National Institutes Of Health Awards Research Articles

Percentile Ranking and Citation Impact of a Large Cohort of National Heart, Lung, and Blood Institute–Funded Cardiovascular R01 Grants

Funding decisions for cardiovascular R01 grant applications at the National Heart, Lung, and Blood Institute (NHLBI) largely hinge on percentile rankings. It is not known whether this approach enables the highest impact science. Our aim was to conduct an observational analysis of percentile rankings and bibliometric outcomes for a contemporary set of funded NHLBI cardiovascular R01 grants. We identified 1492 investigator-initiated de novo R01 grant applications that were funded between 2001 and 2008 and followed their progress for linked publications and citations to those publications. Our coprimary end points were citations received per million dollars of funding, citations obtained <2 years of publication, and 2-year citations for each grant's maximally cited paper. In 7654 grant-years of funding that generated $3004 million of total National Institutes of Health awards, the portfolio yielded 16 793 publications that appeared between 2001 and 2012 (median per grant, 8; 25th and 75th percentiles, 4 and 14; range, 0-123), which received 2 224 255 citations (median per grant, 1048; 25th and 75th percentiles, 492 and 1932; range, 0-16 295). We found no association between percentile rankings and citation metrics; the absence of association persisted even after accounting for calendar time, grant duration, number of grants acknowledged per paper, number of authors per paper, early investigator status, human versus nonhuman focus, and institutional funding. An exploratory machine learning analysis suggested that grants with the best percentile rankings did yield more maximally cited papers. In a large cohort of NHLBI-funded cardiovascular R01 grants, we were unable to find a monotonic association between better percentile ranking and higher scientific impact as assessed by citation metrics.

A Correlation Between National Institutes of Health Funding and Bibliometrics in Neurosurgery

The relationship between metrics, such as the h-index, and the ability of researchers to generate funding has not been previously investigated in neurosurgery. This study was performed to determine whether a correlation exists between bibliometrics and National Institutes of Health (NIH) funding data among academic neurosurgeons. The h-index, m-quotient, g-index, and contemporary h-index were determined for 1225 academic neurosurgeons from 99 (of 101) departments. Two databases were used to create the citation profiles, Google Scholar and Scopus. The NIH Research Portfolio Online Reporting Tools Expenditures and Reports tool was accessed to obtain career grant funding amount, grant number, year of first grant award, and calendar year of grant funding. Of the 1225 academic neurosurgeons, 182 (15%) had at least 1 grant with a fully reported NIH award profile. Bibliometric indices were all significantly higher for those with NIH funding compared to those without NIH funding (P< .001). The contemporary h-index was found to be significantly predictive of NIH funding (P < .001). All bibliometric indices were significantly associated with the total number of grants, total award amount, year of first grant, and duration of grants in calendar years (bivariate correlation, P < .001) except for the association of m-quotient with year of first grant (P= .184). Bibliometric indices are higher for those with NIH funding compared to those without, but only the contemporary h-index was shown to be predictive of NIH funding. Among neurosurgeons with NIH funding, higher bibliometric scores were associated with greater total amount of funding, number of grants, duration of grants, and earlier acquisition of their first grant.

The CTSA Mentored Career Development Program: Supporting the Careers of Child Health Investigators

Training translational scientists is a priority of the Clinical and Translational Science Award (CTSA) consortium. 1) Describe the landscape of CTSA Mentored Research Career Development Awards (CDA) and 2) evaluate participation and outcomes of child health investigators in these programs. Survey of the CTSA Child Health Oversight Committee (CC-CHOC) and review of nonresponders' CTSA Websites. Thirty-two of 53 CC-CHOC members (60%) responded and all nonresponder Websites were reviewed. Institutions supported 1,166 CDA positions from 2006 to 2011, with 134 awarded to child health investigators (11.5%). Respondents reported a mean of 29.8 KL2 positions (95% CI 17.5-42.2) during their award period, with a mean of 2.8 (95% CI 1.8-3.8) awarded to child health investigators. The proportion of child health awardees varied from 0% to 50% across institutions. We identified 45 subsequent National Institutes of Health (NIH) awards to the 134 child health investigators (34%). The CTSA program contributes substantially to training the next generation of translational investigators. One-third of child health investigators obtained subsequent NIH awards in the short follow-up period demonstrating success of the CTSA CDA programs. Child health investigators are represented variably across the consortium. Pediatric institutions can partner with the CTSA program to further support training child health investigators.

