. Portilla LM, Evans G, Eng B, Fadem TJ: Advancing translational research collaborations.

    Sci Transl Med 2010, 22:63.

    63cm30

    OpenURL

  67. Rubio DM, Schoenbaum EE, Lee LS, Schteingart DE, Marantz PR, Anderson KE, Platt LD, Baez A, Esposito K: Defining translational research: Implications for training.

    Acad Med 2010, 85:470-475. PubMed Abstract | Publisher Full Text | PubMed Central Full Text OpenURL

  68. Shahzad A, Cohrs JR, Andersson R, Wang XD, Köhler G: Recommendations for comprehensive translation medicine education and training.

    Transl Biomed 2011, 2:1-3. OpenURL

  69. Yu TQ, Guo Q: Interdisciplinary research and disciplinary construction. modern information 2012, 32:139–142 D. butler: translational research: crossing the valley of death.

    Nature 2008, 453:840-842. PubMed Abstract | Publisher Full Text OpenURL

  70. Tietje KM, Boettcher MG, Nora Disis ML:

    Research Administration from Bench to Bedside: Program Management Tailored to a Clinical Translational Setting.

    http://www.srainternational.org/sra03/uploadedFiles/bench-to-bedside.pdf webcite

    OpenURL

  71. Jiang F, Zhang J, Shen X: Towards evidence-based public health policy in China.

    Lancet 2013, 381:1962-1964. PubMed Abstract | Publisher Full Text OpenURL

  72. Bronwyn B, Patrick D, Karen D, Carla H, Steve H, Jon L, Debbie M, Carol T, Mike P: Case Studies. Colorado State University: Writing@CSU;

    1994–2012

    OpenURL