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BACKGROUND: The surgeon-scientist brings a unique perspective to surgical research. The Association of Academic Surgeons and Society of University Surgeons foster the development of surgeon-scientists through foundation awards to residents and junior faculty. We sought to evaluate the academic success of surgeons who received an Association for Academic Surgery/Society of University Surgeons award. METHODS: Information was collected for individuals who received a resident or junior faculty research award from the Association for Academic Surgery or Society of University Surgeons. Google Scholar, Scopus, and the National Institutes of Health Research Portfolio Online Reporting Tools: Expenditures and Results were used to assess scholarly achievements. RESULTS: Eighty-two resident awardees were included, 31 (38%) of whom were female. Thirteen (24%) are now professors, 12 (22%) are division chiefs, and 4 (7%) are department chairs. Resident awardees have a median of 886 citations (interquartile range 237-2,111) and an H-index of 14 (interquartile range 7-23). Seven (13%) went on to receive K08/K23 awards, and 7 (13%) received R01s, with a total of about $200 million in National Institutes of Health funding (79-fold return on investment). Thirty-four junior faculty awardees were included, 10 (29%) of whom were female. Thirteen (38%) are now professors, 12 (35%) are division chiefs, and 7 (21%) are department chairs. Faculty awardees have a median of 2,617 citations (interquartile range 1,343-7,857) and an H-index of 25 (interquartile range 18-49). Four (12%) received K08 or K23 awards, and 10 (29%) received R01s, with about $139 million in National Institutes of Health funding (98-fold return on investment). CONCLUSION: Association for Academic Surgery/Society of University Surgeons research awardees experience high degrees of success in academic surgery. Most resident awardees pursue fellowship training and remain in academic surgery. A high percentage of both faculty

BACKGROUND: Increasing medical school faculty diversity is an urgent priority. National Institutes of Health (NIH) diversity supplements, which provide funding and career development opportunities to individuals underrepresented in research, are an important mechanism to increase faculty diversity. OBJECTIVE: Analyze diversity supplement utilization by medical schools. DESIGN: Retrospective cohort study. PARTICIPANTS: All R01 grant-associated diversity supplements awarded to medical schools from 2005 to 2020. Diversity supplements were identified using the publicly available NIH RePORTER database. MAIN MEASURES: Main measures were the number of R01-associated diversity supplements awarded to medical schools each year by medical school NIH funding status and the number of R01-associated diversity supplements awarded to individual medical schools in the NIH top 40 by funding status. We also examined the percentage of R01 grants with an associated diversity supplement by NIH funding status and individual medical school in the NIH top 40. KEY RESULTS: From 2005 to 2020, US medical school faculty received 1389 R01-associated diversity supplements. The number of diversity supplements awarded grew from 2012 to 2020, from ten to 187 for top 40 schools, and from seven to 83 for non-top 40 schools. The annual growth rate for diversity supplement awards at NIH top 40 schools (44.2%) was not significantly different than the annual growth rate among non-top 40 schools (36.2%; p = 0.68). From 2005 to 2020, the highest number of diversity supplements that an individual medical school received was 56 and the lowest number was four (mean = 24.6, SD = 11.7). The highest percentage of R01 grants with an associated diversity supplement received by a school was 4.5% and the lowest percentage was 0.79% (mean = 2.3%, SD = 0.98). CONCLUSION: Medical schools may be missing an opportunity to address the continuing shortage of individuals historically underrepresented in biomedical scien

BackgroundLong-term follow-up for clinician-scientist training programs is sparse. We describe the outcomes of clinician-scientist scholars in the National Heart Lung and Blood Institute (NHLBI) K12 program in emergency care research up to 8.7 years after matriculation in the program.MethodsThis was a cohort study of faculty clinician-scientist scholars enrolled in a NHLBI K12 research training program at 6 sites across the US, with median follow-up 7.7 years (range 5.7-8.7 years) from the date of matriculation. Scholars completed electronic surveys in 2017 and 2019, with the 2019 survey collecting information for their current work setting, percent time for research, and grant funding from all sources. We used NIH RePorter and online resources to verify federal grants through March 2021. The primary outcome was a funded career development award (CDA) or research project grant (RPG) where the scholar was principal investigator. We included funding from all federal sources and national foundations.ResultsThere were 43 scholars, including 16 (37%) women. Over the follow-up period, 32 (74%) received an individual CDA or RPG, with a median of 36 months (range 9-83 months) after entering the program. Of the 43 scholars, 23 (54%) received a CDA and 22 (51%) received an RPG, 7 (16%) of which were R01s. Of the 23 scholars who received a CDA, 13 (56%) subsequently had an RPG funded. Time to CDA or RPG did not differ by sex (women vs. men log-rank test p = 0.27) or specialty training (emergency medicine versus other specialties, p = 0.59).ConclusionsAfter 7 years of follow-up for this NHLBI K12 emergency care research training program, three quarters of clinician-scientist scholars had obtained CDA or RPG funding, with no notable differences by sex or clinical training.

The lack of racial diversity among the winners of United States biomedical research prizes reflects a chronic problem of the underappreciation of certain groups of biomedical scientists. Asians continue to be severely underrepresented as awardees of United States biomedical research prizes, a trend that shows no obvious recent improvement.

The lack of racial diversity among the winners of United States biomedical research prizes reflects a chronic problem of the underappreciation of certain groups of biomedical scientists. Asians continue to be severely underrepresented as awardees of United States biomedical research prizes, a trend that shows no obvious recent improvement.