The Association between Scholarly Impact and National Institutes of Health Funding in Ophthalmology

To examine whether there is an association between scholarly impact, as measured by the h-index, academic rank, and National Institutes of Health (NIH) awards in academic ophthalmology. Retrospective analysis of NIH RePORTER and Scopus databases. Not applicable. Five hundred seventy-three NIH awards to 391 primary investigators (PIs) in ophthalmology departments were examined. Grant recipients were organized by academic rank, obtained from online listings, and h-index, calculated using the Scopus database. Non-NIH-funded faculty from 20 randomly chosen academic ophthalmology departments also were organized by rank and h-index for comparison with their NIH-funded colleagues. Scholarly impact, as measured by the h-index, and NIH funding. The h-index increased with successive academic rank among non-NIH-funded and NIH-funded faculty, as did NIH funding among the latter group. The NIH-funded faculty had higher scholarly impact, asmeasured by the h-index, than their non-NIH-funded PIs (h= 18.3 vs. 7.8; P <0.0001), even whenconsidering publications only in the prior 5 years; h-index increased with increasing NIH funding ranges. The h-indices of those holding an MD degree (21.4±1.6 standard error of mean) were not statistically higher than those of PhD holders (17.9±0.6) and those with both an MD and PhD degree (18.1±1.7; P=0.14). The h-index increases with increasing academic rank among NIH-funded and non-NIH-funded faculty in ophthalmology departments. This bibliometric is associated strongly with NIH funding because NIH-funded PIs had higher scholarly impact than their non-NIH-funded colleagues, and increasing impact was noted with higher funding. The h-index is an objective and easily calculable measure that may bevaluable as an adjunct in assessing research productivity, a significant factor for academic promotion inacademic ophthalmology.

Does receiving an American Academy of Otolaryngology–Head and Neck Surgery Foundation Centralized Otolaryngology Research Efforts grant influence career path and scholarly impact among fellowship‐trained rhinologists?

To determine whether American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) Centralized Otolaryngology Research Efforts (CORE) grants influence career paths and scholarly impact of fellowship-trained rhinologists, and whether funding from the National Institutes of Health (NIH) and CORE programs is associated with increased scholarly impact among rhinologists. Another aim was to explore whether obtaining CORE grant funding is associated with NIH award acquisition. Practice setting, academic rank, and fellowship-training status were determined for individuals in the CORE grant database. The h-index and publication experience of practitioners was calculated using the Scopus database. Faculty listings were used to determine this data for a non-CORE-grants-funded "control" group of academic rhinologists. Active and past NIH funding was obtained using the NIH RePORTER database. Fifteen of 26 (57.7%) fellowship-trained rhinologists receiving CORE grants were funded for rhinologic projects. Five of 6 rhinologists receiving NIH funding had a CORE-grants-funding history. Twenty-two of 26 (84.6%) rhinologists receiving CORE funding are currently in academic practice. Academic rhinologists receiving CORE or NIH funding had higher h-indices, a result reaching significance among promoted faculty and those with greater than 10 years of publication experience. Encouraging the pursuit of CORE grants among junior faculty as well as trainees interested in rhinology may be a strategy for developing highly effective research habits that pay dividends after the first few years of one's career. Fellowship-trained rhinologists with a CORE funding history predominantly pursue careers in academic medicine, although their CORE projects are not necessarily related to rhinologic topics.

