01-074-09-1672 · final | july 2, 2009 mayo memorial building simportal and crest remodel...

Final | July 2, 2009

Mayo Memorial BuildingSimPORTAL and CREST Remodel

University of Minnesota 01-074-09-1672

Mayo Memorial Building, SimPORTAL and CREST Remodel | Pre-design | 01-074-09-1672

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Table of ContentsTable of Contents

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Project Participants

Executive Project Summary

Statement of Need

Program Summary

Financial Analysis

Site Analysis

Code | Environmental | Hazardous Material AnalysisBuilding Code Deficiency Survey Hazardous Material ReportFacility Condition Assessment

Project Budget

Project Schedule

Community | Neighborhood Impact Statement

Concept Plans | Concept Images

Construction Narratives

Sustainability

Other Information

J E Dunn Schematic Cost EstimateMcGough Schematic Cost Estimate SimPORTAL/CREST Equipment List and Plans SimPORTAL/CREST Chemical ListFM Participation Memorandum

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Table of Contents

RSP Architects is pleased to present to the University of Minnesota Academic Health Center the Pre-Design Report for the Mayo Memorial Building SimPORTAL and CREST Remodel project. We also extend our gratitude to the persons who were instrumental members in the compilation of this report:

ACADEMIC HEALTH CENTERDonald Adderley, Senior Planner, Academic Health Center

CAPITAL PLANNING PROJECT MANAGEMENTPete Nickel, Project Manager, Capital Planning/Project ManagementBlake Bartelma, Capital Planning/Project Management

SimPORTAL AND CRESTRob Sweet, MD, Assistant Professor of the Department of Urologic SurgeryTroy Reihsen, Department of Urologic Surgery, SimPORTAL

UNIVERSITY STAFFDan Anderson, Facilities ManagementJohn Stoffel, Facilities ManagementAl Mangnuson, Facilities ManagementDonna Edelen, NTS

PRE-DESIGN CONSULTANTSScott Helmes, Director of Medical Planning, RSP ArchitectsDavid Gustafson, RSP ArchitectsTanner Patrick, RSP ArchitectsDarrell Martin, Mechanical Engineer, Dunham, IncTodd Grube, Electrical Engineer, Dunham, IncBrian Stark, J. E. Dunn ConstructionSteve Brown, J. E. Dunn ConstructionThomas Hannasch, McGough Companies

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Table of ContentsExecutive Project Summary 2

The purpose of this project is to establish a single location simulation program Institute that will house an effective and programmatically diverse simulation science research and training hub for the University of Minnesota. By creating an identifiable physical space for the Institute, the collection and sharing of critical data will be fused between educators and researchers and result in a center of excellence that cannot be achieved within the current fragmented operations.

The Institute’s mission is focused on research and development of novel tools to help drive the future of health-care research and professional education. Core resources for these activities lie within CREST, The Center for Research in Education and Simulation Technologies. The current portfolio of projects involves collaborations with researchers and resources from multiple medical school Departments including Surgery, Urologic Surgery, Neurosurgery, Orthopedics and Anatomy as well as the Fairview Health System, the School of Education Psychology, the Minnesota Supercomputing Institute, Mechanical Engineering, Biomedical Engineering, Computer Science and a multitude of prominent industry sponsors for specific applications. The creation of the Institute will have multiple impacts on improved health care delivery and patient safety in the region. In addition, all projects are being designed and completed with the intent for direct licensure to industry and anticipate an enormous impact on the creation of new companies and industries. Concurrently the programs will stimulate existing ones vis-à-vis streamlined medical device development, testing and training.

There are eight core research thrusts in the simulation sciences that will be integrated into the Institute:

defining soft-tissue characteristics•modeling patient-specific 3-D anatomy•modeling virtual soft tissue interactivity and behavior in real time•non-real time, patient-specific predictive finite element computer modeling of •physiologycreation and display of 3-D medical environments to enhance student and •patient educationvalidation and health care professional human factors research•enhance delivery and accessibility of the Institute’s simulation resources•training leaders in the research and delivery of simulation sciences•


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Table of ContentsExecutive Project Summary 2

Each of the activities is thoroughly described in the statement of need and reflects the complex and interdisciplinary nature of the Institute. They will be combined with the Institute’s current technology to deliver live 3-D tele-mentoring and tele-proctoring as well as multi-user virtual reality patient-specific remote access training between anyone with web-access.

The current physical facilities used by CREST have woefully deficient infrastructure support and lack handicapped accessibility. This greatly limits the ability of the simulation programs to function and expand properly. The current layout doesn’t allow for automatic data capture and/or analysis by education researchers. Also lacking are additional core spaces that efficiently and effectively support the functions of CREST’s innovative basic science and translational work.

The completion of the proposed program would enable an innovative mid-western hub for medical research and education. By completing this vision, the Institute would reach beyond the physical space/academia boundaries of the University and be able to serve as a repository and deliverer of simulation services to and from the medical community at large.

The preliminary project cost is estimated at $7,633,650. Two construction cost estimates are provided as part of this report. Additional costs of the project were derived by SimPORTAL, CREST, and CPPM to arrive at the preliminary project cost.

The project timeline is summarized as 7 months of programming, design, engineering, solicitation for CM-Risk and bidding; and 5 months for three-phased construction.


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Table of ContentsStatement of Need

Vision for the transformation of SimPORTAL/CREST into an Institute for Medical Simulation Sciences

In transforming our existing and new portfolio of simulation programs into an Institute, we aim to create a space whereby simulation science research and training missions can simultaneously and successfully be integrated. A major impediment to this is the lack of a physical space that does not allow a program structure where educators and researchers can co-exist while developing, collecting and sharing vital data.

The Institute’s mission is focused on research and development of novel tools to help drive the future of health-care professional education. Our core resource for these activities lies within CREST, The Center for Research in Education and Simulation Technologies. The current portfolio of projects involves collaborations with researchers and resources from multiple medical school Departments including Surgery, Urologic Surgery, Neurosurgery, Orthopedics and Anatomy as well as the Fairview Health System, the School of Education Psychology, the Minnesota Supercomputing Institute, Mechanical Engineering, Biomedical Engineering, Computer Science and a multitude of prominent industry sponsors for specific applications. We anticipate that the impact of such an Institute will be a force multiplier as far as improved health care delivery and patient safety in the region. All of our projects are being designed and completed with the intent for direct licensure to industry and we continue to anticipate an enormous impact on the creation of new companies and industries, while stimulating existing ones vis-à-vis streamlined medical device development, testing and training.

The current facilities used by CREST have woefully deficient infrastructure support and lacks handicapped accessibility. This greatly limits the ability of the simulation programs to function and expand properly. The current layout doesn’t allow for automatic data capture and/or analysis by our education researchers. Also lacking within the medical school are spaces that efficiently and effectively support the functions of our innovative basic science and translational work in simulation sciences.

There are eight core research thrusts in the simulation sciences that will be united as a single collaborative Institute.

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Table of ContentsStatement of Need

Core researCh thrust 1: Defining soft-tissue CharaCteristiCs

1.1 THE HUMAN TISSUE-PROPERTy DATABASEThe creation of a human tissue property database intends to fill a fundamental gap of existing knowledge. Defining soft-tissue properties is absolutely critical to the field of simulation if we intend to create accurate constitutive computer simulation models of structures, injury and disease. To date, there is a surprising paucity of soft-tissue data that is readily available in order for academia, clinicians and industry in the health sciences to draw upon to test new devices, clinical hypotheses, planned surgical approaches, and/or develop their surgical skills. Consequently, soft tissue behavior is completely dependent upon the accuracy of the material property data assigned to each tissue structure. State-of-the-art computer-based models for soft-tissue behavior are based on frozen human cadaver and animal tissue data. Our team combines expertise and resources in finite element modeling, human soft tissue property testing, real-time surgical simulation, advanced medical imaging, medical graphics design, medical device development as well as clinical medicine and education. Our approach has been to harvest soft-tissue specimens within 24 hours of death for patients in our hospital. Our preliminary data have shown a significant difference when compared with frozen cadaver, dog and porcine specimens. Our resulting database will provide benchmarks for the development of artificial tissues (thrust 2.2), novel diagnostic opportunities and potentially drive the development of smart medical devices that automatically tailors the delivery of treatment based on impedence or other detected tissue properties. Currently CREST only does uni-axial testing and it is necessary to do both uni-axial and bi-axial testing, as bi-axial testing is the only experimental methodology that permits the modeling of the anisotropicity of soft-tissues and leads to an accurate representation of the expected behavior of the soft-tissues. When combined and correlated with advanced imaging such as MRI, the constitutive properties will also provide for patient-specific predictive clinical applications and the development of realistic virtual reality education tools.

