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Introduction: External funding is fundamental to surgeon-scientists and many Society of Asian Academic Surgeons (SAAS) members have received funding through National Institutes of Health (NIH) grants. The amount of funding through NIH awards amongst SAAS members has yet to be evaluated. Our objective was to quantify the amount and type of NIH funding among SAAS members., Methods: A list of all active SAAS members was compiled. The NIH Research Portfolio Online Reporting Tool's Expenditure and Results was queried to identify NIH funding among active members., Results: Among 585 active SAAS members, 165 (28%) received NIH funding during their career. Of these, 110 members (66.6%) were male and 55 members (33.3%) were female. A total of 420 NIH grants have been awarded totaling $518.7 million in funding. There are currently 47 active grants totaling $34.1 million in funding. When analyzing by type, there were 226 R research grants, 63 K career development awards, 53 T and F research training and fellowships awards, and 78 other awards. Of the 63 members who received a K award, 35 members (55%) have subsequently received an R award., Conclusions: SAAS members are highly funded with 28% of members having received NIH funding totaling $518.7 million. SAAS' mission is to foster the personal and professional development of academic surgeons and we found that many SAAS members have the experience to mentor other surgeon-scientists through the process of obtaining NIH funding. Participation in organizations like SAAS can help nurture the success of future generations of surgeon-scientists., (Copyright © 2024. Published by Elsevier Inc.)

Introduction: National Institute of Health (NIH) funding is a "gold-standard" of achievement; we examined trends in NIH-funded pediatric surgeons., Methods: NIH Research Portfolio Online Reporting Tools (RePORT) was queried for American Pediatric Surgical Association (APSA) members (2012 vs 2022). Demographics and time-to-award (TTA) from fellowship were compared. Number of grants, funding allotment, award classification, administering institutes/centers, research type were studied., Results: Thirty-eight (4.6%) APSA members were NIH-funded in 2012 compared to 37 (2.9%) in 2022. Of funded surgeons in 2022, 27% were repeat awardees from 2012. TTA was similar (12 vs 14years, p=0.109). At each point, awards were commonly R01 grants (40 vs 52%, p ​= ​0.087) and basic science-related (76 vs 63%, p = ​0.179). Awardees were predominantly men (82% in 2012 vs 78% in 2022, p=0.779) and White (82% in 2012 vs 76% in 2022, p=0.586). Median amount per grant increased: $254,980 (2012) to $364,025 (2022); by $96,711 for men and $390,911 for women. Median awards for White surgeons increased by $215,699 (p=0.035), and decreased by $30,074 for non-White surgeons, though not significantly (p=0.368)., Conclusion: The landscape of NIH-funded pediatric surgeons has remained unchanged between time points. With a substantial number of repeat awardees, predominance of R01 grants, and a median TTA over a decade after fellowship graduation, the phenotypes of early career pediatric surgeon-scientists are facing academic endangerment., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: While mentoring programs have demonstrated success for faculty development, reported rates of formal mentoring programs vary for specific programs as well as academic medical institutions overall. The aim of this paper was to evaluate the overall prevalence of faculty mentoring programs and faculty development offices in anesthesiology departments and at academic medical schools and assess the association between those with mentoring programs and faculty development support and NIH funding., Methods: This study used publicly available data from program and institutional websites to record the presence of faculty mentoring programs and faculty development offices in anesthesiology departments as well as both formal and informal mentoring activities and whether there were offices and deans specifically related to faculty development at the institutional level. Data on NIH funding of anesthesiology departments were recorded from the Blue Ridge Institute for Medical Research rankings of medical schools and their departments. Cramer's V was used to evaluate the association between NIH funding and the presence of mentoring programs offered by the department and/or institution. Logistic regression was used to evaluate the association between total NIH funding of ranked programs (categorized as above or below median of funding) and presence of mentoring programs., Results: The study included 164 US anesthesiology programs, of which 33% had NIH funding. Only 10% of anesthesiology programs had faculty mentoring programs and 29% had offices or leadership positions related to faculty development. At the institutional level, 59% had formal mentoring programs, 73% offered informal mentoring activities, and 77% had offices or deans related to faculty development. Seventy-four percent (74%) of anesthesiology departments offering mentoring resources had NIH funding, compared to only 26% of departments without such resources. For anesthesiology departments with NIH funding, departments in the upper median of funded programs were much more likely to have departmental mentoring resources (OR = 1.429.08; 95% CI: 1.721.03-1.9748.99). Departmental NIH funding was not significantly associated with institutional level presence of formal mentoring programs (OR = 0.91; 95% CI: 0.0.23-3.65)., Conclusions: Our findings suggest an association between the presence of faculty mentoring programs and faculty development support with departmental NIH funding, with the amount of funding associated primarily with department-specific mentoring and faculty development initiatives. Our findings support efforts to create formal mentoring programs and establish offices and other support systems for faculty development and suggest, at least in terms of academic productivity, that efforts should be more focused on department-specific initiatives., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024. Published by Elsevier Inc.)