Objectives/hypothesisTo better understand the obstacles facing residents and K-awardee faculty in choosing a clinician-scientist career in otolaryngology.Study designAnonymous survey.MethodsAn anonymous, online Qualtrics survey was sent to residents participating in T32 training grants and K-awardee junior faculty. The survey was sent to the residents with the permission of their program chair. The results of this survey were compiled and analyzed. A separate survey was sent to current K-awardees in U.S. academic programs. Both surveys were then compared to a survey published in 2008 to determine if the concerns and obstacles faced by aspiring clinician-scientists are still present.ResultsResidents felt that combining a research and clinical career presented many obstacles, including a lower salary, competition with PhDs for grant funding, and the lack of departmental support. Prolonging their training to include a fellowship was not a deterrent. Family/spousal issues which ranked as the primary concern previously were no longer given the same level of importance. The major concerns of K-awardees were the economic disparity of clinician-scientists with their clinical counterparts, the lack of mentors, and department support. Forty percent received their K-award after first try, 100% after two revisions, and one has received an R grant funding.ConclusionsThe obstacles facing clinician-scientists in otolaryngology are highlighted by this survey and require attention by our academic programs, National Institutes of Health, and specialty societies.Level of evidenceNA Laryngoscope, 132:1555-1560, 2022.

Study designRetrospective hospital-registry study.ObjectiveTo characterize the microbial epidemiology of surgical site infection (SSI) in spinal fusion surgery and the burden of resistance to standard surgical antibiotic prophylaxis.Summary of background dataSSI persists as a leading complication of spinal fusion surgery despite the growth of enhanced recovery programs and improvements in other measures of surgical quality. Improved understandings of SSI microbiology and common mechanisms of failure for current prevention strategies are required to inform the development of novel approaches to prevention relevant to modern surgical practice.MethodsSpinal fusion cases performed at a single referral center between January 2011 and June 2019 were reviewed and SSI cases meeting National Healthcare Safety Network criteria were identified. Using microbiologic and procedural data from each case, we analyzed the anatomic distribution of pathogens, their differential time to presentation, and correlation with methicillin-resistant Staphylococcus aureus screening results. Susceptibility of isolates cultured from each infection were compared with the spectrum of surgical antibiotic prophylaxis administered during the index procedure on a per-case basis. Susceptibility to alternate prophylactic agents was also modeled.ResultsAmong 6727 cases, 351 infections occurred within 90 days. An anatomic gradient in the microbiology of SSI was observed across the length of the back, transitioning from cutaneous (gram-positive) flora in the cervical spine to enteric (gram-negative/anaerobic) flora in the lumbosacral region (correlation coefficient 0.94, P < 0.001). The majority (57.5%) of infections were resistant to the prophylaxis administered during the procedure. Cephalosporin-resistant gram-negative infection was common at lumbosacral levels and undetected methicillin-resistance was common at cervical levels.ConclusionIndividualized infection prevention strategies tailored to opera

PurposeNational Institutes of Health career development (K) awards mandate specific allocations of effort to research and training. The authors sought to understand pressures perceived by award recipients to change or misrepresent effort, and whether these perceptions differed by gender.MethodIn 2010-2011 and 2014, the authors surveyed K08 and K23 award recipients. Questions evaluated perceived pressure to change or misrepresent time allocation. Multivariable logistic regression modeling of pressure to misrepresent effort evaluated associations with individual and basic job characteristics.ResultsOf the 1,719 faculty in the initial target population, 493 women and 573 men (1,066, 62%) responded at both time points. Most respondents reported feeling pressure to increase time spent on professional activities other than their K award-related research or career development or to decrease time on their K award-related research. The likelihood of perceiving pressure differed significantly by gender: 68% of women vs 55% of men (P < .001). A minority reported perceiving pressure to misrepresent professional time (women, 29%, vs men, 27%, P = .52). Multivariable analysis revealed that pressure to misrepresent professional time was less likely among respondents at institutions with the most extramural funding (P = .02). A significant pairwise interaction between gender and K award type suggested that female K08 awardees had higher odds than male peers of perceiving pressure to misrepresent time.ConclusionsMost K award recipients reported feeling pressure to do more non-K award-related activities. More than a quarter reported feeling pressure to misrepresent effort. Additional research is needed to evaluate the proportion of academic medical faculty who actually misrepresent professional effort.

Introduction: Leaflet thrombosis (LT) following transcatheter aortic valve replacement (TAVR) is a recognised condition. The association between prosthesis geometry [expansion, implant depth and commissural alignment (CA)] and LT is unclear. Method(s): Patients with intra-annular TAVR prosthesis and post-procedure computed tomography (CT) with a 320-slice scanner were included. LT, defined as at least 50% restricted leaflet motion, was assessed with a 3Mensio workstation by 2 experienced CT readers. Prosthesis expansion was defined as actual divided by expected prosthesis area as a percentage of expected area whilst eccentricity was [(maximum diameter- minimum diameter)/maximum diameter) x100%], both measured at prosthesis inflow, annulus and outflow. Implant depth was the average distance between prosthesis inflow and nadir of each cusp. CA was the average angle between each native and prosthesis leaflet coaptations. Significant commissural misalignment (CMA) was defined as CA greater than 30degree. To exclude anticoagulation bias, similar analysis was also performed in the cohort of non-anticoagulated patients. Result(s): 117 patients were included; the prevalence of LT was 13.7% [13/93 cases (14.0%) of Lotus valves and 3/24 cases (12.5%) of Sapien 3 valves]. Baseline demographics (age, STS score, cardiac risk factors) and procedural characteristics (access site, post-dilation) were similar in both groups. None of the patients with LT were discharged on anticoagulation therapy (0.0% vs 22.8%, p<0.01). There were no differences in actual prosthesis area, perimeter or eccentricity at the three prosthesis levels. Patients with LT had reduced annulus expansion (89.3+/-9.8% vs 94.6+/-8.3%, p=0.02), lower implant depth (6.9+/-1.5mm vs 4.9+/-1.5mm, p<0.01) and more significant CMA (81.3% vs 48.5%, p=0.02). These findings were similar in patients that were not anticoagulated (94/117 patients). Conclusion(s): Patients with LT had reduced annulus expansion, lower implant de