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Table of ContentsStatement of Need 3

Core researCh thrust 2: MoDeling patient-speCifiC 3-D anatoMy

2.1 PHySICAL MODEL DEvELOPMENT-PLASTINATIONThe second core project that leverages the benefit of the Institute is the plastination program. The invention of the plastination process has provided a cleaner and more palpable alternative to the cadaver laboratory for the display of anatomy. Plastination is a process whereby the water content of actual tissues is replaced by plastic resin that can be polymerized to permanently preserve anatomical specimens that are odorless, nontoxic, sterile and durable. The use of plastinated anatomical specimens at the University of Minnesota is being employed for education for medical students, surgeons, and the community. In a novel design project (Thrust 3.1.1) we are integrating this powerful education tool with optical tracking and registered virtual reality models, providing a virtually mentored independent learning activity for learning anatomy.

2.2 PHySICAL MODEL DEvELOPMENT-ARTIFICIAL TISSUE LABORATORy This project focuses on the creation of cost-effective, simulated and representative ‘human’ bench top models and manikins with realistic mechanical properties (Thrust 1). Current methods employed for the manufacturing of manikins and analogue simulators are lacking accurate physiology, and do not benchmark against human tissue properties. Training on inaccurate and unrealistic models has the potential for negative training transfer. While live animal models can be used to practice these skills, there are growing ethical and monetary concerns as well as the potential for non-reproducible results because of the variation of animal physiology. Fresh frozen cadaveric tissue also offers practice with more anatomical accuracy but is costly, lacks live tissue physical characteristics, is greatly dependent on availability, and requires specialized laboratories to properly process, use and dispose of such tissue.

Integrated into our proposed institute, analogue tissue models with material properties representative of human tissue can be designed and benchmarked against the tissue-property database. Such models are generated from and can be registered with patient-specific vR 3-D models (Thrusts 2.3, 3.1). A simple organosilicate recipe was selected to assist, through validation, the development of


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related tissues which can be constructed into models.

If successful, these models have the potential to replace certain animate training models. The Institute will attempt to commercialize these products for use by health care professionals and the medical device industry. 2.3 Rapid patient-specific virtual reality 3-D modeling of human anatomyAt the heart of the Institute’s simulation work is an innovative method for building accurate, 3D reconstructions of human anatomy that are able to be manipulated and deformed in real-time. Our primary focus has been in the rebuilding of abdominal organs and vasculature by using real patient MR and CT data as reference models, and cadaveric photography for accurate texturing (see Thrust 1). Close, daily collaboration between medical professionals and graphic artists ensures the success of this thrust and current space constricts the number of modelers necessary to expand this thrust.

Core researCh thrust 3: MoDeling virtual soft tissue interaCtivity anD behavior in real tiMe

DEvELOPMENT OF vIRTUAL REALITy SURGICAL SIMULATORS Current real-time applications of vR have a difficult time simultaneously achieving realism (see thrust 1) and updating the models in real time so the server doesn’t detect a lag. virtual surgery is one of the most complicated virtual environment scenarios because of the nature of soft-tissue interactions. Current work of the Institute has seen the development of many successful projects and programs. The following programs need further development and will be greatly enhanced with the Institute’s formation.

3.1 DEvELOPMENT OF HyBRID PHySICAL/vR SIMULATORS USING OPTICAL TRACkING

3.1.1 Gross anatomy trainerCurrently, in order to understand relative relationships and structure, students perform a dissection with human cadavers and use physical models for bones that they correlate with 2-dimensional medical illustrations. Commercially available vR models (ADAM) have very little pedagogy for application and


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the models are difficult to navigate and lack accuracy. As an independent learning tool, there is value in having something tangible for a student to learn with; something they can touch and feel and explore freely. The problem is there is no “mentorship” or curriculum embedded in such physical objects. The technology we are developing merges the benefits of the physical and virtual learning modalities. The virtual models provide an opportunity for independent learning with “virtual mentoring” and embedded clinically relevant “learning pearls” from clinicians and web-based links to applicable clinical information, while physical models such as the plastinates (Thrust 2) serve as a palpable object for the student. The two objects are perfectly registered allowing for a rich learning experience.

3.2.2 Wii Transrectal Ultrasound SimulatorTransrectal ultrasound is invasive and poses a challenge to training using live models. virtual reality (vR) models can provide objective learning data and feedback, and further relieve concerns of subject discomfort or injury during training. We have developed a high-fidelity, low-cost prototype vR simulator intended to train the skills necessary in order to perform transrectal Ultrasonography (TRUS) of the prostate.Both of these projects, due to a lack of space, are currently being done in an area outside of our laboratory. This severely hinders our ability to develop and demonstrate these and other similar projects.

Core researCh thrust 4: non-real tiMe, patient-speCifiC preDiCtive finite eleMent CoMputer MoDeling of physiology

Thrust 1 and 2 contribute to this core research thrust, by which constitutive patient-specific models can be created that can potentially serve as a diagnostic tool for individual patients. A prime example of a direct clinical application of our work is a project examining female stress urinary incontinence. Our current facilities do not provide enough space for a bi-axial machine or space for our key personnel to complete this or related work. Currently, these activities occur in three separate areas across campus and the proposed Institute will allow for the entirety of this work to be completed with accurate mechanical material properties being provided by the bi-axial tissue testing system.


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Core researCh thrust 5: the Creation anD Display of 3-D MeDiCal environMents to enhanCe stuDent anD patient eDuCation.

We have designed 3-D virtual health care environments, and combined with our 3-D video display system, we are studying the ability of such tools to enhance the knowledge and alleviate the anxiety for patients undergoing surgical procedures. One specific research project involves patients undergoing surgery for prostate cancer. We currently lack a dedicated space for conducting this research and the visualization laboratory in close proximity to the clinical environment.

The visualization lab represents a 3-D visualization and data-collection hub, offering enhanced, distributed perception, communication and understanding of human anatomy, while providing a novel way to conduct the ever-elusive multi-institutional validation research of newly designed educational tools. This is possible by facilitating bi-directional 2 and 3-dimensional demonstration and assessment opportunities with our interdisciplinary and multi-institutional collaborators.

We also envision that by making our vR based medical modeling and educational expertise, intellectual properties and portfolios more visible; we will stimulate the development of more projects and bring more research resources to the University. To fulfill the ever-expanding projects’ development goals, while adhering to industry and grant deadlines, several new research assistants and a hardware engineer have to be recruited. Because of the interdisciplinary feature, surgical simulation projects demand building up a versatile and interdisciplinary research and development team, as well as an environment that facilitates having joint efforts and resources from other university-wide units, as well as external industrial, clinical and academic partners.

These visualization tools intend to be connected to the computer workstations in the vR development room where the CREST R&D team reside. They will then be able to render their latest medical modeling and simulation work from their individual development platforms to this vR demonstration lab. Also in the 3-D visualization lab will be our 3-D video display system. With LightSpeed Design, Bellevue, WA, we have deployed a novel, live stereoscopic 3D video based


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collaboration system for telemedicine. This system enables physicians, residents, fellows, nurses, medical students, and engineers to observe live stereoscopic 3D video streamed from the operating room. This effort supports the collaborative research activities with peer institutions and national laboratories.

The creation of an Institute will allow us to complete our vision for this hub and spoke system, linking operating theaters across the network, including the Center for MRI, hospitals, and the Medical Devices Center, effectively accelerating interdisciplinary medical device research and development.

Core researCh thrust 6: valiDation anD health Care professional huMan faCtors researCh

While the role of simulation in training technical and communication skills in health care professions is gaining more validity, direct evidence that simulation DIRECTLy impacts patient outcomes is lacking. This is due to several factors. First, there is no standardized validated way of assessing and quantifying team dynamics and behaviors. Second, simulation studies to date have focused on training individuals or small teams of individuals. Third, most critical events are rare, requiring large numbers of subjects and extensive periods of time to appropriately power any study. Metrics of patient safety and patient outcomes are multi-factorial in nature and the variability of the team of practitioners on any given day or during any given event makes the implementation of a simulation training program extremely challenging. This thrust outlines ongoing research/training programs in SimPORTAL. In November of 2006, we did a needs assessment at a medical school simulation retreat and determined that there were five unique “environments” that needed to be recreated including an acute care, image-guided, a minimally invasive surgical suite, a microsurgical suite, and a place for assessing basic surgical skills. We created programs to accommodate each of these themes stretching horizontally across Department lines. Each program described, while accommodating multiple departments’ curricula, requires a distinct environment designed as a behavioral science laboratory for validating, studying and assessing individual and team dynamics for health care delivery. These environments are also being designed


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to be able to help our ongoing efforts toward streamlining the development and refinement of novel procedural techniques and devices.

