National Institutes Of Health Funding Research Articles

A Call to Action: A Specialty-Specific Course to Support the Next Generation of Clinician Scientists in Anesthesiology.

Clinical production pressure is a significant problem for faculty of anesthesiology departments who seek to remain involved in research. Lack of protected time to dedicate to research and insufficient external funding add to this long-standing issue. Recent trends in funding to the departments of anesthesiology and their academic output validate these concerns. A 2022 study examining National Institutes of Health (NIH) grant recipients associated with anesthesiology departments across 10 years (2011-2020) outlines total awarded funds at $1,676,482,440, with most of the funds awarded to only 10 departments in the United States. Of note, the total 1-year NIH funding in 2021 for academic internal medicine departments was 3 times higher than the 10-year funding of anesthesiology departments. Additionally, American Board of Anesthesiology (ABA) diplomats represent a minority (37%) of the anesthesiology researchers obtaining grant funding, with a small number of faculty members receiving a prevalence of monies. Overall, the number of publications per academic anesthesiologist across the United States remains modest as does the impact of the scholarly work. Improving environments in which academic anesthesiologists thrive may be paramount to successful academic productivity. In fact, adding to the lack of academic time is the limited bandwidth of senior academic physicians to mentor and support aspiring physician scientists. Given then the challenges for individual departments and notable successes of specialty-specific collaborative efforts (eg Foundation for Anesthesia Education and Research [FAER]), additional pooled-resource approaches may be necessary to successfully support and develop clinician scientists. It is in this spirit that the leadership of Anesthesia and Analgesia and the Journal of Education in Perioperative Medicine, unified with the Association of University Anesthesiologists, aim to sponsor the Introduction to Clinical Research for Academic Anesthesiologists (ICRAA) Course. Directed toward early career academic anesthesiologists who wish to gain competency specifically in the fundamentals of clinical research and receive mentorship to develop an investigative project, the yearlong course will provide participants with the skills necessary to design research initiatives, ethically direct research teams, successfully communicate ideas with data analysts, and write and submit scientific articles. Additionally, the course, articulated in a series of interactive lectures, mentored activities, and workshops, will teach participants to review articles submitted for publication to medical journals and to critically appraise evidence in published research. It is our hope that this initiative will be of interest to junior faculty of academic anesthesiology departments nationally and internationally.

The catch-22 of promotion: Is becoming department chair of surgery a threat to the triple threat?

BackgroundDespite the “fourth threat” of administrative demands, department chairs of surgery are expected to continue being a “triple threat”: productive in research, outstanding in teaching, and exemplary in practice. Increased demands despite limited time are the catch-22 of promotion. This study investigated the influence of becoming department chair on scholarly vigor. MethodsThe surgeons listed in the Society of Surgical Chairs Membership Directory website (n = 118) were included in this study. Three measures were compared during the pre- and post-promotion phases: (1) research productivity (annual publications); (2) authorship position in publications (first-authorship, co-authorship, and senior-authorship); and (3) scholarly impact (m-index and National Institute of Health funding). ResultsThe median [interquartile range] number of publications per year increased post-promotion versus pre-promotion (7.64 [3.81–14.15] vs 4.12 [2.08–7.03], P < .0005). The median [interquartile range] number of first-authorship publications per year decreased (0.50 [0.00–1.00] vs 0.64 [0.32–1.22], P < .05), whereas the median [interquartile range] number of co-authorship (4.23 [1.98–9.70] vs 2.02 [1.02–3.95], P < .0005) and senior-authorship (1.87 [0.99–4.03] vs 1.00 [0.36–2.24], P < .0005) publications per year increased post-promotion. The mean ± standard deviation m-index increased post-promotion (1.67 ± 1.19 vs 1.23 ± 0.83, P < .01). The mean ± standard deviation annual National Institute of Health grant funding amount of 48% (n = 57) of the department chairs increased post-promotion ($365,000 ± $899,000 vs $98,000 ± $143,000 pre-promotion, P < .05). ConclusionThe fourth threat of administrative demands is not a threat to the triple threat. This study showed the department chairs’ continued scholarly vigor after promotion, providing insight into their tenacity, resilience, and dedication.