Introduction: The National Institutes of Health (NIH) is the primary federal agency in the United States (US) that supports biomedical research, training, and clinical trials. NIH funding creates patents and jobs and thus helps the regional and national economy grow. Therefore, NIH funding would be expected to flow equitably to all 50 US states. However, there is a significant geographic disparity in the level of NIH funding received by various states. To that end, in 1993, authorized by Congress, NIH initiated a funding program called the Institutional Development Award (IDeA) to support states, called IDeA states, which received low levels of NIH funding. However, whether this approach has helped reduce the geographic disparity in NIH funding is unclear., Methods: In the current study, we analyzed data on various NIH funding mechanisms awarded to 23 IDeA states vs. 27 non-IDeA states, as identified by NIH. We compared these data to the population size, federal taxes paid, and the number of PhDs and Post-doctoral Fellows(PDFs) trained in IDeA vs. non-IDeA states., Results: The non-IDeA states received 93.6% of the total NIH funding, whereas IDeA states received only 6.4%. On average, one Institutional Training Grant was received for every 24 PhDs trained in non-IDeA states, while IDeA states received one such grant for every 46 PhDs trained. The non-IDeA states comprised 84.3% of the US population, whereas IDeA states comprised 15.7%. Thus, on a per capita basis, non-IDeA states received $120 from NIH, whereas IDeA states received $45 per person. For every million dollars contributed by the non-IDeA states toward federal taxes, they received $7,903 in NIH funding, while the IDeA States received only $4,617. For FY 2022, the NIH funding created an economic activity of $90.6 Billion in non-IDeA states and only $6.3 billion in IDeA states. When total NIH funding to the states was analyzed for the years 1992, 2002, 2012, and 2022, IDeA states received 4.7% of the total NIH funding in 1992, which increased to 7.2% in 2002 but dropped to 6.8% in 2012 and 6.5% in 2022. This demonstrated that IDeA states' share of NIH funding remained relatively unchanged for the past 20 years., Discussion: Eliminating the geographic disparity in NIH funding is crucial for achieving equitable health outcomes across the US, and for the IDeA states to successfully train future generations of physicians and scientists, as well as grow the regional economy. Although the NIH IDeA programs have helped enhance the research capacity in IDeA states, the funding currently constitutes less than 1% of the total NIH budget. Thus, it is critical to increase NIH funding to IDeA states to improve health outcomes for all Americans., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Caulder, Zhang, Nagarkatti and Nagarkatti.)

Interdisciplinary teams struggle to find a home in siloed federal grant-funding system.

Objectives: Bibliometrics, such as the Hirsch index (h-index) and the more recently developed relative citation ratio (RCR), are utilized to evaluate research productivity. Our study evaluates demographics, research productivity, and National Institutes of Health (NIH) funding in academic otology., Methods: Academic otologists were identified, and their demographics were collected using institutional faculty profiles (N = 265). Funding data were obtained using the NIH Research Portfolio Online Reporting Tools Expenditures and Reports Database. The h-index was calculated using Scopus and mean (m-RCR) and weighted RCR (w-RCR) were calculated using the NIH iCite tool., Results: H-index (aOR 1.18, 95% CI 1.10-1.27, p < 0.001), but not m-RCR (aOR 1.50, 95% CI 0.97-2.31, p = 0.069) or w-RCR (aOR 1.00, 95% CI 0.99-1.00, p = 0.231), was associated with receiving NIH funding. Men had greater h-index (16 vs. 9, p < 0.001) and w-RCR (51.8 vs. 23.0, p < 0.001), but not m-RCR (1.3 vs. 1.3, p = 0.269) than women. Higher academic rank was associated with greater h-index and w-RCR (p < 0.001). Among assistant professors, men had greater h-index than women (9.0 vs. 8.0, p = 0.025). At career duration 11-20 years, men had greater h-index (14.0 vs. 8.0, p = 0.009) and w-RCR (52.7 vs. 25.8, p = 0.022) than women., Conclusion: The h-index has a strong relationship with NIH funding in academic otology. Similar h-index, m-RCR, and w-RCR between men and women across most academic ranks and career durations suggests production of similarly impactful research. The m-RCR may correct some deficiencies of time-dependent bibliometrics and its consideration in academic promotion and research funding allocation may promote representation of women in otology., Level of Evidence: N/A Laryngoscope, 134:3786-3794, 2024., (© 2024 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