6.1 DATA COLLECTION/PERIPHERAL AND CENTRAL CONTROL ROOM AND DEBRIEF ROOMS AND TASk TRAINERS.These central core resources serve as the human factors central control room for researchers and participants to directly observe, record, and discuss behaviors and data. While the peripheral control rooms serve the training mission via control and manipulation of a specific scenario, the central control room’s primary purpose is human factors data collection and research. The debrief environment is critical to the training mission and is often times a critical source of data collection as it relates to a particular scenario and activities here need to be recorded and analyzed just the same. Our current area lacks a central control room with space and resources for human factors researchers to simultaneously collect and analyze data from multiple rooms. This will support a multitude of training/research programs.

The current task trainer room will be relocated to an area available for 24 hour access and large enough to meet the growing number of trainers. This is a place for independent assessment and learning and is the only training area in the center that is not under external supervision. Data collection is still possible from capable trainers.

6.2 DEvELOPMENT AND ASSESSMENT OF SkILLS IN THE ACUTE CARE SETTINGResearch and training of the factors discriminating ineffective from effective delivery of care to the acutely ill patient are of extreme importance and directly impact patient safety. All of our simulation programs have modules that include both individual and team assessments

Two dedicated adjacent, acute care labs will replace one suite and will be used for scenario-based training and human factors/validity research for ongoing training and simulation human factors research programs in Emergency Medicine, Internal Medicine, Surgery, Pediatrics, Urology, OBGyN, Family Practice and Nursing students, residents and faculty. We expect Neurosurgical, Orthopaedic,


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Cardiology, Gastroenterology programs to use these areas as well in the near future.

Basic training to teach motor skills and sequence of events for routine critical care including induction of anesthesia, rapid sequence intubation, and management of laryngospasm on emergence will be centered in these labs. Advanced training for recognition and treatment of uncommon, life threatening events in critical care including team training and crisis resource management will also occur here.

It is imperative that these spaces allow for data capture and analysis of human factors while not interfering with the training program. The design proposed would do just that by providing a local control room for scenario control, and a central control room for standardized data collection and analysis.

6.3 SURGICAL SkILLS HUMAN FACTORS LABORATORyOur largest program is in teaching and assessing surgical skills. We currently conduct modules with students spread throughout the center and staff disjointed from each other in each of these rooms. There is no space large enough to accommodate more than 6 people at one time. These spaces are not ideally set up for data collection and analysis. The new design creates a situation where the educators are forced to collect data as they teach and have researchers collect data simultaneously. When surgery courses are ongoing, it is impossible for any other programs to simultaneously run even a small course. The current design would allow for our three biggest programs (Emergency Medicine, Anesthesia and Surgery) to literally be running simultaneously. As the demand for simulation services has grown exponentially in the last two years at our institution, and if we expect to serve the community as well, such an expansion of services is critical.

The proposed design will provide a flexible 1200sq foot space with data collection capabilities. It will have the capability to run large-scale simulations in everything from microsurgery, part-task cadaver and animal parts to laparoscopic box and vR trainers. With a link to the Boreas net for remote access training and learning, this state-of-the-art space will provide large scale, consolidated training and human factors research opportunities to the program. The current space configuration makes it very difficult to standardize our educational interventions for our medical students and first-year residents. Both of


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these groups number 25 or more at a time. The curriculum for medical students runs 49 weeks out the year and serves 300 students; the curriculum for interns runs 8 weeks a year and serves up to 30+ residents from general surgery and urology. To fit our curriculum to the space, we subdivide the groups into as many as four or five subgroups. This immediately compromises our ability to ensure curriculum fidelity due to having to recruit, train, and accommodate numerous instructors. Simply put, learners are not getting the same educational treatment, which thereby introduces an unwanted source of variance (unreliability) into our assessment data. A large, multi-use space will ensure superior contact between lead instructors and all learners, and also ensure appropriate demonstration of skills and procedures being taught. Teaching psychomotor skills relies on learners internalizing a clear model of correct performance; currently, it is difficult for instructors to establish this cognitive schema because of the space problems. The secondary benefit of the large, multi-use space is that it will allow for types of learner assessments that are best done in live groups, such as technical skill “Olympics,” in which teams compete simultaneously on tasks ranging from basic fundamental laparoscopic skills to knot tying and suturing and short procedures. In summary, research stemming from laboratory assessments of learners is currently compromised by our inability to ensure curriculum fidelity and optimum delivery of the intervention, and by limitations for group-based assessments.

6.4 DEvELOPMENT AND ASSESSMENT OF IMAGE-GUIDED SURGICAL SkILLSImage guidance is now becoming an important part of many surgical specialties including neurosurgery, orthopedics, thoracic surgery, otolaryngology and maxillofacial surgery. Image guidance began in neurosurgery where the history of stereotaxis coupled with advances in computing merged to provide reliable localization of critical structures inside the skull. While still considered investigational in some of these fields, in neurosurgery, otolaryngology and to some extent in orthopedics, it is an essential part of education and practice.

Image guidance relies on two major factors: 1) understanding the technology and interfaces used to generate a usable model for navigation, 2) interpreting the data presented in the context of the surgical anatomy and using it to guide the surgical therapy. Image guidance may be as simple as repeated fluoroscopic or ultrasound images, or as complex as three-dimensional stereotactic spaces merging anatomic


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and physiologic data, repeatedly updated throughout a procedure, such as with intraoperative MRI. In order to best study methods of image guidance and to train resident surgeons to effectively utilize techniques of image guided navigation, any training environment must contain the proper tools to replicate these two factors. Any lab that would simulate this process should be able to simulate a wide range of surgical techniques that utilize image guidance.

Such a model for training image-guided techniques has been department focused, while this space will be flexible to accommodate the multitude of Departments that perform image-guided surgery. Programs from Interventional Radiology, Cardiology, Neurosurgery, Orthopaedics, Urology, and Otolaryngology have all written curriculum focused on these skill-sets. A well developed image guidance laboratory will allow residents to understand the potential uses and pitfalls of image guidance and explore potential novel applications, in an environment away from the time-pressured clinical implementation of image guidance. Residents will be able to amass experience with image guidance and have a better understanding of the relevant anatomy prior to ever treating a patient. Such a laboratory will be an ideal environment to investigate new applications of image guidance in established fields and to develop new applications in surgical specialties that do not currently use these techniques. Among the possible applications are combining the use of image guidance and robotic surgery, refining real time techniques for tracking instruments and updating images, as well as directly measuring the effects of the training on anatomic understanding and surgical accuracy of surgeons. This laboratory would mesh with our developing research efforts to further understand the anatomic limitations of minimally invasive cranial and spinal surgery, as well as research into the effects of training on the surgical precision of residents and faculty.

6.5 MICROSURGICAL HUMAN FACTORS AND RESEARCH LABORATORyA larger Institute will allow us to transition from an isolated temporal bone laboratory housed within the Department of Otolaryngology to a comprehensive microsurgical skills research laboratory that simultaneously serves research and training missions for staff, residents, and students from Otolaryngology, Neurosurgery, Plastics, Ophthalmology, Orthopedics and Urology.


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There are a number of reasons that we propose to house the facility in new shared space. First, there is consensus, strongly supported by Otolaryngology, that a common space provides synergy in the medical school, and allows each department’s trainees to take advantage of shared resources and expertise. Second, Otolaryngology, Urology and Ophthalmology as departments will be moving to a new ambulatory care center, where the use of live animals (mice) will be prohibited. Third, members from Plastics and Neurosurgery will not have routine access to this new building. Therefore, we believe that common space in the medical school will allow all members to access the training facility. In addition, the medical school space allows use of small animals.

We have developed a novel method for streaming and projecting HD 3-D live video from microscopes. The microscope configuration and design must be flexible, because microsurgery requires two-person teams, while temporal bone surgery is a single person operation. Technique and ergonomics are critically important in this skill-set. We envision a 10-person station, with a fixed microscope at each station.

The new design will allow proximity for all Departments, access to trained staff, a research infrastructure as well as the opportunity for large scale skills-based courses to be run in the flexible surgical skills suite (reference to that section).