Characteristics of clinical trials related to hip fractures and factors associated with completion

BackgroundThis study aimed at investigating the characteristics of clinical trials related to hip fractures that were registered at ClinicalTrials.gov. It also aimed to identify potential risk factors associated with completion.Main bodyWe obtained 733 clinical studies related to hip fractures from the ClinicalTrials.gov database and included 470 studies in the analysis. These clinical trials were divided into behavioral, drug/biological, device, procedure, and other categories based on intervention types. Clinical trials investigating drugs or biologics were categorized based on the specific agents administered in each trial. Multiple logistic and Cox regression models were used to test the ability of 24 potential risk factors in predicting recruitment status and completion time, respectively. Among the included clinical trials, 44.89% (211/470) had complete recruitment status. The overall median completion time was 931.00 days (95% confidence interval [CI]: 822.56–1039.44 days). The results of only 8.94% (42/470) of clinical trials were presented on the ClinicalTrials.gov website. Bupivacaine (a local anesthetic) was most commonly investigated (in 25 clinical trials); this was followed by ropivacaine (another local anesthetic, 23 clinical trials) and tranexamic acid (a hemostatic, 21 clinical trials). Multivariate analysis showed that trials including children (P = 0.03) and having National Institutes of Health funds (P < 0.01) had significantly higher rates of complete recruitment. Higher enrollment (P < 0.01), National Institutes of Health funding (P < 0.01), location in the United States (P = 0.04), and location in Europe (P = 0.03) predisposed to longer completion time, while studies involving drugs/biologics (P < 0.01) had shorter completion times.ConclusionsA considerable proportion of clinical trials related to hip fractures were completed, but the results of only a small fraction were presented on the ClinicalTrials.gov website. The commonly investigated drugs focused on anesthesia, pain relief, and hemostasis. Several independent risk factors that affect recruitment status and completion time were identified. These factors may guide the design of clinical trials relating to hip fractures.

U.S. Leading Causes of Death and Years of Potential Life Lost, 1981-2019: Implications for Surgical Research

IntroductionExamining burden of diseases could shed light on priorities of public health interventions and research funding. This study examined trends of the U.S. top leading causes of death from 1981 to 2019 using the total number of deaths, age-adjusted death rate, and years of potential life lost (YPLLs). MethodsData were from the Web-based Injury Statistics Query and Reporting System. This study gathered total number of deaths, age-adjusted death rates per 100,000 people, and YPLLs under 70 y of age (YPLL-70) from 1981 to 2019 for the top 10 leading causes of death and human immunodeficiency virus/acquired immunodeficiency syndrome (AIDS) for each year. The 39 y from 1981 to 2019 were evenly divided into three study periods: 1981-1993, 1994-2006, and 2007-2019. The percent change of YPLL-70 over three time periods for the top ten leading causes of death and AIDS was calculated. Trends of age-adjusted death rates and YPLL-70 of the top five leading causes of death based on the 2018-2019 death data were also reported by graphing them against time from 1981 to 2019 to highlight major mortality causes. Age-adjusted death rates for the top five leading causes of deaths and the National Institutes of Health (NIH) annual funding level in 2019 were graphed together to illustrate funding discrepancy in injury research and prevention. ResultsThe total number of deaths caused by malignant neoplasms in 2019 was 244,994, followed by 183,442 deaths of heart diseases, 121,476 deaths of unintentional injuries, and 41,051 suicide deaths. Despite an initial -22.20% drop of YPPL-70 during 1981-1993, unintentional injuries experienced significant increases of 19.38% and 18.59% of YPLL-70 in 1994-2006 and 2007-2019, respectively. The age-adjusted death rate for unintentional injuries was 1182 per 100,000 people in 2019, and the NIH funding in the same year was $897 million. In comparison, the age-adjusted death rate for cancer, heart disease, and human immunodeficiency virus/AIDS was 786, 649, and 30 per 100,000 people while the NIH funding was $2,560, $2,394, and $3037 million, respectively. ConclusionsUnintentional injuries, suicide, and homicide were consistently among the top leading causes of death and YPLL-70, so they should be prioritized in public health planning, research, and federal funding allocation. Injury and trauma research is severely underfunded by the U.S. premier funding agency.