The International Society of Nephrology (ISN) established the Young Nephrologists Committee (YNC) in 2007 to increase the awareness of the ISN mission and activities among younger nephrologists and thus increase their involvement. One of the primary aims of the YNC is to empower young nephrologists from developing countries by providing education and mentoring support. This is being achieved by establishing ISN YN workshops in the developing world for junior medical staff and nephrology trainees, with local younger nephrologists supervising the workshops. Mentoring is important for young nephrologists, and the ISN YNC have established a mentoring program through the ISN where mentors and the mentored are matched, and also meet-the professor sessions at ISN Nexus conferences. Research is being encouraged by establishing the World Congress of Nephrology Young Nephrology awards in basic and clinical science from the developing and developed world, allowing young nephrologists the opportunity to attend the WCN and present their work in plenary sessions. Another important focus of the ISN YNC has been to raise the awareness of ISN activities and their relevance to young nephrologists in the developing world. In conclusion, the ISN YNC is hoping to empower young nephrologists from developing countries and this will improve the prevention, diagnosis, and treatment of kidney disease worldwide.Copyright © 2013 International Society of Nephrology

The International Society of Nephrology (ISN) established the Young Nephrologists Committee (YNC) in 2007 to increase the awareness of the ISN mission and activities among younger nephrologists and thus increase their involvement. One of the primary aims of the YNC is to empower young nephrologists from developing countries by providing education and mentoring support. This is being achieved by establishing ISN YN workshops in the developing world for junior medical staff and nephrology trainees, with local younger nephrologists supervising the workshops. Mentoring is important for young nephrologists, and the ISN YNC have established a mentoring program through the ISN where mentors and the mentored are matched, and also meet-the professor sessions at ISN Nexus conferences. Research is being encouraged by establishing the World Congress of Nephrology Young Nephrology awards in basic and clinical science from the developing and developed world, allowing young nephrologists the opportunity to attend the WCN and present their work in plenary sessions. Another important focus of the ISN YNC has been to raise the awareness of ISN activities and their relevance to young nephrologists in the developing world. In conclusion, the ISN YNC is hoping to empower young nephrologists from developing countries and this will improve the prevention, diagnosis, and treatment of kidney disease worldwide.Copyright © 2013 International Society of Nephrology

Introduction: Leaflet thrombosis (LT) following transcatheter aortic valve replacement (TAVR) is a recognised condition. The association between prosthesis geometry [expansion, implant depth and commissural alignment (CA)] and LT is unclear. Method(s): Patients with intra-annular TAVR prosthesis and post-procedure computed tomography (CT) with a 320-slice scanner were included. LT, defined as at least 50% restricted leaflet motion, was assessed with a 3Mensio workstation by 2 experienced CT readers. Prosthesis expansion was defined as actual divided by expected prosthesis area as a percentage of expected area whilst eccentricity was [(maximum diameter- minimum diameter)/maximum diameter) x100%], both measured at prosthesis inflow, annulus and outflow. Implant depth was the average distance between prosthesis inflow and nadir of each cusp. CA was the average angle between each native and prosthesis leaflet coaptations. Significant commissural misalignment (CMA) was defined as CA greater than 30degree. To exclude anticoagulation bias, similar analysis was also performed in the cohort of non-anticoagulated patients. Result(s): 117 patients were included; the prevalence of LT was 13.7% [13/93 cases (14.0%) of Lotus valves and 3/24 cases (12.5%) of Sapien 3 valves]. Baseline demographics (age, STS score, cardiac risk factors) and procedural characteristics (access site, post-dilation) were similar in both groups. None of the patients with LT were discharged on anticoagulation therapy (0.0% vs 22.8%, p<0.01). There were no differences in actual prosthesis area, perimeter or eccentricity at the three prosthesis levels. Patients with LT had reduced annulus expansion (89.3+/-9.8% vs 94.6+/-8.3%, p=0.02), lower implant depth (6.9+/-1.5mm vs 4.9+/-1.5mm, p<0.01) and more significant CMA (81.3% vs 48.5%, p=0.02). These findings were similar in patients that were not anticoagulated (94/117 patients). Conclusion(s): Patients with LT had reduced annulus expansion, lower implant de

Pioneering research from Mina Bissell established the "Dynamic-Reciprocity" view of biology in which there is a bidirectional interaction between cells and their microenvironment. Her revolutionary work showed that extracellular matrix signaling and microenvironment impact gene expression, taking cancer research beyond genetics. For these contributions, she is the recipient of the 2020 Canada Gairdner International Award. Growing up in a well-educated family in Iran, Mina liked to ask many "why" questions. She spoke with Cell editor Miao-Chih Tsai about how she tackles scientific questions and life challenges. Excerpts from this conversation are presented below, and the full conversation is available with the article online.

PurposeNational Institutes of Health career development (K) awards mandate specific allocations of effort to research and training. The authors sought to understand pressures perceived by award recipients to change or misrepresent effort, and whether these perceptions differed by gender.MethodIn 2010-2011 and 2014, the authors surveyed K08 and K23 award recipients. Questions evaluated perceived pressure to change or misrepresent time allocation. Multivariable logistic regression modeling of pressure to misrepresent effort evaluated associations with individual and basic job characteristics.ResultsOf the 1,719 faculty in the initial target population, 493 women and 573 men (1,066, 62%) responded at both time points. Most respondents reported feeling pressure to increase time spent on professional activities other than their K award-related research or career development or to decrease time on their K award-related research. The likelihood of perceiving pressure differed significantly by gender: 68% of women vs 55% of men (P < .001). A minority reported perceiving pressure to misrepresent professional time (women, 29%, vs men, 27%, P = .52). Multivariable analysis revealed that pressure to misrepresent professional time was less likely among respondents at institutions with the most extramural funding (P = .02). A significant pairwise interaction between gender and K award type suggested that female K08 awardees had higher odds than male peers of perceiving pressure to misrepresent time.ConclusionsMost K award recipients reported feeling pressure to do more non-K award-related activities. More than a quarter reported feeling pressure to misrepresent effort. Additional research is needed to evaluate the proportion of academic medical faculty who actually misrepresent professional effort.