The lab will be designed to be human tissue compatible and able to: 1) allow for independent study of dry bone and cadaver prosections, 2) allow for independent individual cadaver dissections, 3) allow for group demonstrations and courses, informal and formal, 4) allow for anatomical research, 5) allow for cadaver-based practice of novel or unfamiliar surgical approaches, and 6) allow practice with new instruments before using them in the operating room.

We believe that this laboratory has potential to expand our research capabilities in a number of directions. The most obvious avenue of research is for learning about optimal methods for microsurgical training. Although numerous curricula have been developed for microsurgical training, validation and acceptance of these approaches are lacking. A newly designed Institute provides a unique opportunity to lead in developing methods for testing, validating and comparing alternate methods for teaching complex, rigorous microsurgerical techniques. The physical


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space would provide the laboratory where trainees from every surgical department could be tested with the numerous tools that have already been developed for general surgical training. In addition, the impact on clinical research projects is potentially tremendous.

For example, in Otolaryngology alone, an enhanced microsurgical laboratory could be used for a number of ongoing research programs. We have a grant to develop a robotic scrub nurse and need the ear surgery apparatus to optimize the robot. The development of implantable hearing aids, middle ear prostheses, and cochlear implants requires extensive laboratory work to test its design, configuration, and feasibility. We have developing projects for implants to treatment tinnitus and imbalance, and electrode placement and configuration are areas of active investigation in Otolaryngology and Electrical Engineering.

6.6 DEvELOPMENT AND ASSESSMENT OF ENDOSCOPIC, LAPAROSCOPIC AND ROBOTIC TECHNIqUESThe rapid development of complex surgical technologies, particularly in minimally invasive therapy, has resulted in challenging learning curves for surgeons. In addition, limited case experience as a result of restricted resident work hours and limited case volumes in surgical practice add additional challenges to surgical education in the 21st century. Maintenance of skills is becoming an increasingly important aspect of ongoing surgical education especially for the new technically challenging minimally invasive surgical therapies. In addition, minimally invasive therapies are highly dependent on uniquely specialized teams of healthcare workers. For all of these reasons, simulation is gaining increasing attention as an additional component to the surgical education armamentarium for the development and refinement of minimally invasive surgical skills and technique. Our group is involved in numerous validation and assessment research projects in minimally invasive surgery. Progress however, is stymied by multiple factors, one of which is the lack of a facility that could effectively connect to and collect data from multiple institutions simultaneously. The relatively small number of trainees at a given institution created a huge impediment to predictive validity study design.


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6.7 DEvELOPMENT AND ASSESSMENT OF AIRWAy MANAGEMENT SkILLSAnesthesia training and research provides an outstanding example of how the creation of such an institute will transform medical education. The Institute would greatly facilitate integration of our clinical and education expertise with our tissue-property, advanced 3-D modeling and manikin building capabilities, allowing for the rapid development of patient-specific difficult airway models that could be rapidly distributed to market. Our distributed learning network and remote access project would allow users to remotely consult with experts pre-operatively and provide virtual mentoring with simultaneously tracked vR models accessed vis-à-vis a library housed at the supercomputing institute.

While teaching advanced airway skills management, including fiber optic, videolaryngoscopic, laryngeal mask airway, retrograde wires, lightwands, AirTRAq, double lumen tubes, bronchial blockers, jet ventilation, cricothyroidotomy, etc., we plan to study the ergonomics of intubation as well as the relative effectiveness and impact of videolaryngoscopy as well as design manikins that can detect relative trauma and provide formative feedback to the learner as to where they were applying undue pressure.

6.8 IN SITU SIMULATION PROGRAMSIn situ simulation represents one of our most successful research and training programs. The in situ environment by its very definition represents the highest fidelity team-based atmosphere for studying and training team dynamics in health care scenarios. It also provides the unique opportunity for individual hospitals/units to unearth and correct for latent conditions within their environments that may serve as a detriment to optimal patient care.

To achieve the highest fidelity, the in situ simulation training takes place in the perinatal unit, allowing the practitioner teams to experience actual organizational processes and to practice simulation scenarios that reflect real patient-care emergencies. The simulation training consists of (a) a briefing; (b) in situ simulations, using a series of project-developed event sets to trigger specific learning behaviors; (c) a debriefing; and (d) repetition to reinforce skills and create resiliency. The debriefings allow members of the inter-professional team to view their videotaped simulation performance and engage in rigorous, guided


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discussion with an expert facilitator. Debriefing focuses on improving team dynamics and interpersonal communication during critical perinatal events. While there was no significant change in perception at any of the hospitals, only the hospital with simulation training showed a marked and sustained drop in perinatal morbidity and mortality for emergent c-sections. This unpublished data, to our knowledge, is the first data directly supporting a positive impact of simulation on patient-safety on a system wide level.

While we successfully demonstrated that in-situ simulation team-training for emergency cesarean section diminished perinatal morbidity and mortality for a medium-sized community hospital, as we plan on expanding this successful program to other applications, this renovation and data-collection hub would provide the ability to directly capture quality and meaningful data from the in-situ critical care environments across our network of hospitals. Such a design would greatly facilitate data collection in general and specifically, the examination of training transfer from the simulated to the real-world environment. It would also rapidly facilitate the creation of standards of care for team-based care.

Core researCh thrust 7: enhanCe Delivery anD aCCessibility of our siMulation resourCes

UNIvERSITy MULTI-USER MEDICAL ONLINE TRAINING INITIATIvE FOR vIRTUAL EDUCATION (UM-MOTIvE)Our remote access project (CREST/MSI)-IT network is being developed to allow for distribution and real time collaboration on patient specific models between users anywhere in the world. The fast advances in technologies of supercomputing and network communication have been boosting many research frontiers forward including those in biomedical modeling and telemedicine work, and similarly, applying these technologies to the work toward full digital, hi-fidelity, multi-user surgical training and rehearsal should not be an exception. However, current Industrial-standard virtual reality (vR) based simulators run on individual workstations or personal computers. These vR trainers are typically purchased and managed by individual “simulation centers”, thus limiting the number of beneficiaries to “onsite” visitors. Their training context is also limited to their locally installed simulation software, whose performance is limited by the


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hardware configuration of each simulator. These isolate and preset vR trainers do not facilitate surgical curriculums involving team work, remote training, dynamic or patient-specific updates. Furthermore, in the progress of developing high-fidelity vR surgery simulation, researchers tend to exert necessarily sophisticated algorithms or high-resolution models to handle the challenges in modeling the behaviors of virtual organs and their interactions with surgical instruments, in “real time”. Such processing load or data volume can easily reach supercomputing levels and impose a gap between the expected performance and the available from the individual vR trainers. Following the path our entertainment colleagues have taken with video games, we intend to lead the transition of video-games for training from the arcade model as it is currently through to easily accessible “online-multiplayer” gaming.

In order to strengthen the University and State of Minnesota’s position as a health professional education and technology hub for our region, we propose to leverage our expertise in advanced medical modeling and vR simulation development with the capabilities that the Minnesota Supercomputing Institute (MSI) provides. Investment in developing the resources of such a relationship would broaden the reach and utilization of the simulation tools and modules within the University of Minnesota Medical School’s American College of Surgeons Level 1 accredited Simulation PeriOperative Resource for Training and Learning (SimPORTAL) and our Center for Research in Education and Simulation Technologies (CREST) to the community. SimPORTAL and CREST have been working with MSI in developing a method by which practitioners from around the region remotely upload patient-specific 3D datasets, which are translated into patient-specific virtual mesh models. Subsequently, with merely a laptop and off-the-shelf tracking devices, surgeons and residents could remotely share, rehearse and even practice critical portions of a patient’s surgical procedure, or one similar to it prior to doing it in the operating room. Such a “multiplayer” and “patient specific” approach allows for both virtual and active mentorship as well as a platform to safely test novel surgical approaches. In order to meet the real time computational demand in the emerging full digital, hi-fidelity, multi-user surgical simulation, we propose that the computation-intensive processing such as 3D visualization, soft tissue deformation, collision detection and response, occurs on a supercomputer at the Minnesota Supercomputing Institute (MSI) on U of M campus, and the


21


peripheral workstations handle only the client-side interactions and graphical rendering remotely.

vR simulation is an interdisciplinary research area that demands expertise and intense collaboration in surgical techniques and education, biomedical and biomechanical engineering, computer science and graphics and human-machine interface technology. Our remote access project is being proposed as a collaboration among University of Minnesota research units including CREST and MSI with support from SimPORTAL, departments within the Academic Health Center, the Center for Magnetic Imaging and the Medical Imaging Lab at Fairview University hospital. We can envision involvement with the Medical Devices Center for hardware development in the future as well. Current and pending industrial collaborators include, but are not limited to IBM, METI, TRANS1, American Medical System, Inc. and Gyrus ACMI.