Investigation of the Gender Distribution of National Institutes of Health Grants Across Six Surgical Specialties From 2015 to 2020: Toward Promoting Equity in Academic Surgery.

There is a paucity of literature evaluating research-funding differences between male and female surgeons. Our study aims to evaluate possible disparities in the National Institutes of Health (NIH) grant awards by surgeon gender, type of medical degree (MD/DO), and advanced degrees among six surgery specialties: general surgeons, neurosurgeons, urologists, obstetricians/gynecologists, plastic, and orthopedic surgeons, from 2015 to2020. A retrospective cohort study was performed investigating the number of NIH grants received by male and female surgeon-scientists overall and within each listed specialty, 2015-2020. As a surrogate for grants submitted, the proportion of active surgeon-scientists per specialty was used. A priori level of significance was defined as P<0.05. After adjusting for confounders, male surgeons had a higher mean number of NIH grants and higher grant funding than female surgeons (P<0.001 for both). Type of medical degree (MD/DO) was not significantly associated with NIH funding. An advanced degree was associated with NIH funding among neurosurgeons only (P<0.05). Differences in the proportion of active surgeon-scientists and proportion of NIH grants received by male and female surgeon-scientists were found only in the fields of orthopedic surgery (5.8% female surgeons and received 20.7% of grants, P=0.003) and plastic surgery (17.2% female surgeons and received 33.3% of grants, P=0.01). Male surgeons received most of the total surgical NIH grants. However, funding for female surgeons in orthopedic and plastic surgery outpaces that of their male counterparts when compared to gender proportions in their respective field. Future studies should further investigate the effects of additional applicant demographics on securing NIH grant funding.

Developing a Comprehensive Resident-driven Research Training Pathway: A Chief Resident's Perspective

Wide variation exists in research training, experience, opportunities, and exposure across various radiology residency training programs, ranging from having a dedicated research track to no exposure to hypothesis driven projects. Studies conducted at different residency training programs with varied resources and National Institutes of Health funding have shown that resident-driven research initiatives and mentorship programs have the potential to improve research experience during residency training, engage more medical students in research, increase departmental peer-reviewed publications and increase peer-reviewed publications of early-career faculty physicians. In an attempt to standardize the research training during radiology residency, we propose a standardized resident-led program which institutions may adapt, as well as resources that the American Alliance of Academic Chief Residents in Radiology (A3CR2) might compile in collaboration with other national organizations to improve trainee's research experience during their radiology residency training.

Promoting the Pipeline of Diverse Individuals Within Gastroenterology: Reflections From AGA FORWARD Program Scholars

Promoting the Pipeline of Diverse Individuals Within Gastroenterology: Reflections From AGA FORWARD Program Scholars

Analyzing the Scholarly Impact of Cardiothoracic Surgery Research Using the Relative Citation Ratio.

The National Institutes of Health (NIH) recently developed the relative citation ratio (RCR), calculated as article citations benchmarked to NIH-funded publications in the same field. Here, we characterized the scholarly impact of academic cardiothoracic (CT) surgeons and their research using the RCR. Using a database of 992 CT surgeons, we calculated the RCR for all articles published by each surgeon since 1980 using the NIH iCite database. All data were collected from publicly available online sources. Data are presented as median (interquartile range) or as odds ratios (ORs) for multivariable logistic regression analysis. Where RCR 1.00 indicates equal impact as an NIH-funded publication, the RCR among all 37,402 CT surgery articles was 0.84 (0.33-1.83) and the RCR among NIH-funded CT surgery articles was 1.07 (0.53-2.17). CT surgeons exhibited a career median RCR of 0.82 (0.54-1.13) and maximum RCR of 6.20 (3.04-13.57). Predictors of career median RCR >1.00 included female gender (OR 2.23, P=0.001), thoracic subspecialization (OR 2.50, P<0.001), full professor rank (OR 1.89, P=0.001), and NIH funding (OR 1.75, P=0.001). Predictors of career maximum RCR >50th percentile among CT surgeons included male gender (OR 1.87, P=0.030), thoracic subspecialization (OR 2.05, P<0.001), full professor rank (OR 4.89, P<0.001), NIH funding (OR 3.17, P<0.001), and career duration (OR 1.03, P=0.002). We present the first assessment of the NIH-validated RCR for academic CT surgery. CT surgery research is highly impactful, although gender disparities persist with respect to the highest-impact research of our specialty.