Diversity-focused committees continue to play essential roles in the efforts of professional scientific societies to foster inclusion and facilitate the professional development of underrepresented minority (URM) young scientists in their respective scientific disciplines. Until recently, the efforts of these committees have remained independent and disconnected from one another. Funding from the National Science Foundation has allowed several of these committees to come together and form the Alliance to Catalyze Change for Equity in STEM Success, herein referred to as ACCESS. The overall goal of this meta-organization is to create a community in which diversity-focused committees can interact, synergize, share their collective experiences, and have a unified voice on behalf of URM trainees in science, technology, engineering, and mathematics disciplines. In this Essay, we compare and contrast the broad approaches that scientific societies in ACCESS use to implement and assess their travel award programs for URM trainees. We also report a set of recommendations, including both short- and long-term outcomes assessment in populations of interest and specialized programmatic activities coupled to travel award programs.

PURPOSE: National Institutes of Health career development (K) awards mandate specific allocations of effort to research and training. The authors sought to understand pressures perceived by award recipients to change or misrepresent effort, and whether these perceptions differed by gender. METHOD: In 2010-2011 and 2014, the authors surveyed K08 and K23 award recipients. Questions evaluated perceived pressure to change or misrepresent time allocation. Multivariable logistic regression modeling of pressure to misrepresent effort evaluated associations with individual and basic job characteristics. RESULTS: Of the 1,719 faculty in the initial target population, 493 women and 573 men (1,066, 62%) responded at both time points. Most respondents reported feeling pressure to increase time spent on professional activities other than their K award-related research or career development or to decrease time on their K award-related research. The likelihood of perceiving pressure differed significantly by gender: 68% of women vs 55% of men (P < .001). A minority reported perceiving pressure to misrepresent professional time (women, 29%, vs men, 27%, P = .52). Multivariable analysis revealed that pressure to misrepresent professional time was less likely among respondents at institutions with the most extramural funding (P = .02). A significant pairwise interaction between gender and K award type suggested that female K08 awardees had higher odds than male peers of perceiving pressure to misrepresent time. CONCLUSIONS: Most K award recipients reported feeling pressure to do more non-K award-related activities. More than a quarter reported feeling pressure to misrepresent effort. Additional research is needed to evaluate the proportion of academic medical faculty who actually misrepresent professional effort.

I am deeply humbled and honored to receive the American Society for Cell Biology (ASCB) Prize for Excellence in Inclusivity. Thank you to the ASCB for recognizing the contributions of faculty to inclusion and diversity in STEM and the importance of this for the advancement of science. Thank you to the Howard Hughes Medical Institute (HHMI) for your generous support of inclusivity. The prize money will be used to fund outreach activities aimed at increasing inclusion in science and to create research opportunities for students from underrepresented groups in the sciences. In this essay, I share bits of my life's story that I hope will resonate with a broad audience, especially students from underrepresented groups in STEM, and that drive my passion for inclusion and diversity. I provide points of consideration for students to enhance their preparation for science careers and for faculty to improve the current landscape of inclusion and diversity in STEM.

BackgroundIn 1976, the U.S. Sugar Association (SA), a globally networked trade organization representing the cane and beet sugar industry, won the Public Relations Society of America's (PRSA) Silver Anvil Award for a crisis communication campaign. Their campaign successfully limited the diffusion of sugar restriction policies to control obesity, heart disease, diabetes, and dental caries, and marked the beginning of the modern-day SA. The sugar industry continues to resist measures to reduce sugar consumption, therefore understanding and addressing industry opposition is crucial to achieving global targets to reduce non-communicable disease.MethodsWe critically analyze common crisis management rhetorical strategies used by SA to defend itself from perceived wrongdoing, and sugar from perceptions of harm using a thematic content analysis based on Hearit's Corporate Apologia theory. Data sources were internal SA documents related to the 1976 Silver Anvil Award in 1) PRSA records, 2) Great Western Sugar Company records, and 3) William Jefferson Darby Papers.ResultsSA, using prototypical apologia stances (counterattack, differentiation, apology, and corrective action) and rhetorical dissociation strategies (appearance/reality, opinion/knowledge, and act/essence) constructed a persuasive narrative to successfully defend sugar from a product safety crisis, and the sugar industry from a social legitimacy crisis. SA's overarching narrative was that restricting sugar, which it claimed was a valuable food that makes healthy foods more palatable, would cause harm and that claims to the contrary were made by opportunists, pseudoscientists, food-faddists, lay nutritionists or those who had been misled by them. SA's apologia does not meet criteria for truthfulness or sincerity.ConclusionCorporate apologia theory provides an accessible way of understanding sugar industry crisis communication strategies. It enables public health actors to recognize and predict industry corporate ap

BackgroundIn 1976, the U.S. Sugar Association (SA), a globally networked trade organization representing the cane and beet sugar industry, won the Public Relations Society of America's (PRSA) Silver Anvil Award for a crisis communication campaign. Their campaign successfully limited the diffusion of sugar restriction policies to control obesity, heart disease, diabetes, and dental caries, and marked the beginning of the modern-day SA. The sugar industry continues to resist measures to reduce sugar consumption, therefore understanding and addressing industry opposition is crucial to achieving global targets to reduce non-communicable disease.MethodsWe critically analyze common crisis management rhetorical strategies used by SA to defend itself from perceived wrongdoing, and sugar from perceptions of harm using a thematic content analysis based on Hearit's Corporate Apologia theory. Data sources were internal SA documents related to the 1976 Silver Anvil Award in 1) PRSA records, 2) Great Western Sugar Company records, and 3) William Jefferson Darby Papers.ResultsSA, using prototypical apologia stances (counterattack, differentiation, apology, and corrective action) and rhetorical dissociation strategies (appearance/reality, opinion/knowledge, and act/essence) constructed a persuasive narrative to successfully defend sugar from a product safety crisis, and the sugar industry from a social legitimacy crisis. SA's overarching narrative was that restricting sugar, which it claimed was a valuable food that makes healthy foods more palatable, would cause harm and that claims to the contrary were made by opportunists, pseudoscientists, food-faddists, lay nutritionists or those who had been misled by them. SA's apologia does not meet criteria for truthfulness or sincerity.ConclusionCorporate apologia theory provides an accessible way of understanding sugar industry crisis communication strategies. It enables public health actors to recognize and predict industry corporate ap