The current “market” for health care professional simulation tools is limited to academic institutions, societies and industry courses. By providing us the opportunity to build the infrastructure to support the development of this Institute, there is an opportunity to shatter these boundaries. This would effectively and logarithmically break open the market for patient-specific simulation tools and live multi-user collaboration to health care professionals and patients anywhere in the web-connected world. Such a transformation would effectively create a vibrant new industry, while simultaneously enhancing the rapid dissemination of breakthroughs in procedural and surgical concepts and techniques to users worldwide.

Core thrust 8: training leaDers in the researCh anD Delivery of siMulation sCienCes

8.1 SIMULATION FELLOWSHIPWhile having already trained fellows from Israel and India in the science of simulation, we have secured 3 years of funding for the world’s first Surgical Simulation Fellow. The goal of these one year positions is to provide a foundation for creating international leaders in the development, evaluation and delivery of curricula enhanced by surgical simulation. The fellow participates in the design


22


and implementation of all surgical simulation activities and research that occur within SimPORTAL. The fellow is also involved in an array of simulation research projects via the Center for Research in Education and Simulation Technologies (CREST) and via participation in the SimPORTAL’s Curriculum and Assessment Council. Once each fellowship is completed, the Surgical Simulation Fellow will be facile in simulation education theory and practice, and will be able to develop their own technical skills with an array of simulation activities. Our first fellow, upon graduation, will have written at least 5 papers, completed 3 validation studies, developed 2 simulators and will provide a blueprint for the first simulation center in Turkey at the University of Istanbul. The core renovation will allow us to provide an office in the heart of the institute for this individual.

8.2 MEDICAL SCHOOL FACULTy, RESIDENT AND STUDENT DEvELOPMENTWe have provided, and will continue to provide, University-wide development opportunities in the area of simulation sciences. Our programs have impacted courses and research projects from General Surgery, Anesthesia, Emergency Medicine, Urology, Otolaryngology, Neurosurgery, Orthopaedics, Obstetrics and Gynecology, Internal Medicine, Family Medicine, Neonatology and Radiology. We even provide opportunities for remedial training and maintenance of certification for physician re-entry. The transformation of our current programs into an institute will have an enormous impact on research and training across these disciplines as the demand and interest in simulation sciences are growing exponentially at our institution.

8.3 OUTREACHWe have supported and provided learning and research opportunities for various high school groups and undergraduate medical education programs from across the state of Minnesota. We have also participated in activities at the Minnesota State Fair to increase the general public’s awareness of diseases such as prostate cancer.

We currently have basic and translational simulation science projects that support over 60 graduate and undergraduate pre-med, engineering and educational psychology students working on simulation research projects. In addition we


23


host students in undergraduate biomedical engineering courses. Currently we are unable to accommodate these courses beyond a 1 or 2 day per year “tour”. The core renovation will allow for adequate space and an IT network that allows us to better serve our community and develop this important new area of research. We envision and have support for creating dedicated courses and curricula for these students, allowing them to experience medical scenarios/procedures and encouraging them to design elegant solutions, driving the future of health care delivery and training.


24

Table of ContentsProgram Summary

SimPORTAL and CREST PROGRAM ANALYSISThe SimPORTAL and CREST project will expand, remodel, and update the current facilities located on the 4th and 5th floor in the Mayo Memorial Building, Minneapolis campus, in order to increase the flow, scope, functionality, and appearance of the workspace. Work would include removal of several walls to create a larger room for briefing/debriefing, increase meeting and network capabilities. Several walls will be removed to produce a modular, multipurpose and dividable space for simulations and classes that will have updated ventilation to allow for the use of cadaveric and animal tissue. Additionally, space would be converted to employ the use of temporal bone, robotics, and microsurgery.

DebriefThis space will be used to provide pre-scenario situation and expectation. It will be a friendly and confidential learning environment to discuss and review post simulation what happened, what was learned and what could be done differently (including video viewing of simulation). This time will aid facilitators to identify and address learning gaps. These rooms have been designed to accommodate smaller, private groups or a single large group.

Task TrainerThis clinical learning lab will allow staff to learn the basics of a particular skill with repeated practice while developing competence and confidence. The skill can be broken down into separate sections, each of which can be taught and practiced separately before bringing the parts together and practicing in appropriate combinations until the whole procedure has been mastered. These skills can then be utilized in simulation with the full body manikin. This room will be accessible 24/7 to accommodate all staff.

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25

Table of Contents

The Mayo Memorial Building CREST and SimPORTAL Remodel ProjectSpace Program for Floors Four and Five:

Fourth Floor Mayo-CREST Corridor A

vR Software Development Laboratory 565 gsf3-D Display Lab 320 gsfArtificial Tissue Laboratory 420 gsfCirculation 636 gsfMechanical 175 gsf

SUB-TOTAL CREST Corridor A 2,116 gsf

Fifth Floor Mayo-SimPORTAL Corridor A

Reception Area/Assistant Desks 260 gsfDirector Office 140 gsfManager Office 120 gsfTechnicians Office 90 gsfTask Trainers 450 gsfIn-Patient/MOC/Skills Testing/Data Collection 245 gsfIn-Patient/MOC Control 65 gsfMicrosurgical Human Factors & Training Lab 465 gsfImage Guided Surgery Research 455 gsfImage Guided/MIS/Robotic Control 135 gsfMIS/Robotic Skills Research 450 gsfBasic Surgical Skills Research 1260 gsfBasic Surgical Skills Control 150 gsfPreparation 135 gsfData 120 gsfStorage 260 gsfMens/Womens ADA Toilets 297 gsfCirculation 1,952 gsf

SUB-TOTAL SimPORTAL Corridor A 7,049 gsf

Program Summary 4


26

Table of Contents

Fifth Floor Mayo-SimPORTAL/Anesthesia Corridor B

Debrief/Anesthesia Conference 780 gsfAirway Skills Research 315 gsfAcute Care Human Factors Lab 2@ 340 ea 680 gsfControl 155 gsfBreak 90 gsfCirculation 1,115 gsf

SUB-TOTAL SimPORTAL/Anesthesia Corridor B 3,335 gsf

Project TOTAL 12,500 gsf

Program Summary 4


27

Table of Contents

LEGEND LAB / SIMULATION RESEARCH

SUPPORT

TISSUE LAB

VR SOFTWARE DEVELOPMENT

LAB

3D DISPLAYLAB

MECH

UP

DN

DN

Program Summary

Mayo 4th Floor - CRESTProgram Plans

4


28

Table of Contents

LEGEND

OTHER

LAB / SIMULATION RESEARCH

SUPPORT

OFFICE

CONTROLROOM

BASIS SURGICAL SKILLS RESEARCH

TISSUEPREP

CORR

IDO

R

MIS / ROBOTIC

SKILLS RESEARCH

STORAGE

TECH CO

NTR

OL

ROO

M

IMAGE GUIDED

SURGERY RESEARCH

ANESCART

GASMACH

ROBOT

TOWER

CONSOLE

BMS

X

X

BOOMWITHLIGHTS

BOOMWITHALLMLS

XBOOMWITHGASSES

X

UP

DN

Program Summary

Mayo 5th Floor - SimPORTAL Area 1Program Plans

4


29

Table of ContentsProgram Summary

Mayo 5th Floor - SimPORTAL Area 2Program Plans

ANESCART

GAS

MACH

BMS

BMS

X

ANESCABINET

LEGEND

OTHER


SUPPORT

OFFICE

CORR

IDO

R

CONTROL ROOM

IMAGE GUIDED

SURGERY RESEARCH

MICROSURGICAL HUMAN

FACTORS & TRAINING LAB

TASK TRAINERS

CONTROL ROOM for HUMAN

FACTORS DATA COLLECTION

OBSERVATION

DIRECTOR

MANAGER

RECEPTION

MENS

CONTROLTELE-EDUC.HUB

4


30

Table of Contents

RAMP DOWN

DN

LEGEND

OTHER


SUPPORT

OFFICE

ANESTHESIA CONFERENCE

ROOM

BREAKROOM

AIRWAY SKILLS

RESEARCH

CONTROLROOM

ACUTE CARE HUMAN FACTORS

LAB #1

ACUTE CARE HUMAN FACTORS

LAB #2

Program Summary

Mayo 5th Floor - Anesthesia AreaProgram Plans

4


31

Table of ContentsFinancial Analysis

This project will be funded by successful award of a CO6 Federal Grant - Extramural Research Facilities Improvement Program.