Impact of Orthopaedic Surgeons on National Institutes of Health Funding for Hip and Knee Arthroplasty Research.

The National Institutes of Health (NIH) remains one of the predominant sources of biomedical research funding in the United States, yet its impact on total hip and knee arthroplasty research is poorly understood. This study defines the portfolio of NIH funding for total joint arthroplasty (TJA) and the impact of orthopaedic surgeons on this portfolio. The Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) database was queried for NIH grants that had been awarded for total hip and knee arthroplasty and total NIH funding from 2010 to 2020. Compound annual growth rates (CAGRs) were calculated. Funding totals were compared with those from 20 other clinical areas. The principal investigators (PIs) and grants were characterized, and comparisons were made with use of the Student t test. A total of 489 grants were awarded, totaling $181 million (CAGR of 10.3%). This was >3 times the growth rate for the total NIH budget (CAGR of 2.9%), which increased from $31.2 to $41.7 billion over the 11-year period. When compared with 20 other clinical areas, TJA received the least amount of NIH funding over that period. Alzheimer disease received the most funding ($12.1 billion, CAGR of 19.5%), and cerebral palsy received the penultimate amount of funding ($284 million, CAGR of 6.3%). The R01 grant mechanism was the predominant source (63.1%), and the Mayo Clinic (Rochester, Minnesota) received the most funding (9.7%). Departments of orthopaedic surgery were awarded the most funding (23.5%), yet only 20 orthopaedic surgeons were identified as PIs (16.0%). There were no significant differences in NIH funding totals by PI demographic and academic characteristics (p > 0.05), yet orthopaedic surgeons had among the highest Hirsch indices (h-indices) (p < 0.001). Funding supported clinical (63.5%), translational (19.3%), basic science (7.1%), and other types (10.1%) of research. The top areas with funding were postoperative complications (44.4%), postoperative pain management (17.6%), rehabilitation (15.1%), and implant design (12.4%). There is a paucity of orthopaedic surgeon representation among NIH grants awarded for TJA. Opportunities may exist for orthopaedic surgeons to collaborate in identified areas of clinical interest. Additional research is needed to understand the obstacles to obtaining NIH grant funding for orthopaedic surgeon PIs. Increasing the levels of funding from the NIH is a strategic priority for departments of orthopaedic surgery. Understanding levels of funding for clinical areas in total joint arthroplasty is critical to foster research and discovery support from the NIH.

Exploring Match Space: How Medical School and Specialty Characteristics Affect Residency Match Geography in the United States

To explore how school and specialty characteristics impact the geographic match location of U.S. senior medical students. The authors collected student match data between 2018 and 2020 from U.S. MD-granting medical schools and calculated the distance between students' medical schools and residency training programs. They use the term "match space" to describe this distance. Match space was codified on a 5-point ordinal scale by where the student matched: 1 = home institution, 2 = home state, 3 = an adjacent state, 4 = the same or adjacent U.S. Census division (and not adjacent state), and 5 = skipped at least one U.S. Census division. Ordinal logistic regression correlated school and specialty characteristics with match space. During the study period, 26,102 medical students, representing 66 medical schools from 28 states, matched in 23 specialties. Fifty-nine percent of students were from public institutions, and 27% of schools ranked in the top 40 of National Institutes of Health (NIH) research funding. The match space was higher for students graduating from private institutions (odds ratio [OR] 1.14; 95% confidence interval [CI], 1.06 to 1.22) and matching into more competitive specialties (OR 1.07; 95% CI, 1 to 1.14). The match space was lower for students graduating from top NIH-funded institutions (OR 0.89; 95% CI, 0.85 to 0.94) and from schools with a higher percentage of in-state matriculants (OR 0.75; 95% CI, 0.72 to 0.77). School characteristics such as region, public/private designation, NIH funding, and percentage of in-state students were associated with residency match geography. Matching into more competitive specialties also showed a marginal increase in match distance. These findings suggest that a student's choice of specialty and medical school may impact subsequent geographic placement for residency training, which should be considered by students and residency programs alike.