I am deeply humbled and honored to receive the American Society for Cell Biology (ASCB) Prize for Excellence in Inclusivity. Thank you to the ASCB for recognizing the contributions of faculty to inclusion and diversity in STEM and the importance of this for the advancement of science. Thank you to the Howard Hughes Medical Institute (HHMI) for your generous support of inclusivity. The prize money will be used to fund outreach activities aimed at increasing inclusion in science and to create research opportunities for students from underrepresented groups in the sciences. In this essay, I share bits of my life's story that I hope will resonate with a broad audience, especially students from underrepresented groups in STEM, and that drive my passion for inclusion and diversity. I provide points of consideration for students to enhance their preparation for science careers and for faculty to improve the current landscape of inclusion and diversity in STEM.

The Joan Sheales Staff Education Award grant is intended to assist a staff member to attend an appropriate local or international educational meeting, conference, seminar, course or similar educational event. Professor Barry Baker made a generous donation in 2014 in honour of past ANZCA Chief Executive Officer Ms Joan Sheales, which provides for a small grant to be available every second year to help an ANZCA staff member to develop their professional capacity to support the College’s delivery of high-quality training and education in the specialties. In 2018, Hannah Sinclair, ANZCA membership manager, was the recipient of the award. Her project was to undertake a study tour to visit the Royal College of Physicians and Surgeons of Canada (RCPSC). RCPSC is a pre-eminent leader in the non-for profit medical sector with regards to membership services offering world class membership services to support their 50,000 members. The aims of the study tour were to: • Learn and better understand the services that RCPSC offer to members and what engagement methods they use. • Learn how RCPSC integrate their strategic plan with the delivery of better service to members. • Study technology and online services used by RCPSC to better engage with members and improve member access. • Learn more about how RCPSC is addressing bullying, discrimination and the health, and wellbeing of doctors. • Understand evaluation methods to better measure member satisfaction. Due to not being able to travel an alternative plan was developed for the study tour. A virtual tour was planned and Hannah worked closely with the RCPSC to organise a series of video conferences with RCPSC senior staff. Not only proving a sustainable and cost effective option for working with our international partners, the virtual study tour has created a new way of working. The vision for the virtual project focussed on the following shared practices of ANZCA and RCPSC. 1. Value and perception of membership 2. Continuing Pro

Why do members of some species live in groups while others are solitary? Group living (sociality) has often been studied from an evolutionary perspective, but less is known about the neurobiology of affiliation outside the realms of mating and parenting. Colonial species offer a valuable opportunity to study nonsexual affiliative behavior between adult peers. Meadow voles (Microtus pennsylvanicus) display environmentally induced variation in social behavior, maintaining exclusive territories in summer months, but living in social groups in winter. Research on peer relationships in female meadow voles demonstrates that these selective preferences are mediated differently than mate relationships in socially monogamous prairie voles, but are also impacted by oxytocin and HPA axis signaling. This review addresses day-length dependent variation in physiology and behavior, and presents the current understanding of the mechanisms supporting selective social relationships in meadow voles, with connections to lessons from other species.

The Joan Sheales Staff Education Award grant is intended to assist a staff member to attend an appropriate local or international educational meeting, conference, seminar, course or similar educational event. Professor Barry Baker made a generous donation in 2014 in honour of past ANZCA Chief Executive Officer Ms Joan Sheales, which provides for a small grant to be available every second year to help an ANZCA staff member to develop their professional capacity to support the College’s delivery of high-quality training and education in the specialties. In 2018, Hannah Sinclair, ANZCA membership manager, was the recipient of the award. Her project was to undertake a study tour to visit the Royal College of Physicians and Surgeons of Canada (RCPSC). RCPSC is a pre-eminent leader in the non-for profit medical sector with regards to membership services offering world class membership services to support their 50,000 members. The aims of the study tour were to: • Learn and better understand the services that RCPSC offer to members and what engagement methods they use. • Learn how RCPSC integrate their strategic plan with the delivery of better service to members. • Study technology and online services used by RCPSC to better engage with members and improve member access. • Learn more about how RCPSC is addressing bullying, discrimination and the health, and wellbeing of doctors. • Understand evaluation methods to better measure member satisfaction. Due to not being able to travel an alternative plan was developed for the study tour. A virtual tour was planned and Hannah worked closely with the RCPSC to organise a series of video conferences with RCPSC senior staff. Not only proving a sustainable and cost effective option for working with our international partners, the virtual study tour has created a new way of working. The vision for the virtual project focussed on the following shared practices of ANZCA and RCPSC. 1. Value and perception of membership 2. Continuing Pro