From the Grant Application:

This Funding Opportunity Announcement (FOA) issued by the National Center for Research Resources, National Institutes of Health, solicits applications from institutions that propose to expand, remodel, renovate, or alter biomedical or behavioral research facilities. The major objective of the FOA is to facilitate and enhance the conduct of Public Health Service-supported biomedical and behavioral research by supporting the costs of improving non-Federal basic research, clinical research, and animal facilities to meet the biomedical or behavioral research, research training, or research support needs of an institution. Since the funds for this FOA come from the American Recovery and Reinvestment Act of 2009, it is expected that all awards will be expended expeditiously and that applicants will consider green/sustainable technologies and design approaches.

Budgets for direct cost between $2M and $15M may be requested in the application.

Application for the grant is due by July 17, 2009. Earliest anticipated start date: December 2009.

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Table of ContentsSite Analysis

The Mayo building is made up of six different buildings with various completed construction dates. It is situated in the Medical Campus North of the Mississippi River and South of Washington Ave SE.

The project is an interior remodeling project and thus has no effect on the exterior site. Project Location

6


33

Table of ContentsCode | Environmental | Hazardous Material Analysis

No significant environmental issues are anticipated. A limited building survey for this area was provided April 8, 2009. A Facility Condition Assessment has been completed and reviewed for this building. Any remaining hazardous materials will be removed before the project is started. Refer to the Attachments of this report for further information.

Building Code RequirementsThe Pre-Design Schematic plan has been designed to fully be code compliant.

The Work associated with this project will be designed and constructed in conformance with the following applicable codes, regulations and laws:

2007 Minnesota State Building Code •2006 International Building Code •2007 Minnesota Accessibility Code – Chapter 1341 •1999 Minnesota Energy Code – Chapters 7676 and 7678 •2007 Minnesota State Fire Code •2006 International Fire Code•2000 Life Safety Code – NFPA 101 •2008 National Electrical Code •2008 Minnesota State Plumbing Code •2004 Minnesota State Mechanical Code •2000 International Mechanical Code•2000 International Fuel Gas Code•2007 Minnesota State Elevator Code •1999 Standard for Health Care Facility – NFPA 99 •

Occupancy Type: B/A3/SConstruction Type: 1-AAllowable Area: Unlimited (822,310 SF actual)Number of Stories: Unlimited (15 actual)

Fire Safety:Sprinkler Protection: Fully ProtectedStandpipe Protection: Fully ProtectedFire Walls: Fully ProtectedFire Alarm: Partial Notification/Detection

Hazardous Material AnalysisThe Building Code Deficiency Survey, Hazardous Material Report, and Facility Condition Assessment are in the following pages of this section.

7

Twin Cities Campus Facilities Management 300 Donhowe Building Hazardous Material Program 319-15th Avenue S.E. Minneapolis, MN 55455

612-625-7547 Fax: 612-624-1189

May 11, 2009 REPORT: Limited Building Survey TO: Pete Nickel CPPM Small and Mid-Range Projects

300 Donhowe Bldg 319 15th Ave SE Minneapolis, MN 55455

FROM: Jayd Lindom Facilities Management Hazardous Materials Program (FM-HMP) 1521 4th Street SE Minneapolis, MN 55455 SUBJECT: Limited Hazardous Material Survey – CREST 5th Floor A-Wing Mayo Building 420 Delaware Street SE Minneapolis, MN 55455 FM Project No.: 01-074-09-1672 Scope of Work: A limited hazardous material survey was conducted in July of 1994 and April 2009 at Mayo. The purpose of this survey was to:

1. Identify asbestos-containing materials (ACM) as defined by the Environmental Protection Agency (EPA). Any material that is greater than 1% asbestos is considered to be ACM. The intent of the survey was to identify both friable and non-friable suspect ACM, identify non-friable ACM that may become friable under demolition or renovation conditions.

2. Identify Lead based paint using an XRF Spectrum Analyzer on suspect lead-containing paint.

Results of testing are listed in Appendix II. It is recommended that throughout the general renovation activities associated with this building, where the contractor will be impacting lead materials, the contractor follow OSHA regulation 29 CFR 1926.62 Lead Exposure in Construction; Interim Final Rule.

3. Identify possible Mercury contamination; sampling was done using the Lumex Mercury Vapor

Analyzer, all samples were collected within six inches of sampling area. Results of testing are listed in Appendix III of this report.

Project Description Asbestos: One (1) suspect ACM sample was collected on-site and analyzed via polarized light microscopy (PLM) for asbestos content. The remaining samples were collected in July of 1999. Depending on the scope of work, more investigation may be required there was no destructive surveying done. Black board and cork board adhesives will need to be tested if demolition is to take place. Results of asbestos analyses are listed in Appendix I of this report. Appendix I is formatted to provide a room by room inventory of suspect ACM, the asbestos content of each material listed, and friability. Minnesota Department of Health (MDH) Asbestos Rules regulate only friable ACM (material may be reduced to powder or dust under hand pressure) while the EPA regulates ACM that may become friable under demolition or renovation conditions. The following friable or potentially friable materials tested Positive as ACM:

• < 4” Pipe Fitting Insulation on Cork • < 4” Felt with Tar Pipe Insulation • < 4” Fibrous Pipe Fitting Insulation Felt with Tar • < 4” Pipe Fitting Insulation on White Fibrous Pipe Insulation • < 4” White Fibrous Pipe Insulation • 1’x1’ Pegboard Ceiling Tile • 12”x12” Floor Tile • 4”-8” Felt with Tar Pipe Insulation • 4”-8” Fibrous Pipe Fitting Insulation Felt with Tar • 4”-8” Pipe Fitting Insulation on Cork • 4”-8” Pipe Fitting Insulation on White Fibrous Pipe Insulation • 4”-8” White Fibrous Pipe Insulation • 9”x9” Floor Tile • Black Duct Adhesive • Floor Tile Adhesive • Grey Duct Adhesive • Sink Undercoating • Stainless Counter Top Undercoating • White Paper

The following suspect materials tested none detected (ND) as ACM in the building:

• 1’x1’ Ceiling Tile • 12”x12” Floor Tile • 2’x2’ Ceiling Tile • 2’x4’ Ceiling Tile • 4”-8” Cork with Tar Pipe Insulation • 9”x9” Floor Tile • Baseboard Adhesive • Brown Duct Adhesive • Ceiling Plaster • Ceiling Tile Adhesive • Ceramic Tile Mortar • Clay tile Mortar • Concrete Block Mortar • Floor Tile Adhesive • Lab Sink • Linoleum • Linoleum Adhesive

• Red Brick Mortar • Sheetrock and Taping Compound • Spray-on Fireproofing • Tar Paper Duct Wrap • Wall Plaster • White Block and Mortar

Project Description Lead: Seventy-nine (79) XRF Spectrum Analyzer readings were collected on-site and analyzed for lead content. Results of analyses are listed in Appendix II of this report. Directions are represented in the following fashion: North, South, East and West. Suspect materials tested for lead included ceilings, cabinets, doors, door frames, glass windows, radiator covers, walls, and window frames. Refer to the report for specific materials and locations. Overall, materials tested were in fair condition. The Minnesota Pollution Control Agency (MPCA) stipulates that peeling and flaking paint be stabilized prior to demolition and structures with paint adhered to the substrate may be deposited in a properly permitted demolition landfill. The following materials tested Positive for Lead Paint:

• Tan Wall (X-Ray Booth) • Glass Window (X-Ray Booth)

The following materials tested Negative for Lead Paint:

• Beige Cabinet • Blue Door • Blue Door Frame • Brown Door Frame • Brown Window Frame • Glass Window (X-Ray Booth) • Grey Door Frame • Grey Radiator Cover • Grey Window Frame • Red Fire Cabinet • Tan Door • Tan Wall • White Ceiling • White Door Frame • White Wall • White Window Frame • Yellow Wall