Exploring static and dynamic relationships between burden of disease and research funding in the United States

BackgroundThe relationship between burden of disease and research funding has been examined cross-sectionally, but temporal patterns have not been investigated. It is logical to assume that temporal improvements in disability-adjusted life-years (DALYs) reflect benefits from research funding; such assumptions are tempered by an unknown lag time for emergence of benefits from research.MethodsWe studied National Institutes of Health (NIH) research fund allocations and United States DALY estimates for overlapping disease categories (matched disease categories, MDC, N = 38). Using a general linear model, we separately analysed DALYs for MDCs in 2017 in relation to NIH research allocations in 2017 and 2007. We also examined how changes in DALYs were related to cumulative NIH research funding (2006–2017). After regressing DALY change on summed funding, we obtained model residuals as estimates of the discrepancy for each MDC between observed and expected change in burden, given funding.ResultsIn 2017, there was a positive association between NIH research fund allocations and DALYs for the same year (F1,36 = 16.087, p = 0.0002921; slope = 0.35020; model R2 = 0.3088), suggesting proportionate allocation. There was a positive association between 2017 DALYs and 2007 NIH research allocation, implying a beneficial impact of research (F1,36 = 15.754, p = 0.0003; slope = 0.8845; model R2 = 0.3044). In contrast, there was a nonsignificant association between summed NIH funding and percent change in DALYs over 2006–2017 (F1,36 = 0.199; p = 0.65; beta coefficient = −1.144). When MDCs were ordered based on residuals, HIV/AIDS ranked first. Mental, neurologic or substance abuse (MNS) disorders comprised most residuals in the lower half.ConclusionsNIH fund allocation is proportional to DALYs for MDCs. Temporal changes in DALYs vary by MDCs, but they are not significantly related to cumulative research outlays. Further analysis of temporal changes in DALYs could help to inform research outlays for MDCs and to study the impact of research.

23. Effect of COVID-19 Restrictions on 2021 Integrated Plastic Surgery Match Outcomes

Background: Due to the Coronavirus Disease 2019 Pandemic (COVID-19), guidelines regarding both elimination of visiting subinternships and substitution of virtual interviews for the 2021 match were adapted. We hypothesize that these changes will result in an increase in home institution match rates compared to previous years. Methods: Program match data was obtained using information posted to residency program Instagram pages and the hashtag #PRSMatch2021. Medical school regions were categorized as West, Midwest, South, and Northeast and compared to match program region. Applicants who successfully matched from a medical school with an associated plastic surgery residency program or from a 2021 Top 40 US News and World Report Medical School Rankings for Research and National Institute of Health funding were recorded. Chi square was used to assess differences between groups. Results: A total of 181/187 (96.8%) integrated plastic surgery matched candidates were identified. Compared to historical controls, there was a statistically significant increase in the home match rate (24.3% vs 15.1%, p=.004) and statistically significant decrease in match rate for students without a home plastic surgery program (23.3% vs 30.5%, p=.004). Similar to prior years, applicants were more likely to match in their own region for all regions (p<.001); however, there was a statistical increase in students staying in the South region for residency compared to previous years (p=.007). The majority of applicants from Top 40 medical schools matched at Top 40 programs (62%, 62/100), compared to 21% of applicants graduating from other medical schools or international programs matching at Top 40 programs (17/81). Conclusion: The 2021 match cycle resulted in an increase in home program match rates, while decreasing match rates among students without a home plastic surgery program. COVID-19 polices may have resulted in disadvantages to students from diverse institutional backgrounds. Influences of virtual subinternships and virtual interviews should be further evaluated. Although short-term costs may be substantial to medical students, long-term benefits of resuming away subinternships and increasing diversity in plastic surgery trainees likely warrants safe resumption of in-person interactions when safely allowed.