The pediatric surgeon's road to research independence: utility of mentor-based National Institutes of Health grants

BackgroundThe current research environment for academic surgeons demands that extramural funding be obtained. Financial support from the National Institutes of Health (NIH) is historically the gold standard for funding in the biomedical research community, with the R01 funding mechanism viewed as indicator of research independence. The NIH also supports a mentor-based career development mechanism (K-series awards) in order to support early-stage investigators. The goal of this study was to investigate the grants successfully awarded to pediatric surgeon-scientists and then determine the success of the K-series award recipients at achieving research independence. MethodsIn July 2012, all current members of the American Pediatric Surgery Association (APSA) were queried in the NIH database from 1988–2012 through the NIH Research Portfolio Online Reporting Tools. The following factors were analyzed: type of grant, institution, amount of funding, and funding institute or center. ResultsAmong current APSA members, there have been 83 independent investigators receiving grants, representing 13% of the current APSA membership, with 171 independent grants funded through various mechanisms. Six percent currently have active NIH funding, with $7.2 million distributed in 2012. There have been 28 K-series grants awarded. Of the recipients of expired K08 awards, 39% recipients were subsequently awarded an R01 grant. A total of 63% of these K-awarded investigators transitioned to an independent NIH award mechanism. ConclusionsPediatric surgeon-scientists successfully compete for NIH funding. Our data suggest that although the K-series funding mechanism is not the only path to research independence, over half of the pediatric surgeons who receive a K-award are successful in the transition to independent investigator.

AMDA Medical Director of the Year Nominees, 2013

AMDA Medical Director of the Year Nominees, 2013

Comparing National Institutes of Health Funding of Emergency Medicine to Four Medical Specialties

The purpose of this study was to compare National Institutes of Health (NIH) funding received in 2008 by emergency medicine (EM) to the specialties of internal medicine, pediatrics, anesthesiology, and family medicine. The hypothesis was that EM would receive fewer NIH awards and less funding dollars per active physician and per medical school faculty member compared to the other four specialties. Research Portfolio Online Reporting Tools (RePORT) were used to identify NIH-funded grants to 125 of the 133 U.S. allopathic medical schools for fiscal year 2008 (the most recent year with all grant funding information). Eight medical schools were excluded because six were not open in 2008, one did not have a website, and one did not have funding data available by medical specialty. From RePORT, all grants awarded to EM, internal medicine, family medicine, anesthesiology, and pediatric departments of each medical school were identified for fiscal year 2008. The authors extracted the project number, project title, dollars awarded, and name of the principal investigator for each grant. Funds awarded to faculty in divisions of EM were accounted for by identifying the department of the EM division and searching for all grants awarded to EM faculty within those departments using the name of the principal investigator. The total number of active physicians per medical specialty was acquired from the Association of American Medical Colleges' 2008 Physician Specialty report. The total number of faculty per medical specialty was collected by two research assistants who independently counted the faculty listed on each medical school website. The authors compared the total number of NIH awards and total funding per 1,000 active physicians and per 1,000 faculty members by medical specialty. Of the 125 medical schools included in the study, 84 had departments of EM (67%). In 2008, NIH awarded over 9,000 grants and approximately $4 billion to the five medical specialties of interest. Less than 1% of the grants and funds were awarded to EM. EM had the second-lowest number of awards and funding per active physician, and the lowest number of awards and funding per faculty member. A higher percentage of grants awarded to EM were career development awards (26%, vs. a range of 11% to 19% for the other specialties) and cooperative agreements (26%, vs. 2% to 10%). In 2008, EM was the only specialty of the five not to have a fellowship or T32 training grant. EM had the lowest proportion of research project awards (42%, vs. 58% to 73%). Compared to internal medicine, pediatrics, anesthesiology, and family medicine, EM received the least amount of NIH support per active faculty member and ranked next to last for NIH support by active physician. Given the many benefits of research both for the specialty and for society, EM needs to continue to develop and support an adequate cohort of independent investigators.

Combined inhibition of nitric oxide and vasodilating prostaglandins abolishes forearm vasodilatation to systemic hypoxia in healthy humans