PURPOSE: To explore faculty perspectives on which characteristics of high-performing clerkship students are most important when determining an honors or top grade designation for clinical performance. METHOD: In 2016-2017, the authors surveyed faculty (teaching ward attendings) for internal medicine clerkships and 1 pediatrics clerkship in inpatient settings at 5 U.S. academic medical centers. Survey items were framed around competencies, 24 student characteristics, and attitudes toward evaluation. Factor analysis examined constructs defining high-performing students. RESULTS: Of 516 faculty invited, 319 (62%) responded. The top 5 characteristics as rated by respondents were taking ownership, clinical reasoning, curiosity, dependability, and high ethical standards (in descending order). Twenty-one characteristics fit into 3 factors (Cronbach alpha, 0.81-0.87). Clinical reasoning did not fit into a factor. Factor 1 was the most important (mean rating, 8.7/10 [95% confidence interval (CI), 8.6-8.8]). It included professionalism components (ownership, curiosity, dependability, high ethical standards), presentation and interviewing skills, seeking feedback, and documentation. Factor 2 (mean, 7.9 [95% CI, 7.7-8.0]) included aspects of teamwork and communication, such as positive attitude and comments from others. Factor 3 (mean, 7.6 [95% CI, 7.4-7.7]) addressed systems-based thinking, including patient safety and care transitions. CONCLUSIONS: Professionalism components, clinical reasoning, and curiosity were among the most important characteristics distinguishing high-performing clerkship students. These may represent behaviors that are highly valued, observable, and relevant to training stage. Improved definition of the characteristics associated with clinical honors would assist students, faculty, and residency program directors when interpreting clinical performance within core clerkships.

Background: Results of a 2014 National Stroke Foundation medical record audit demonstrated inconsistent delivery of stroke education across Community Rehabilitation (CR). This did not meet the National Stroke Foundation guidelines. In response, our service developed a consumer driven, evidence based, interdisciplinary education program for stroke survivors and their carers. Method(s): The Community Rehabilitation Neurology Special Interest Group formed an interprofessional working party to complete benchmarking, a literature review and consumer surveys. This directed the development of the Stroke Education Program. All presentations were then video recorded to enable the use of E-education. This program was piloted at 3 CR sites. Staff and consumer feedback was collected. This informed changes for future stroke education. Result(s): In 2016 and 2017 ten stroke education groups were conducted across CR with a total of 63 clients and carers attending. 45% of clients reported "learning" to be the best part of the program. The advantages of e-education were found to be; * New presenters can use the videos as a learning tool * Decreased disturbance to the group, as interpreters and clients watch the e-education in a separate room * Catch up sessions for clients who cannot attend the group * Clients and family receive stroke education at the Community Rehabilitation Centre or at home Conclusion / discussion: The program received positive feedback from clients and staff and was named as a finalist in the Stroke Care Champion category of the Stroke Foundation 2016 Stroke Awards. E-education enhances accessibility for stroke survivors and their carers.

There is growing concern that the physician-scientist is endangered due to a leaky training pipeline and prolonged time to scientific independence (1). The NIH Physician-Scientist Workforce Working Group has concluded that as many as 1,000 individuals will need to enter the pipeline each year to sustain the workforce (2). Moreover, surveys of postgraduate training programs document considerable variability in disposition and infrastructure (3). Programs can be broadly grouped into two classes: physician-scientist training programs (PSTPs) that span residency and fellowship training, and research-in-residency programs (RiRs), which are limited to residency but trainees are able to match into PSTPs upon transitioning to fellowship (Figure 1). Funding sources for RiRs and PSTPs are varied and include NIH KL2 and T32 awards, charitable foundations, philanthropy, and institutional support. Furthermore, standards for research training and tools for evaluating programmatic success are lacking. Here, we share consensus generated from iterative workshops hosted by the Alliance of Academic Internal Medicine (AAIM) and the student-led American Physician Scientists Association (APSA).

Cellular physiology depends on the alteration of protein structures by covalent modification reactions. Using a combination of bioinformatic, genetic, biochemical, and mass spectrometric approaches, it has been possible to probe ribosomal proteins from the yeast Saccharomyces cerevisiae for post-translationally methylated amino acid residues and for the enzymes that catalyze these modifications. These efforts have resulted in the identification and characterization of the first protein histidine methyltransferase, the first N-terminal protein methyltransferase, two unusual types of protein arginine methyltransferases, and a new type of cysteine methylation. Two of these enzymes may modify their substrates during ribosomal assembly because the final methylated histidine and arginine residues are buried deep within the ribosome with contacts only with RNA. Two of these modifications occur broadly in eukaryotes, including humans, whereas the others demonstrate a more limited phylogenetic range. Analysis of strains where the methyltransferase genes are deleted has given insight into the physiological roles of these modifications. These reactions described here add diversity to the modifications that generate the typical methylated lysine and arginine residues previously described in histones and other proteins.

BACKGROUND: Controversy exists over the surgical treatment for severe patellofemoral osteoarthritis. We therefore wished to compare the outcome of patellofemoral arthroplasty (PFA) with TKA in a blinded randomized controlled trial.QUESTIONS/PURPOSES: In the first 2 years after surgery: (1) Does the overall gain in quality of life differ between the implants based on the area under the curve of patient-reported outcomes (PROs) versus time? (2) Do patients obtain a better quality of life at specific points in time after PFA than after TKA? (3) Do patients get a better range of movement after PFA than after TKA? (4) Does PFA result in more complications than TKA?METHODS: Patients were eligible if they had debilitating symptoms and isolated patellofemoral disease. One hundred patients were included from 2007 to 2014 and were randomized to PFA or TKA (blinded for the first year; blinded to patient, therapists, primary care physicians, etc; quasiblinded to assessor). Patients were seen for four clinical followups and completed six sets of questionnaires during the first 2 postoperative years. SF-36 bodily pain was the primary outcome. Other outcomes were range of movement, PROs (SF-36, Oxford Knee Score [OKS], Knee injury and Osteoarthritis Outcome Score [KOOS]) as well as complications and revisions. Four percent (two of 50) of patients died within the first 2 years in the PFA group (none in the TKA group), and 2% (one of 50) became ill and declined further participation after 1 year in the PFA group (none in the TKA group). The mean age at inclusion was 64 years (SD 8.9), and 77% (77 of 100) were women.RESULTS: The area under the curve (AUC) up to 2 years for SF-36 bodily pain of patients undergoing PFA and those undergoing TKA was 9.2 (SD 4.3) and 6.5 (SD 4.5) months, respectively (p = 0.008). The SF-36 physical functioning, KOOS symptoms, and OKS also showed a better AUC up to 2 years for PFA compared with TKA (6.6 [SD 4.8] versus 4.2 [SD 4.3]