Why language matters in alcohol research: Reducing stigma.

The use of pejorative or stigmatizing language to describe individuals with alcohol and drug use disorders adversely affects treatment seeking, quality of care, and treatment outcomes. In 2015, the International Society of Addiction Journal Editors released terminology guidelines that recommended against the use of words that contribute to stigma against individuals with an addictive disorder. This study examined the use of stigmatizing language in National Institutes of Health (NIH)-funded research and reviews published by the journal, Alcoholism: Clinical and Experimental Research (ACER) from 2010 to 2020, with the goal of sharing the results with the alcohol research community to enhance awareness. The search for stigmatizing language in ACER was limited to NIH-funded articles made publicly available on PubMed Central (PMC). Though ACER is not an open-access journal, original research and reviews directly funded by NIH are published to PMC for open access to the public as required by the conditions of NIH funding. ACER articles published on PMC were searched from 2010 to 2020 with specific queries for individual terms of interest including those considered pejorative ("alcoholic," "addict," and "abuser") and outdated ("alcohol dependent," "alcohol abuse," and "alcoholism"). The number of articles containing a term of interest for a given year was divided by the total number of articles published in that year to determine the percent use of each term per year. Our search of research and reviews (n=1903) published in ACER on PMC determined that although the use of pejorative and outdated terminology has decreased over time, there is continued use of the term "alcoholic" over the last decade. Specifically, in 2020, over 40% of articles searched for in PMC still included "alcoholic." The results of a separate manual search (n=110) on the Wiley Online Database showed that approximately 30% of articles used the term "alcoholic" in a stigmatizing manner. Stigmatizing language can perpetuate negative biases against people with alcohol use disorder. We encourage researchers to shift away from language that maintains discriminatory conceptions of alcohol use disorder. Reducing stigma has the potential to increase rates of treatment seeking and improve treatment outcomes for individuals with alcohol use disorder.

Growing the next generation of trauma surgeon-scientists: Reflections on 20 years of research investment.

The Eastern Association for the Surgery of Trauma mission includes fostering research and providing career development opportunities. Eastern Association for the Surgery of Trauma has awarded for 20 years a research scholarship to a promising young investigator. The research mentorship efforts were expanded 5 years ago with the INVEST-C Hack-a-thon. INVEST-C provides an intensive, short-term engagement to propel junior faculty toward establishing research independence. This study investigates the impact of these programs on academic productivity. Pubmed records, National Institutes of Health (NIH) Reporter data, and SCOPUS h-index were acquired for all scholarship (SCH) awardees from 2002 to 2021 (n = 20) and all INVEST-C (INV) participants (2017-2020, n = 19). Current type of practice, total number of funding awards, and timing of first award were ascertained. INVEST-C participants were also surveyed on an annual basis to track their progress. Medians (interquartile range [IQR]) are reported and compared (analysis of variance). Median publications (PUBs) of SCH awardees were 56 (IQR, 33-88), h-index was 16 (IQR, 12-21), and 25% of awardees have ≥1 NIH grant since their SCH. Among the last 10 awardees with a minimum of 2 years from SCH, 40% have received an NIH award compared with a mean NIH funding rate of 18.5% over the same period. For those remaining in academics (90% SCH), PUBs were higher for those >5 years (66 [IQR, 51-115]) versus <5 years from their SCH (33 [22-59]; p = 0.05), but there was no difference in h-index (16 [IQR, 14-25] vs. 15 [9-19], p = NS). Comparing the most recent 5 years of SCH to INV group, there was no difference in academic productivity as measured by total PUBs (SCH, 33 [IQR, 22-59] vs. INV, 34 [IQR, 18-44]; p = 0.7) or h-index (INV, 9 [IQR, 5-14]; p = 0.1). However, no attendee held research funding before INV, but 31.6% (6 of 19 attendees) have subsequently acquired ≥1 funding award (11 non-NIH, 1 NIH) in the short interval since participation. Investments in research activities have translated to significant extramural funding. Those in the last 5 years have been particularly fruitful with INV participants already achieving equal median academic productivity to SCH recipients. Prognostic and Epidemiologic; Level III.