Project Description Mercury: Fifty-two (52) locations were analyzed with the direct read Lumex vapor detector. Areas checked for Mercury vapor contamination included cabinets, counter tops, floors, linen chute, sink drains and shelves. Refer to the table in Appendix III for specific locations. Summary: The purpose of the survey was to find potential areas of spilled mercury or mercury contaminated building materials within the renovation area. The Lumex detects mercury vapor levels in nanograms per square meter. When mercury vapor levels above 500 nanograms per square meter are detected, specialized cleaning procedures will be implemented to cleanup the existing contamination prior to bulk sample collection for waste disposal. Mercury was not present in the areas tested, once the areas have been cleared of building occupants and contents a full survey of construction area shall be conducted prior to casework removal. Also mercury vapor monitoring is recommended during casework removal for evaluating mercury content of materials and debris under the casework. Please refer to the attached five page mercury demolition flowchart that the University of Minnesota has produced for more specific information. Results: The Lumex did not detect airborne mercury vapors at the sample locations. For specific results, see the tables in Appendix III of this report. If visible liquid mercury is discovered during demolition or renovation activities, work shall immediately stop and report the discovery to FM-HMP at 612-625-7547. If there is any further information required, or other questions arise regarding this request, please contact Jayd Lindom at (612) 625-5052. Written By: Jayd Lindom Jayd Lindom Facilities Management Hazardous Materials Program Minnesota Department of Health Inspector #: AI 2665 CC: Sean Gabor [email protected]

mailto:[email protected]

Appendix I

Suspect

Asbestos

Materials

EXPLANATION OF TABLES IN APPENDIX I

Flr Location Samp# Code Description Asbestos (%) Quan Unit Fri Cond Rate AHERA B Room 02 1 T

EXPLANATION OF AHERA RATING

The suspect asbestos-containing materials have been assigned AHERA ratings based on physical condition at the time of the survey. Numerical ratings are assigned based on the following: X= Samples of this material did not contain detectable trace amounts of asbestos and requires no asbestos abatement action. 1= Damaged or significantly damaged TSI (thermal system insulation) ACBM (asbestos containing building material). 2= Damaged friable surfacing ACBM. 3= Significantly damaged friable surfacing ACBM. 4= Damaged or significantly damaged friable miscellaneous ACBM. 5= ACBM with potential for damage. 6= ACBM with potential for significant damage. 7= Any remaining friable ACBM or friable suspected ACBM.

EXPLANATION OF CONDITION RATING

The suspect asbestos-containing materials have been assigned condition ratings based on the physical condition at the time of the survey. Numerical ratings are assigned based on the following: 0 = Samples of this material did not contain detectable trace amounts of asbestos and requires no asbestos abatement action. 1 = Material contains asbestos, is non-friable and requires no action unless sanded, abraded, drilled or otherwise disturbed in a manner that may cause fiber release. 2 = Material contains asbestos and is friable. Damage was not observed; no immediate abatement action is required. Periodic re- inspections are recommended to reassess the condition of this material. 3 = Material contains asbestos and is friable. Signs of localized damage were noted during the survey and potential for future disturbance exists. Repair or removal is recommended to reduce the potential for fiber releases. 4 = Material contains asbestos, is friable and is heavily damaged. Removal of this material should be given a high priority.

Appendix I Material Identification Inventory Project #:01-074-09-1672

Building Name: Mayo Inspector: JLBuilding #: 74 Date: 5/8/09

UNITASBESTOS REF. Lin. Ft. PHYSICAL

MAT'L MATERIAL CONTENT SAM. Sq. Ft. ASSESSMENT CONDITION AHERALOCATION CODE IDENTIFICATION (%/TYPE) NUM. QUAN. Each FRI CON RATING RATING

hall A519-A597 S ceiling plaster ND 44 SF F N 0 Xhall A519-A597 S wall plaster ND 45 SF F N 0 Xhall A519-A597 M 12"x12" pinkish hue w/ tan & cream FT 5% Chrys 94 1100 SF N N 1 5hall A519-A597 M floor tile adhesive (sample 94) 5% Chrys 94.5 1100 SF N N 1 5hall A519-A597 M baseboard adhesive ND 141 LF F N 0 Xhall A519-A597 M 1'x1' plain white CT ND 255 1100 SF F N 0 Xhall A519-A597 M ceiling tile adhesive (sample 255) ND 255.5 1100 SF N N 0 Xhall A519-A597 Carpet Squares over Floor Tile

hall A519-A597(hatches) T





room A501 M 9"x9" grey w/ white smears FT 20% Chrys 55 106 SF N N 1 5room A501 M floor tile adhesive (sample 55) ND 55.5 106 SF N N 0 Xroom A501 M baseboard adhesive ND 141 LF F N 0 Xroom A501 Carpet over Floor Tile

room A501-1 S ceiling plaster ND 44 SF F N 0 Xroom A501-1 S wall plaster ND 45 SF F N 0 Xroom A501-1 M baseboard adhesive ND 141 LF F N 0 Xroom A501-1 unable to view above ceiling 1001

room A503 S ceiling plaster ND 44 SF F N 0 Xroom A503 S wall plaster ND 45 SF F N 0 Xroom A503 M 9"x9" grey w/ white smears FT 20% Chrys 55 280 SF N N 1 5room A503 M floor tile adhesive (sample 55) ND 55.5 280 SF N N 0 Xroom A503 M baseboard adhesive ND 141 LF F N 0 X

room A503(hatch) T





room A505 S wall plaster ND 45 SF F N 0 Xroom A505 M 12"x12" cream w/ tan, green & grey FT ND 73 126 SF N N 0 Xroom A505 M floor tile adhesive (sample 73) ND 73.5 126 SF N N 0 Xroom A505 M 1'x1' small pegboard CT 3% Chrys 102 120 SF F N 2 5room A505 M ceiling tile adhesive (sample 102) ND 102.5 120 SF N 0 Xroom A505 M baseboard adhesive ND 141 LF F N 0 X

room A505(ceiling hatch) T





room A506(hatch) T





room A507-1 S wall plaster ND 45 SF F N 0 Xroom A507-1 M 12"x12" cream w/ tan, green & grey FT ND 73 38 SF N N 0 Xroom A507-1 M floor tile adhesive (sample 73) ND 73.5 38 SF N N 0 Xroom A507-1 M 2'x2' cratered CT ND 108 34 SF F N 0 Xroom A507-1 M sheetrock & mud ND 140 SF F N 0 Xroom A507-1 M baseboard adhesive ND 141 LF F N 0 Xroom A507-1 M clay tile mortar ND 144 SF F N 0 Xroom A507-1 M white block and mortar ND 145 SF F N 0 X

room A509 S ceiling plaster ND 44 SF F N 0 Xroom A509 S wall plaster ND 45 SF F N 0 Xroom A509 M 12"x12" cream w/ tan, green & grey FT ND 73 126 SF N N 0 Xroom A509 M floor tile adhesive (sample 73) ND 73.5 126 SF N N 0 Xroom A509 M baseboard adhesive ND 141 LF F N 0 Xroom A509 M lab sink ND 149 1 EA N N 0 X

room A509(above ceiling) T





room A511 S wall plaster ND 45 SF F N 0 Xroom A511 M 9"x9" grey w/ white smears FT 20% Chrys 55 85 SF N N 1 5room A511 M floor tile adhesive (sample 55) ND 55.5 85 SF N N 0 Xroom A511 M baseboard adhesive ND 141 LF F N 0 X

room A511(hatch) T





room A513 S wall plaster ND 45 SF F N 0 Xroom A513 M baseboard adhesive ND 141 LF F N 0 Xroom A513 M 9"x9" black FT 15% Chrys 207 45 SF N N 1 5room A513 M floor tile adhhesive (sample 207) ND 207.5 45 SF N N 0 X






Xroom A517-1 S ceiling plaster ND 44 SF F N 0 Xroom A517-1 S wall plaster ND 45 SF N N 0 Xroom A517-1 unable to view above ceiling 1001

room A519 S ceiling plaster ND 44 SF F N 0 Xroom A519 S wall plaster ND 45 SF F N 0 Xroom A519 M 9"x9" grey w/ white smears FT 20% Chrys 55 100 SF N N 1 5room A519 M floor tile adhesive (sample 55) ND 55.5 100 SF N N 0 Xroom A519 M baseboard adhesive ND 141 LF F N 0 Xroom A519 unable to view above ceiling 1001room A519 Carpet over Floor Tile