BackgroundIn 2009, the Get With The Guidelines-Stroke (GWTG-Stroke) program offered additional recognition if hospitals performed well on certain stroke quality measures. We sought to determine whether quality of care for all hospitals participating in GWTG-Stroke improved with this expanded recognition program.Methods and resultsWe examined hospital-level performance on 6 quality of care (process) measures and 1 defect-free composite quality measure for stroke following expansion of the existing performance measure recognition program. Compliance with all measures improved following launch of the expanded program, and this rate increased significantly for all 9 measures. When evaluated as the relative rate of increase in use over time, process improvement slowed significantly (P<0.05) following launch of the program for 2 measures, and accelerated significantly for 1 measure. However, when evaluated as a gap in care, the decrease in the quality gap was greater following launch of the program for 5 of 6 (83%) measures. There was no evidence that other processes of stroke care suffered as the result of the increase in measures and expanded recognition program.ConclusionsWhile care for stroke continues to improve in this country, expanded hospital process performance recognition had mixed results in accelerating this improvement. However, the quality gap continues to shrink among those participating in provider performance programs.

PurposeTo learn the size, composition, and scholarly output of biostatistics, epidemiology, and research design (BERD) units in U.S. academic health centers (AHCs).MethodEach year for four years, the authors surveyed all BERD units in U.S. AHCs that were members of the Clinical and Translational Science Award (CTSA) Consortium. In 2010, 46 BERD units were surveyed; in 2011, 55; in 2012, 60; and in 2013, 61.ResultsResponse rates to the 2010, 2011, 2012, and 2013 surveys were 93.5%, 98.2%, 98.3%, and 86.9%, respectively. Overall, the size of BERD units ranged from 3 to 86 individuals. The median FTE in BERD units remained similar and ranged from 3.0 to 3.5 FTEs over the years. BERD units reported more availability of doctoral-level biostatisticians than doctoral-level epidemiologists. In 2011, 2012, and 2013, more than a third of BERD units provided consulting support on 101 to 200 projects. A majority of BERD units reported that between 25% and 75% (in 2011) and 31% to 70% (in 2012) of their consulting was to junior investigators. More than two-thirds of BERD units reported their contributions to the submission of 20 or more non-BERD grant or contract applications annually. Nearly half of BERD units reported 1 to 10 manuscripts submitted annually with a BERD practitioner as the first or corresponding author.ConclusionsThe findings regarding BERD units provide a benchmark against which to compare BERD resources and may be particularly useful for institutions planning to develop new units to support programs such as the CTSA.

Introduction: Polycystic ovary syndrome (PCOS) is a common condition affecting up to 18% of reproductive-aged women. In addition to reproductive complications, women with PCOS have elevated risk factors for cardiovascular disease including insulin resistance and dyslipidaemia. Lipidomics identifies specific molecular lipid species and classes and subclasses with important implications for lipid profiling for disease classification, risk assessment and lipid metabolism associated with specific disease states. There is no research examining lipidomics in PCOS and the pathphysiological features of hyperandrogenism and insulin resistance in PCOS. Method(s): In biobanked samples, we examined the lipidomic profile in 156 pre-menopausal overweight women (n = 92 with PCOS and 64 without PCOS), specifically 24 lipid classes comprising 325 species using liquid chromatography mass spectrometry. Result(s): There were no differences in lipid classes or species between women with or without PCOS. There were no association of lipid classes with total testosterone on unadjusted or adjusted models. There was a significant negative association of SHBG with diacylglycerol and triacylglyercol on adjusted models. There was a significant positive association of FAI with ceramide, phosphatidylcholine, lysophosphatidylcholine, phosphatidylethanolamine, lysophosphatidylethanolamine, phosphatidylinositol, diacylglycerol and triacylglyercol on adjusted models. Conclusion(s): While PCOS status was not associated with differences in lipid classes or species, SHBG and FAI (as key pathophysiological aspects in PCOS and correlates of obesity) were associated with differences in a number of lipid classes. This highlights the interaction between reproductive hormones in women and cardiovascular risk, independent of PCOS status.

Introduction: Polycystic ovary syndrome (PCOS) is a common condition affecting up to 18% of reproductive-aged women. In addition to reproductive complications, women with PCOS have elevated risk factors for cardiovascular disease including insulin resistance and dyslipidaemia. Lipidomics identifies specific molecular lipid species and classes and subclasses with important implications for lipid profiling for disease classification, risk assessment and lipid metabolism associated with specific disease states. There is no research examining lipidomics in PCOS and the pathphysiological features of hyperandrogenism and insulin resistance in PCOS. Method(s): In biobanked samples, we examined the lipidomic profile in 156 pre-menopausal overweight women (n = 92 with PCOS and 64 without PCOS), specifically 24 lipid classes comprising 325 species using liquid chromatography mass spectrometry. Result(s): There were no differences in lipid classes or species between women with or without PCOS. There were no association of lipid classes with total testosterone on unadjusted or adjusted models. There was a significant negative association of SHBG with diacylglycerol and triacylglyercol on adjusted models. There was a significant positive association of FAI with ceramide, phosphatidylcholine, lysophosphatidylcholine, phosphatidylethanolamine, lysophosphatidylethanolamine, phosphatidylinositol, diacylglycerol and triacylglyercol on adjusted models. Conclusion(s): While PCOS status was not associated with differences in lipid classes or species, SHBG and FAI (as key pathophysiological aspects in PCOS and correlates of obesity) were associated with differences in a number of lipid classes. This highlights the interaction between reproductive hormones in women and cardiovascular risk, independent of PCOS status.