Factors Associated With Endowed Chair Allocation in Medical Oncology in the United States.

To explore persisting gender disparities across leadership roles in medicine, we examined factors associated with holding endowed chairs in US oncology divisions. In 2019, we identified 95 academic oncology divisions, using the Oncology Division Chiefs and Department Chairs listing in the American Society of Clinical Oncology myConnection forum. We collected public information on gender, degree, total National Institutes of Health funding as principal investigator, H-indices, publication and citation numbers, and graduation year and constructed a multivariable logistic regression model. All statistical tests were 2-sided. We identified 1087 oncology full professors. Of these, 287 (26.4%) held endowed chairs: 60 of 269 women (22.3%) vs 227 of 818 men (27.8%) (P = .08). On multivariable analysis, greater research productivity and National Institutes of Health funding were associated with having an endowed chair (P < .001), whereas gender was not (P = .45). Though sample size was limited, if gender differences are in fact smaller in certain subspecialties than other fields of internal medicine, insights might emerge to guide efforts to promote equity.

Presentation to Publication: Analysis of Departmental Research Funding and Trainee Research Productivity [A61

INTRODUCTION: Conducting research is critical to the development of physician scientists; the authors’ obstetrics and gynecology department requires each resident to conduct an original research project that is then presented during an annual trainee Research Day (RD). A department research fund (DRF) was implemented in 2008 and a formal research curriculum subsequently implemented in effort to foster trainee academic success. This analysis explores associations between trainee DRF funding, peer-reviewed publication, and future National Institutes of Health (NIH) funding at a single academic institution over a 32-year period. METHODS: RD project titles and funding status were compiled from a single academic obstetrics and gynecology department from 1989-2020. Significant milestones were the DRF (2008) and implementation of a formal research curriculum (2017). Outcomes were peer-reviewed publication of the RD project within 5 years of RD presentation and subsequent NIH funding of the trainee. Chi-squared tests were used to investigate these relationships. RESULTS: Among 361 obstetrics and gynecology trainee (238 resident and 123 fellow) research projects presented at RD between 1989-2020, 169/361(46.8%) were peer-review published. Any funding of an RD project was associated with increased publication rate across the study period (85.9% versus 32%; P&lt;.01). DRF-funded projects were also more likely to be published within 5 years (78.6% versus 57.7%; P=.03). DRF recipients were more likely to garner future NIH funding than non-recipients (37.9% versus 6.5%; P&lt;.001). CONCLUSION: Trainee receipt of DRF funding is associated with both future NIH funding and trainee research publication. Program leaders may consider a formal research curriculum and a DRF to enhance the trainee research experience.

IL-18R signaling impairs hematopoietic recovery after severe, shock-like infection