Xroom A519-1 S ceiling plaster ND 44 SF F N 0 Xroom A519-1 S wall plaster ND 45 SF F N 0 Xroom A519-1 unable to view above ceiling 1001

room A558 T





room A558 M brown duct adhesive ND 157 16 LF N N 0 Xroom A558 M tar paper duct wrap ND 178 4 SF F N 0 Xroom A558 possible padding behind metal backing of radiator 1000

room A558-1 M 2'x2' cratered CT ND 108 22 SF F N 0 Xroom A558-1 M clay tile mortar ND 144 SF F N 0 Xroom A558-1 M white block and mortar ND 145 SF F N 0 Xroom A558-1 M brown duct adhesive ND 157 8 LF N N 0 Xroom A558-1 M tar paper duct wrap ND 178 2 SF F N 0 X

room A559 S ceiling plaster ND 44 SF F N 0 Xroom A559 S wall plaster ND 45 SF F N 0 Xroom A559 M 9"x9" grey w/ white smears FT 20% Chrys 55 6 SF N N 1 5room A559 M floor tile adhesive (sample 55) ND 55.5 6 SF N N 0 Xroom A559 M 12"x12" pinkish hue w/ tan & cream FT 5% Chrys 94 1 SF N N 1 5room A559 M floor tile adhesive (sample 94) 5% Chrys 94.5 1 SF N N 1 5room A559 M baseboard adhesive ND 141 LF F N 0 X

room A560 T





room A566 T





room A568 T





room A574 M 2'x2' cratered CT ND 108 240 SF F N 0 Xroom A574 M baseboard adhesive ND 141 LF F N 0 Xroom A574 M clay tile mortar ND 144 SF F N 0 Xroom A574 M white block and mortar ND 145 SF F N 0 Xroom A574 M grey duct adhesive 10% Chrys 156 10 LF N N 1 5room A574 M brown duct adhesive ND 157 10 LF N N 0 Xroom A574 M tar paper duct wrap ND 178 3 SF F N 0 Xroom A574 possible padding behind metal backing of radiator 1000

room A574-1 M 2'x2' cratered CT ND 108 18 SF F N 0 Xroom A574-1 M clay tile mortar ND 144 SF F N 0 Xroom A574-1 M white block and mortar ND 145 SF F N 0 X

room A575 S ceiling plaster ND 44 SF F N 0 Xroom A575 S wall plaster ND 45 SF F N 0 Xroom A575 M 12"x12" cream w/ tan, green & grey FT ND 73 9 SF N N 0 Xroom A575 M floor tile adhesive (sample 73) ND 73.5 9 SF N N 0 Xroom A575 M baseboard adhesive ND 141 LF F N 0 X

room A575(above ceiling) T 4"-8" felt w/ tar PI 60% Chrys 20 3 LF F N 2 5room A575(above ceiling) M white block and mortar ND 145 SF F N 0 X

room A576 T





room A576 M baseboard adhesive ND 141 LF F N 0 Xroom A576 M clay tile mortar ND 144 SF F N 0 Xroom A576 M white block and mortar ND 145 SF F N 0 Xroom A576 M brown duct adhesive ND 157 16 LF N N 0 Xroom A576 M tar paper duct wrap ND 178 4 SF F N 0 Xroom A576 possible padding behind metal backing of radiator 1000

room A579 S ceiling plaster ND 44 SF F N 0 Xroom A579 S wall plaster ND 45 SF F N 0 X






room A580(hatch) T 4"-8" PFI on white fibrous 3% Amos 7% Chrys 17 2 EA F N 2 5room A580(hatch) T 4"-8" felt w/ tar PI 60% Chrys 20 27 LF F N 2 5room A580(hatch) T 4"-8" PFI on felt 10% Amos 15% Chrys 21 3 EA F N 2 5room A580(hatch) S spray-on fireproofing ND 43 95 SF F N 0 Xroom A580(hatch) M clay tile mortar ND 144 SF F N 0 Xroom A580(hatch) M white block and mortar ND 145 SF F N 0 Xroom A580(hatch) M brown duct adhesive ND 157 20 LF N N 0 Xroom A580(hatch) M tar paper duct wrap ND 178 5 SF F N 0 X

room A580-1 S ceiling plaster ND 44 SF F N 0 Xroom A580-1 S wall plaster ND 45 SF F N 0 Xroom A580-1 M baseboard adhesive ND 141 LF F N 0 X

room A582 S ceiling plaster ND 44 SF F N 0 Xroom A582 S wall plaster ND 45 SF F N 0 Xroom A582 M 12"x12" cream w/ tan, green & grey FT ND 73 140 SF N N 0 Xroom A582 M floor tile adhesive (sample 73) ND 73.5 140 SF N N 0 Xroom A582 M 1'x1' small pegboard CT 3% Chrys 102 136 SF F N 2 5room A582 M ceiling tile adhesive (sample 102) ND 102.5 136 SF N N 0 Xroom A582 M baseboard adhesive ND 141 LF F N 0 X






room A582(above ceiling) M tar paper duct wrap ND 178 2 SF F N 0 X

room A584 S ceiling plaster ND 44 SF F N 0 Xroom A584 S wall plaster ND 45 SF F N 0 Xroom A584 M 12"x12" cream w/ tan, green & grey FT ND 73 140 SF N N 0 Xroom A584 M floor tile adhesive (sample 73) ND 73.5 140 SF N N 0 Xroom A584 M 1'x1' small pegboard CT 3% Chrys 102 136 SF F N 2 5room A584 M ceiling tile adhesive (sample 102) ND 102.5 136 SF N N 0 Xroom A584 M baseboard adhesive ND 141 LF F N 0 Xroom A584 Carpet over Floor Tile

room A584(hatch) T





room A590-1(above ceiling) T





room A590-3 M 9"x9" grey w/ white smears FT 20% Chrys 55 180 SF N N 1 5room A590-3 M floor tile adhesive (sample 55) ND 55.5 180 SF N N 0 Xroom A590-3 M baseboard adhesive ND 141 LF F N 0 Xroom A590-3 Carpet over Floor Tile

room A590-3(hatch) T





room A595(hatch) T 4"-8" PFI on white fibrous 3% Amos 7% Chrys 17 2 EA F N 2 5room A595(hatch) T 4"-8" felt w/ tar PI 60% Chrys 20 17 LF F N 2 5room A595(hatch) T 4"-8" PFI on felt 10% Amos 15% Chrys 21 12 EA F N 2 5room A595(hatch) M clay tile mortar ND 144 SF F N 0 Xroom A595(hatch) M white block and mortar ND 145 SF F N 0 Xroom A595(hatch) M brown duct adhesive ND 157 10 LF N N 0 Xroom A595(hatch) M tar paper duct wrap ND 178 10 SF F N 0 X

room A597 S ceiling plaster ND 44 SF F N 0 Xroom A597 S wall plaster ND 45 SF F N 0 Xroom A597 M 9"x9" grey w/ white smears FT 20% Chrys 55 134 SF N N 1 5room A597 M floor tile adhesive (sample 55) ND 55.5 134 SF N N 0 Xroom A597 M baseboard adhesive ND 141 LF F N 0 X

room B580 T





room B580 M black tar on duct 5% Chrys 155 75 SF N N 1 5room B580 M 12"x12" beige, tan & cream mottled FT 5% Chrys 219 470 SF N N 1 5room B580 M floor tile adhesive (sample 219) 5% Chrys 219.5 470 SF N N 1 5room B580 Floor Tile partialy abatedroom B580 Carpet over Floor Tile

room B580-1 T





room B582 S wall plaster ND 45 SF F N 0 Xroom B582 M 9"x9" grey w/ white smears FT 20% Chrys 55 136 SF N N 1 5room B582 M floor tile adhesive (sample 55) ND 55.5 186 SF N N 0 Xroom B582 M baseboard adhesive ND 141 LF F N 0 Xroom B582 unable to view above ceiling 1001room B582 Carpet over Floor Tile

room B584 T





room B584-1(above ceiling) T





room B586(hatch) T 4"-8" felt w/ tar PI 60% Chrys 20 25 LF F N 2 5room B586(hatch) T 4"-8" PFI on felt 10% Amos 15% Chrys 21 24 EA F N 2 5room B586(hatch) S spray-on fireproofing ND 43 126 SF F N 0 Xroom B586(hatch) M clay tile mortar ND 144 SF F N 0 Xroom B586(hatch) M white block and mortar ND 145 SF F N 0 X

room B590 S ceiling plaster ND 44 SF F N 0 Xroom B590 S wall plaster ND 45 SF F N 0 Xroom B590 M 9"x9" grey w/ white smears FT 20% Chrys

01-074-09-1672 · final | july 2, 2009 mayo memorial building simportal and crest remodel...

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