We tested the hypothesis that nitric oxide (NO) and vasodilating prostaglandins (PGs) contribute independently to hypoxic vasodilatation, and that combined inhibition would reveal a synergistic role for these two pathways in the regulation of peripheral vascular tone. In 20 healthy adults, we measured forearm blood flow (Doppler ultrasound) and calculated forearm vascular conductance (FVC) responses to steady-state (SS) isocapnic hypoxia (O₂ saturation ~85%). All trials were performed during local α- and β-adrenoceptor blockade (via a brachial artery catheter) to eliminate sympathoadrenal influences on vascular tone and thus isolate local vasodilatory mechanisms. The individual and combined effects of NO synthase (NOS) and cyclooxygenase (COX) inhibition were determined by quantifying the vasodilatation from rest to SS hypoxia, as well as by quantifying how each inhibitor reduced vascular tone during hypoxia. Three hypoxia trials were performed in each subject. In group 1 (n = 10), trial 1, 5 min of SS hypoxia increased FVC from baseline (21 ± 3%; P < 0.05). Infusion of N(G)-nitro-L-arginine methyl ester (L-NAME) for 5 min to inhibit NOS during continuous SS hypoxia reduced FVC by -33 ± 3% (P < 0.05). In Trial 2 with continuous NOS inhibition, the increase in FVC from baseline to SS hypoxia was similar to control conditions (20 ± 3%), and infusion of ketorolac for 5 min to inhibit COX during continuous SS hypoxia reduced FVC by -15 ± 3% (P < 0.05). In Trial 3 with combined NOS and COX inhibition, the increase in FVC from baseline to SS hypoxia was abolished (~3%; NS vs. zero). In group 2 (n = 10), the order of NOS and COX inhibition was reversed. In trial 1, five minutes of SS hypoxia increased FVC from baseline (by 24 ± 5%; P < 0.05), and infusion of ketorolac during SS hypoxia had minimal impact on FVC (-4 ± 3%; NS). In Trial 2 with continuous COX inhibition, the increase in FVC from baseline to SS hypoxia was similar to control conditions (27 ± 4%), and infusion of L-NAME during continuous SS hypoxia reduced FVC by -36 ± 7% (P < 0.05). In Trial 3 with combined NOS and COX inhibition, the increase in FVC from baseline to SS hypoxia was abolished (~3%; NS vs. zero). Our collective findings indicate that (1) neither NO nor PGs are obligatory to observe the normal local vasodilatory response from rest to SS hypoxia; (2) NO regulates vascular tone during hypoxia independent of the COX pathway, whereas PGs only regulate vascular tone during hypoxia when NOS is inhibited; and (3) combined inhibition of NO and PGs abolishes local hypoxic vasodilatation (from rest to SS hypoxia) in the forearm circulation of healthy humans during systemic hypoxia.

What is a biomarker? Research investments and lack of clinical integration necessitate a review of biomarker terminology and validation schema

A continual trend of annual growth can be seen within research devoted to the discovery and validation of disease biomarkers within both the natural and clinical sciences. This expansion of intellectual endeavours was quantified through database searches of (a) research grant awards provided by the various branches of the National Institutes of Health (NIH) and (b) academic publications. A search of awards presented between 1986 and 2009 revealed a total of 28,856 grants awarded by the NIH containing the term “biomarker”. The total funds for these awards in 2008 and 2009 alone were over $2.5 billion. During the same respective timeframes, searches of “biomarker” and either “discovery”, “genomics”, “proteomics” or “metabolomics” yielded a total of 4,928 NIH grants whose combined funding exceeded $1.2 billion. The derived trend in NIH awards paralleled the annual expansion in “biomarker” literature. A PubMed search for the term, between 1990 and 2009, revealed a total of 441,510 published articles, with 38,457 published in 2008. These enormous investments and academic outputs however have not translated into the expected integration of new biomarkers for patient care. For example no proteomics derived biomarkers are currently being utilized in routine clinical management. This translational chasm necessitates a review of the previously proposed biomarker definitions and evaluation schema. A subsequent discussion of both the analytical and pre-analytical considerations for such research is also presented within. This required knowledge should aid scientists in their pursuit and validation of new biological markers of disease.

The vanishing physician-scientist?

The vanishing physician-scientist?

Defining the components of the research pipeline.

The National Institutes of Health (NIH) has proposed that research moves from "bench to bedside" through a Pipeline consisting of distinct research categories bridged by bidirectional translation. The original NIH Pipeline has now been expanded to include practice- and community-based research. We developed operational definitions for the elements along the expanded NIH Pipeline. The proposed definitions were pilot-tested and refined using the Computer Retrieval of Information on Scientific Projects (CRISP) and the Secure Internet-Linked Web Technologies (SILK) database containing funding information for individual NIH awards. Using our definitions, two reviewers independently agreed on the categorization of 94% of 866 National Heart, Lung, and Blood Institute (NHLBI)-funded projects, and 99% of projects could be placed into a single research category.