Background: The National Institutes of Health (NIH) is the major funding agency for biomedical research in the United States. To initiate a scholarly dialog about research and career development in the thyroid field, here we reviewed recent trends in NIH funding for this area. We used the Research Portfolio Online Reporting Tool database to estimate the level of NIH extramural support during 2013-2022 (number of active grants/year and $amount/year weighed by the total number of active grants/year and $amount/year), provided by the NIH to the thyroid field. We determined that in 2013, the NIH supported ∼140 grants/year, totaling almost $50 million/year, the majority in the form of R01 grants. Within the thyroid field, support was evenly split between thyroid cancer and thyroid hormone metabolism and action subareas. In the subsequent years (2014-2022), the total number of active grants peaked at 150/year ($55 million) in 2014 but progressively decreased to about 100 active grants/year ($30 million) in 2022. This trend occurred while the NIH budget increased from $29 to $46 billion/year. Globally, the number of thyroid-related publications increased by ∼70% during the study period, and the fractional contribution of several countries remained relatively stable, except for China which increased by ∼600%. Remarkably, the fraction of thyroid-related publications in the United States sponsored by the NIH decreased from 5.5% to 3.1% of the global number. Conclusion: These results constitute a very concerning scenario for research and education in the thyroid field. We appeal to the NIH, the professional societies in endocrinology and thyroidology, and all other relevant stakeholders such as thyroid-related professionals and thyroid patients to engage in further discussions to identify the root causes of this trend and implement an action plan to stabilize and eventually reverse this situation.

This study examines the influence of National Institutes of Health (NIH) funding on the publication choices of dermatologists, particularly in terms of journal tiers and pay-to-publish (P2P) versus free-to-publish (F2P) models. Utilizing k-means clustering for journal ranking based on SCImago Journal Rank, h-index, and Impact Factor, journals were categorized into three tiers and 54,530 dermatology publications from 2021 to 2023 were analyzed. Authors were classified as Top NIH Funded or Non-Top NIH Funded according to Blue Ridge Institute for Medical Research rankings. The study finds significant differences in publication patterns, with Top NIH Funded researchers in Tier I journals demonstrating a balanced use of P2P and F2P models, while they preferred F2P models in Tier II and III journals. Non-Top NIH Funded authors, however, opted for P2P models more frequently across all tiers. These data suggest NIH funding allows researchers greater flexibility to publish in higher-tier journals despite publication fees, while prioritizing F2P models in lower-tier journals. Such a pattern indicates that funding status plays a critical role in strategic publication decisions, potentially impacting research visibility and subsequent funding. The study's dermatology focus limits broader applicability, warranting further research to explore additional factors like geographic location, author gender, and research design., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: The number of cerebrovascular (CV) surgeons has grown with the rise of endovascular neurosurgery. However, it is unclear whether the number of CV surgeon-scientists has concomitantly increased. With increasing numbers of CV neurosurgeons in the US workforce, the authors analyzed associated changes in National Institutes of Health (NIH) and Neurosurgery Research and Education Foundation (NREF) funding trends for CV surgeons over time., Methods: Publicly available data were collected on currently practicing academic CV surgeons in the US. Inflation-adjusted NIH funding between 2009 and 2021 was surveyed using NIH RePORTER and Blue Ridge Institute for Medical Research data. The K12 Neurosurgeon Research Career Development Program and NREF grant data were queried for CV-focused grants. Pearson R correlation, chi-square analysis, and the Mann-Whitney U-test were used for statistical analysis., Results: From 2009 to 2021, NIH funding increased: in total (p = 0.0318), to neurosurgeons (p < 0.0001), to CV research projects (p < 0.0001), and to CV surgeons (p = 0.0018). During this time period, there has been an increase in the total number of CV surgeons (p < 0.0001), the number of NIH-funded CV surgeons (p = 0.0034), and the percentage of CV surgeons with NIH funding (p = 0.370). Additionally, active NIH grant dollars per CV surgeon (p = 0.0398) and the number of NIH grants per CV surgeon (p = 0.4257) have increased. Nevertheless, CV surgeons have been awarded a decreasing proportion of the overall pool of neurosurgeon-awarded NIH grants during this time period (p = 0.3095). In addition, there has been a significant decrease in the number of K08, K12, and K23 career development awards granted to CV surgeons during this time period (p = 0.0024). There was also a significant decline in the proportion of K12 (p = 0.0044) and downtrend in early-career NREF (p = 0.8978) grant applications and grants awarded during this time period. Finally, NIH-funded CV surgeons were more likely to have completed residency less recently (p = 0.001) and less likely to have completed an endovascular fellowship (p = 0.044) as compared with non-NIH-funded CV surgeons., Conclusions: The number of CV surgeons is increasing over time. While there has been a concomitant increase in the number of NIH-funded CV surgeons and the number of NIH grants awarded per CV surgeon in the past 12 years, there has also been a significant decrease in CV surgeons with K08, K12, and K23 career development awards and a downtrend in CV-focused K12 and early-career NREF applications and awarded grants. The latter findings suggest that the pipeline for future NIH-funded CV surgeons may be in decline.