Abstract Severe infection dramatically alters blood production, but the mechanisms impacting hematopoietic stem and progenitor cell (HSC/HSPC) recovery have not been carefully investigated. Using Ixodes ovatus Ehrlichia (IOE), a pathogen that causes severe shock-like illness and bone marrow (BM) aplasia, we explored the kinetics and mechanisms of hematopoietic recovery. Doxycycline treatment is necessary to prevent IOE-induced death and control bacterial burden in mice, but is not sufficient to prevent HSC/HSPC loss. During recovery from acute infection (12dpi) we saw increased cellularity of LT-HSCs and MPPs, accompanied by diminished function measured by decreased colony forming units (CFUs) in methocult assays. Reduced CFUs indicate a deficiency in BM myelopoietic function during recovery phase post- IOE. We previously showed that IL-18R-deficient mice exhibited improved CFUs at 12dpi, suggesting IL-18R signaling is detrimental to recovery from shock-like IOE. Utilizing a mixed BM chimeric mouse model (50:50 WT:IL-18R−/−), we observed that during recovery at 15dpi, IL-18R−/− cellularity predominates the LT-HSC and MPP2 populations, demonstrating an intrinsic role for IL-18R in limiting recovery of these populations. Additionally, BM chimeras at 15dpi showed increased levels of cell death (Annexin V+ and 7AAD+) in WT HSCs compared with IL-18R−/− HSCs. Transplantation of whole BM from mixed BM chimeric mice revealed a pronounced bias for IL-18R−/− cells, indicating that IL-18R−/− cells had a competitive advantage and improved function after IOE infection. Together, these data support the conclusion that IL-18R signaling impairs HSC function during recovery from severe, shock-like infection via decreased HSC viability. This work was supported by National Institutes of Health funding from NIGMS (R35GM131842) to KCM.

The ripple effects of funding on researchers and output.

Using unique, new, matched UMETRICS data on people employed on research projects and Author-ity data on biomedical publications, this paper shows that National Institutes of Health funding stimulates research by supporting the teams that conduct it. While faculty—both principal investigators (PIs) and other faculty—and their productivity are heavily affected by funding, so are trainees and staff. The largest effects of funding on research output are ripple effects on publications that do not include PIs. While funders focus on research output from projects, they would be well advised to consider how funding ripples through the wide range of people, including trainees and staff, employed on projects.

Updated ME/CFS prevalence estimates reflecting post-COVID increases and associated economic costs and funding implications

ABSTRACT In this article, we update our earlier analyses of myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS) economic impact and its National Institutes of Health (NIH) funding versus disease burden, taking into account the anticipated new cases of ME/CFS resulting from COVID-19. Prior to the COVID pandemic, we estimated a United States ME/CFS prevalence of 1.5 million and an annual economic impact of $36–51 billion. Now, due to COVID and its resulting post-acute sequalae, we estimate total ME/CFS prevalence could rise to between five and nine million. This would incur an annual U.S. economic impact of $149 to $362 billion in medical expenses and lost income, exclusive of other costs, such as disability benefits, social services, and lost wages of caretakers. NIH funding for ME/CFS research would need to expand from the current amount of $15 million per year to approximately $472–$600 million annually, up to a 40-fold increase, to be commensurate with that of similarly burdensome diseases.

Characteristics of International Medical Graduates in Academic Plastic Surgery.

International medical graduates play a significant role in meeting U.S. health care needs, and contribute to a more diverse provider workforce. This study aimed to determine the prevalence, characteristics, and academic productivity of plastic surgery international medical graduate faculty. A cross-sectional study was conducted to compare characteristics of international medical graduates against domestic medical graduates including demographics, trainings, academic ranks, leadership positions, number of publications and citations, and Hirsch index. International medical graduates represent 10.3 percent of all 918 academic plastic surgeons in the United States, with the majority having graduated from India (16.8 percent), Brazil (8.4 percent), and the United Kingdom (8.4 percent). International medical graduates were more likely to have graduated from independent programs (OR, 5.7; p < 0.0001) and to have completed research fellowship (OR, 2.1; p = 0.0001) and burn fellowship (OR, 6.5; p < 0.0001). Programs led by international medical graduate chairs employed more international medical graduate faculty (21 percent versus 9 percent; p < 0.0001). International medical graduates had comparable Hirsch indices, number of publications, and citations, but received less National Institutes of Health funding ($32,020 versus $223,365). International medical graduates also had comparable rates of attaining leadership positions such as fellowship director and chair but required fewer years of experience to become residency director (8.3 years versus 17.3 years). The contribution of international medical graduates in academic plastic surgery was evident based on research productivity, academic ranks, and leadership positions. International medical graduates are more likely to be employed in programs led by international medical graduate chairs. This study may help guide aspiring international medical graduate academics and aid in hiring decisions at academic institutions.