Identification of Methylated Loci in the Trypanosoma brucei Genome

Previous mass spectrometry and blotting experiments in our laboratory have shown that Trypanosoma brucei, the causative agent of African Sleeping Sickness, contains low levels of 5‐methylcytosine in its genomic DNA. In order to determine the location of 5‐methylcytosine in the genome, an immunoprecipitation strategy was utilized. T. brucei DNA was cut with DpnII, modified by linker addition, and immunoprecipitated with an antibody against 5‐methylcytosine. Immunoprecipitated DNAs were amplified by PCR, inserted into the pGEM‐T Easy plasmid, and analyzed by DNA sequencing. In total, greater than 100 clones have been analyzed representing DNA from the insect stage and bloodstream stage of the parasite. To date, all methylated loci are in the nuclear genome. Several loci were found in the immunoprecipitate multiple times, including variant surface glycoprotein genes and retrotransposon genes. Thus, DNA methylation may regulate expression of these genes. However, housekeeping genes were also found in the immunoprecipitate indicating that DNA methylation is not restricted to a single locus. To pinpoint the position of 5‐methylcytosine within specific genes, sodium bisulfite sequencing of retrotransposon genes was initiated. In total, our data demonstrate that 5‐methylcytosine is present in the nuclear genome and may be overrepresented in multi‐gene families and repeated sequences. This work is supported by National Institutes of Health award AI074035‐01 to K.T.M.

Advances and Challenges in Developing Research Capacity in Social Work

Significant improvements in research capacity have been realized in social work in the past two decades. Investments by federal entities such as the National Institutes of Health (NIH) and concentrated efforts by deans, directors, and faculty members have led to important advances in research infrastructure and capacity in many social work programs. These developments have contributed to historic improvements in the scope and quality of social work research. Despite recent accomplishments, however, considerable variation exists in infrastructure support and research capacity across social work programs. For example, whereas some schools and universities have developed impressive internal supports for faculty research, other programs have struggled to simply create the culture necessary to address deficiencies in research capacity. Demands for new knowledge about the etiology, prevention, and treatment of individual and social problems as well as growing interest in evidence-based policy and practice suggest that the time has come to evaluate recent advances and identify the persistent challenges associated with enhancing infrastructure support and research capacity in social work. ADVANCES IN RESEARCH CAPACITY Research and knowledge development activities vary considerably across the continuum of social work undergraduate and graduate education. On one hand, well-established graduate programs located in research-oriented universities generally value research and strongly encourage faculty members to pursue external funding. Conversely, many undergraduate and graduate social work programs recognize the importance of research but place greater emphasis on the teaching and practice missions associated with the profession. Regardless of where a program might fall in this continuum, most educators would agree that nearly all schools of social work have increased their attention to topics of research capacity. A variety of approaches have been used in the past two decades to increase infrastructure supports and research capacity in social work. For example, some schools have pursued an ambitious program of federal research sponsorship through entities such as NIH, the National Institute of Justice, the Department of Health and Human Services, and others. NIH has been particularly responsive to social work as evidenced by the creation and funding of eight social work research centers in the 1990s. In recent years, NIH has continued its commitment to the field by developing and disseminating a social work research agenda (NIH, 2003) and by issuing a call for proposals to investigate the effects of theoretically and empirically based social work practice on health outcomes for people experiencing medical and behavioral problems (NIH, 2005). Released in 2005, Research on Social Work Practice and Concepts in Health (PA-06-081) is important because it publicly acknowledges the contribution of social work practice to the enhancement and efficacy of interventions targeting health problems. Significantly, the language in the PA goes beyond the proposition that social work strategies are mere enhancements to existing medical services and interventions. The existence of a social work knowledge base that offers unique and significant clinical expertise to interdisciplinary intervention efforts with client groups across multiple systems of care is clearly recognized in this announcement. Advances in federally funded social work research are perhaps best measured by the number of NIH awards made to social work investigators. It is important to note that 621 grants have been awarded to social work researchers since 1993 (Corvo, Zlotnik, & Chen, 2008; Institute for the Advancement of SocialWork Research [IASWR], 2008). Awards have ranged from a low of 18 in 1993 to more than 60 funded grants in 1998. Reflecting current economic constraints at the federal level, only 24 grants were funded in 2007. …