Research investigating the impact of barriers to care on health-related quality of life (HRQoL) among US adults with chronic inflammatory skin diseases (CISDs) is limited. In this study, we utilize multivariable-adjusted logistic regression to analyze the associations between cost barriers (e.g., delaying specialist and mental health care due to cost) and non-cost barriers (e.g., delaying care due to transportation issues and the lack of provider diversity) with HRQoL among US adults with several common CISDs in the National Institutes of Health's All of Us Research Program (AoURP). Among the 19,208 adults with CISDs included in our analysis, the prevalence of poorer HRQoL(i.e., "fair" or "poor" HRQoL) was significantly higher among adults with CISDs who experienced cost (aOR, 2.39;95% CI, 2.10-2.73) and non-cost barriers (aOR, 2.52; 95% CI, 2.20-2.88) than those with CISDs who did not experience those barriers. Since dermatologists are often the only physician caring for patients with CISDs, this study reinforces the critical role dermatologists have in addressing social determinants of health and advocating to reduce cost and non-cost barriers for their patients with CISDs., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Industry payments to US cancer centers are poorly understood., Methods: US National Cancer Institute (NCI)-designated comprehensive cancer centers were identified (n = 51). Industry payments to NCI-designated comprehensive cancer centers from 2014 to 2021 were obtained from Open Payments and National Institutes of Health (NIH) grant funding from NIH Research Portfolio Online Reporting Tools (RePORT). Given our focus on cancer centers, we measured the subset of industry payments related to cancer drugs specifically and the subset of NIH funding from the NCI., Results: Despite a pandemic-related decline in 2020-2021, cancer-related industry payments to NCI-designated comprehensive cancer centers increased from $482 million in 2014 to $972 million in 2021. Over the same period, NCI research grant funding increased from $2 481  million to $2 724  million. The large majority of nonresearch payments were royalties and licensing payments., Conclusion: Industry payments to NCI-designated comprehensive cancer centers increased substantially more than NCI funding in recent years but were also more variable. These trends raise concerns regarding the influence and instability of industry payments., (© The Author(s) 2024. Published by Oxford University Press.)

The very low success rates of grant applications to the National Institutes of Health (NIH) and the National Science Foundation (NSF) are highly detrimental to the progress of science and the careers of scientists. The peer review process that evaluates proposals has been claimed arbitrarily to be the best there is. This consensus system, however, has never been evaluated scientifically against an alternative. Here we delineate the 15 major problems with the peer review process. We challenge the Science Advisor to the President, and the leadership of NIH, NSF, the U.S. National Academy of Sciences and other funding agencies throughout the world to refute each of these criticisms. We call for the implementation of more equitable alternatives that will not constrain the progress of science. We propose a system that will fund at least 80,000 principal investigators, including young scientists, with about half the current NIH budget, seven-times as many as the current number of NIH "research project grants," and that will forego the cumbersome, expensive, and counterproductive "peer" review stage. Further, we propose that the success of the two systems over 5-10 years be compared scientifically., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Düzgüneş N.)