PurposeTo learn the size, composition, and scholarly output of biostatistics, epidemiology, and research design (BERD) units in U.S. academic health centers (AHCs).MethodEach year for four years, the authors surveyed all BERD units in U.S. AHCs that were members of the Clinical and Translational Science Award (CTSA) Consortium. In 2010, 46 BERD units were surveyed; in 2011, 55; in 2012, 60; and in 2013, 61.ResultsResponse rates to the 2010, 2011, 2012, and 2013 surveys were 93.5%, 98.2%, 98.3%, and 86.9%, respectively. Overall, the size of BERD units ranged from 3 to 86 individuals. The median FTE in BERD units remained similar and ranged from 3.0 to 3.5 FTEs over the years. BERD units reported more availability of doctoral-level biostatisticians than doctoral-level epidemiologists. In 2011, 2012, and 2013, more than a third of BERD units provided consulting support on 101 to 200 projects. A majority of BERD units reported that between 25% and 75% (in 2011) and 31% to 70% (in 2012) of their consulting was to junior investigators. More than two-thirds of BERD units reported their contributions to the submission of 20 or more non-BERD grant or contract applications annually. Nearly half of BERD units reported 1 to 10 manuscripts submitted annually with a BERD practitioner as the first or corresponding author.ConclusionsThe findings regarding BERD units provide a benchmark against which to compare BERD resources and may be particularly useful for institutions planning to develop new units to support programs such as the CTSA.

In 2009, the Get With The Guidelines-Stroke (GWTG-Stroke) program offered additional recognition if hospitals performed well on certain stroke quality measures. We sought to determine whether quality of care for all hospitals participating in GWTG-Stroke improved with this expanded recognition program. We examined hospital-level performance on 6 quality of care (process) measures and 1 defect-free composite quality measure for stroke following expansion of the existing performance measure recognition program. Compliance with all measures improved following launch of the expanded program, and this rate increased significantly for all 9 measures. When evaluated as the relative rate of increase in use over time, process improvement slowed significantly (P<0.05) following launch of the program for 2 measures, and accelerated significantly for 1 measure. However, when evaluated as a gap in care, the decrease in the quality gap was greater following launch of the program for 5 of 6 (83%) measures. There was no evidence that other processes of stroke care suffered as the result of the increase in measures and expanded recognition program. While care for stroke continues to improve in this country, expanded hospital process performance recognition had mixed results in accelerating this improvement. However, the quality gap continues to shrink among those participating in provider performance programs.

During a Research Career Development Award from the National Eye Institute, I spent a year at the University of Cambridge doing research with John Robson. The goal was to use a visual stimulation approach that had not been previously attempted, with the intention of exploring fundamental organization principles of the neural basis of binocular vision. The idea was to use sinusoidal gratings that drifted before both eyes such that the relative phase for one eye was fixed while that of the other was varied. This provided binocular stimuli of variable relative phase, i.e. retinal disparity, to enable testing of binocular response characteristics. We were able to obtain different types of disparity tuning functions for neurons in the primary visual cortex. This work, followed by extended investigations in Berkeley, provided basic information regarding response characteristics of simple and complex cells. We have also shown for monocular deprivation, an approximate model for human amblyopia, that many neurons remain connected to the deprived eye, as demonstrated with dichoptic activation. A selected portion of this work is described here.

ObjectivesIn the United States, emergency medicine (EM) researchers hold proportionately fewer federal career development awards than researchers in other specialties. Others hypothesize that this deficit may partly be attributed to lack of mentors, departmental resources, and qualified applicants. Our objectives were to examine the association between departmental and institutional resources and career development awards and to describe the barriers to conducting research and btaining grants in EM.MethodsWe conducted an online, cross-sectional survey study of vice chairs for research and research directors at academic emergency departments in the United States in January and February 2016. Participants provided quantitative information regarding their department's demographics, available research resources, number of funded independent investigators, and number of career development awards. They were also asked about the perceived adequacy of departmental and institutional resources and perceived barriers to research and grant success. Data were analyzed using descriptive statistics and multivariable linear regression, as appropriate.ResultsOf 178 eligible participants, 103 (58%) completed the survey. Most departments reported some infrastructure for research and grant submission, including research coordinator(s) (n = 75/99; 76%, 95% confidence interval [CI] = 66%-84%), research associates (69/99; 70%, 95% CI = 60%-79%), and administrative/secretarial research support (79/101; 78%, 95% CI = 69%-86%). The majority of departments (56/103; 49%, 95% CI = 44%-64%) had no R01-funded researchers, and only 15 (15%, 95% CI = 8%-23%) had three or more R01-funded researchers. The most frequently reported challenge to junior faculty applying for grants was low motivation for applying (62/103; 60%, 95% CI = 50%-70%), followed closely by insufficient mentorship (50/103; 49%, 95% CI = 39%-59%) and discouragement from low funding rates

I thought long and hard whether I could avoid talking about family and personal life, and just share the excitement of being a scientist and how science continues to sustain us all. But so many people, especially younger scientists, want to know-and always ask-How did you do it? A woman from Iran, a Middle Eastern country and essentially Muslim, now considered backwards and misguided if not downright scary, traveling very young and alone to the United States, finishing college and graduate school together with having children, first-year graduate school and second-year post doc-years ago, going against a number of entrenched dogmas, and yet succeeding against many odds and obstacles, and all the while on soft money? Below is my personal narrative answering some of these questions.

This essay summarizes my personal journey toward the atomic visualization of microtubules and a mechanistic understanding of how these amazing polymers work. During this journey, I have been witness and partaker in the blooming of a technique I love-cryo-electron microscopy.

This essay summarizes my personal journey toward the atomic visualization of microtubules and a mechanistic understanding of how these amazing polymers work. During this journey, I have been witness and partaker in the blooming of a technique I love-cryo-electron microscopy.