Capacity for the Advancement of Nursing Science: Issues and Challenges

The purpose of this study was to determine whether nursing is meeting its espoused goals of scientific development of the discipline and preparation for academic careers. With a comparative cross-sectional design, data on research funding, faculty number and characteristics, and the published literature across nursing, public health, and medicine were analyzed. Significant differences were found among the groups in terms of the number of National Institutes of Health research grants and the amount of funding awarded, as well as the number of faculty. The number of faculty significantly predicted the number of National Institutes of Health awards for all disciplines (R(2) = .666, P < .000). Within nursing, the number of full-time doctoral faculty was also significant (R(2) = .531, P < .000). The conclusion reached was that the current system for doctoral education in nursing does not prepare the number of graduates necessary to either replace retiring faculty or expand capacity. The lack of nurses with doctoral degrees affects the discipline's ability to generate and use high-impact science. Among the strategies for improvement were leveraging existing research-intensive schools by augmenting doctoral faculty and expanding the capability of nurses to engage in clinical scholarship through the new clinical doctorate, the doctor of nursing practice.

Off the Roadmap? Family Medicine's Grant Funding and Committee Representation at NIH

Family medicine is challenged to develop its own research infrastructure and to inform and contribute to a national translational-research agenda. Toward these ends, understanding family medicine's engagement with the National Institutes of Health (NIH) is important. We descriptively analyzed NIH grants to family medicine from 2002 through 2006 and the current NIH advisory committee memberships. Grants (and dollars) awarded to departments of family medicine increased from 89 ($25.6 million) in 2002, to 154 ($44.6 million) in 2006. These values represented only 0.20% (0.15% for dollars) and 0.33% (0.22% for dollars), respectively, of total NIH awards. Nearly 75% of family medicine grants came from just 6 of NIH's grant-funding 24 institutes and centers. Although having disproportionately fewer grant continuations (62% vs 72%) and R awards (68% vs 74%)-particularly R01 awards (53% vs 84%)-relative to NIH grantees overall, family medicine earned proportionately more new (28% vs 21%) and K awards (25% vs 9%) and had more physician principal investigators (52% vs 15%). Ten of the nation's 132 departments of family medicine (7.6%) earned almost 50% of all family medicine awards. Representatives from family medicine were on 6.4% of NIH advisory committees (0.38% of all members); family physicians were on 2.7% (0.16% of members). Departments of family medicine, and family physicians in particular, receive a miniscule proportion of NIH grant funding and have correspondingly minimal representation on standing NIH advisory committees. Family medicine's engagement at the NIH remains near well-documented historic lows, undermining family medicine's potential for translating medical knowledge into community practice, and advancing knowledge to improve health care and health for the US population as a whole.

National Institutes of Health funding for cardiothoracic surgical research

Our objective was determine the status of National Institutes of Health (NIH) funding for cardiothoracic surgery research. (1) Funding from the NIH is critical if new procedures and devices are to be developed. (2) The success rate for NIH applications coming from cardiothoracic surgery faculty is thought to be inferior. (3) Per capita numbers of surgical NIH application and awards and application success rate have recently been found to be below the average for the NIH. Application and award data for full-time academic cardiothoracic surgeons were obtained by matching records in the NIH IMPAC II database with membership rosters of The Society of Thoracic Surgeons and The American Association for Thoracic Surgery. Manpower data were obtained from 1999, 2003, and 2005 reports of the STS/AATS Workforce committee. Society membership was used as a surrogate for investigator experience. The number of NIH applications has increased steeply in the past 7 years; however, the number of awards has remained constant. This pattern was observed for surgery and cardiothoracic surgery as well. Until 2003, the cardiothoracic surgery application success rate was actually higher than that of surgery and the NIH as a whole (between 25% and 40%). Since then, however, the cardiothoracic surgery application success rate has declined steeply and is now only 14%. NIH applications and awards per 100 cardiothoracic surgeons, although similar to those of surgery, are very much less than the NIH as a whole. Per capita NIH funding of cardiothoracic surgeons is very much less than that of the NIH as a whole. The primary cause is the low per capita number of applications submitted by cardiothoracic surgeons. Junior cardiothoracic faculty should be encouraged to apply for career development awards. However, since the ability to shift cost from clinical to academic faculty is declining, affirmative action from the NIH may be necessary.

National Institutes of Health Funding for Surgical Research

The objective was to compare National Institutes of Health (NIH) funding rates and application success rates among surgeon and nonsurgeon-scientists over the past 2 decades. Surgeons may be capable of accelerating the translation of basic research into new clinical therapies. Nevertheless, most surgeon-scientists believe they are at a disadvantage in competing for peer-reviewed funding, despite a recent emphasis on "translational science" by organizations such as the NIH. We accessed databases from the NIH and the American Association of Medical Colleges. Although total competing NIH awards rose 79.2% from 5608 to 10,052, the much smaller number of surgical awards increased only by 41.4% from 157 to 222. There was a small but statistically significant difference between total NIH and surgical application success rates (29% vs. 25%, P < 0.01). However, the persistently low percent of NIH funding going to surgical investigators was due primarily to the very small number of surgical applications, and to a much smaller increase in the absolute number of applications over time (464 vs. 23,847). As a result, the number of grants per 100 faculty members was more than 4 times higher among nonsurgical than surgical faculties at US medical schools. NIH funding to academic surgeons is declining relative to their nonsurgical colleagues. This trend will likely be reversed only by an increase in the number of grant applications submitted by surgeon-scientists. Structural changes in surgical training programs, and in the economics of academic surgery, may support a greater contribution of surgeon-scientists to the success of translational research.

Little Science, Big Science

To evaluate National Institutes of Health (NIH) funding for academic surgery departments and to determine whether optimal portfolio strategies exist to maximize this funding. The NIH budget is expected to be relatively stable in the foreseeable future, with a modest 0.7% increase from 2005 to 2006. Funding for basic and clinical science research in surgery is also not expected to increase. NIH funding award data for US surgery departments from 2002 to 2004 was collected using publicly available data abstracted from the NIH Information for Management, Planning, Analysis, and Coordination (IMPAC) II database. Additional information was collected from the Computer Retrieval of Information on Scientific Projects (CRISP) database regarding research area (basic vs. clinical, animal vs. human, classification of clinical and basic sciences). The primary outcome measures were total NIH award amount, number of awards, and type of grant. Statistical analysis was based on binomial proportional tests and multiple linear regression models. The smallest total NIH funding award in 2004 to an individual surgery department was a single $26,970 grant, whereas the largest was more than $35 million comprising 68 grants. From 2002 to 2004, one department experienced a 336% increase (greatest increase) in funding, whereas another experienced a 73% decrease (greatest decrease). No statistically significant differences were found between departments with decreasing or increasing funding and the subspecialty of basic science or clinical research funded. Departments (n = 5) experiencing the most drastic decrease (total dollars) in funding had a significantly higher proportion of type K (P = 0.03) grants compared with departments (n = 5) with the largest increases in total funding; the latter group had a significantly increased proportion of type U grants (P = 0.01). A linear association between amount of decrease/increase was found with the average amount of funding per grant and per investigator (P < 0.01), suggesting that departments that increased their total funding relied on investigators with large amounts of funding per grant. Although incentives to junior investigators and clinicians with secondary participation in research are important, our findings suggest that the best strategy for increasing NIH funding for surgery departments is to invest in individuals with focused research commitments and established track records of garnering large and multiple research grants.

Biomedical research funding: when the game gets tough, winners start to play

Extramural funding provides major support for biomedical research in academia, and National Institutes of Health (NIH) grants often constitute direct evaluation criteria for promotions and tenure. Therefore, NIH budget trends influence long-term scientific strategies and career decisions, as well as the progress of science itself. Our analysis of the last 37 years of NIH awards, however, reveals that the success rate of grant applications submitted for funding is negatively related to the total yearly amount of (inflation-adjusted) NIH extramural expenditure. Instead, as might be expected, the ratio between available funding and the number of submission directly predicts the probability of winning support in any given year. We purport that the considerable success rate variability can be parsimoniously explained by a proportional but delayed reaction of the number of applications to budget fluctuations. As a counterintuitive consequence, grant proposals conceived during lean periods might stand the best chance of success.