Importance: Surgeon-scientists are uniquely positioned to facilitate translation between the laboratory and clinical settings to drive innovation in patient care. However, surgeon-scientists face many challenges in pursuing research, such as increasing clinical demands that affect their competitiveness to apply for National Institutes of Health (NIH) funding compared with other scientists., Objective: To examine how NIH funding has been awarded to surgeon-scientists over time., Design, Setting, and Participants: This cross-sectional study used publicly available data from the NIH RePORTER (Research Portfolio Online Reporting Tools Expenditures and Results) database for research project grants awarded to departments of surgery between 1995 and 2020. Surgeon-scientists were defined as NIH-funded faculty holding an MD or MD-PhD degree with board certification in surgery; PhD scientists were NIH-funded faculty holding a PhD degree. Statistical analysis was performed from April 1 to August 31, 2022., Main Outcome: National Institutes of Health funding to surgeon-scientists compared with PhD scientists, as well as NIH funding to surgeon-scientists across surgical subspecialties., Results: Between 1995 and 2020, the number of NIH-funded investigators in surgical departments increased 1.9-fold from 968 to 1874 investigators, corresponding to a 4.0-fold increase in total funding (1995, $214 million; 2020, $861 million). Although the total amount of NIH funding to both surgeon-scientists and PhD scientists increased, the funding gap between surgeon-scientists and PhD scientists increased 2.8-fold from a $73 million difference in 1995 to a $208 million difference in 2020, favoring PhD scientists. National Institutes of Health funding to female surgeon-scientists increased significantly at a rate of 0.53% (95% CI, 0.48%-0.57%) per year from 4.8% of grants awarded to female surgeon-scientists in 1995 to 18.8% in 2020 (P < .001). However, substantial disparity remained, with female surgeon-scientists receiving less than 20% of NIH grants and funding dollars in 2020. In addition, although there was increased NIH funding to neurosurgeons and otolaryngologists, funding to urologists decreased significantly from 14.9% of all grants in 1995 to 7.5% in 2020 (annual percent change, -0.39% [95% CI, -0.47% to -0.30%]; P < .001). Despite surgical diseases making up 30% of the global disease burden, representation of surgeon-scientists among NIH investigators remains less than 2%., Conclusion and Relevance: This study suggests that research performed by surgeon-scientists continues to be underrepresented in the NIH funding portfolio, highlighting a fundamental need to support and fund more surgeon-scientists.

Importance: Women have made substantial advancements in academic surgery, but research funding disparities continue to hamper their progress, and current literature on the status of National Institutes of Health (NIH) funding awarded to women surgeon-scientists appears to be conflicting., Objective: To examine gender-based differences in NIH funding awarded to surgeon-scientists by comparing total grant amounts awarded and the distribution of grants by gender and research type., Design, Setting, and Participants: This cross-sectional study was performed using a previously created database of NIH-funded surgeons from 2010 to 2020. Active physician data from the Association of American Medical Colleges were used to calculate total surgeon populations. This study was performed at the NIH using the NIH internal data platform, iSearch Grants. A total of 715 men and women surgeon-scientists funded by the NIH in 2010 and 1031 funded in 2020 were included in the analysis., Main Outcomes and Measures: The main outcome was the number of women among the total number of surgeons who received NIH grants and the total grant amounts awarded to them. Bivariate χ2 analyses were performed using population totals and substantiated by z tests of population proportions., Results: This study included 715 physicians (n = 579 men [81.0%]) in 2010 and 1031 physicians (n = 769 men [74.6%]) in 2020. In 2020, women comprised 27.4% of the surgical workforce and 25.4% of surgeons with research funding in the US, but they received only 21.7% of total NIH research funding awarded to all surgeons. The number of funded women surgeon-scientists, however, significantly increased from 2010 to 2020 (262 [25.4%] in 2020 vs 136 [19.0%] in 2010; P < .001) as did their funding ($189.7 million [21.7%] in 2020 vs $75.9 million [12.3%] in 2010; P < .001). Furthermore, the proportion of US women surgeons overall with NIH funding significantly increased in 2020 vs 2010 (0.7% vs 0.5%; P < .001). Basic science, clinical outcomes, and clinical trial R01 grants also increased among women surgeon-scientists. Women and men K grant holders had a similar mean (SD) number of R01 application attempts before success (2.7 [3.01] vs 2.3 [3.15]; P = .60) and similar K-to-R award conversion rates (23.5% vs 26.7%; P = .55)., Conclusions and Relevance: This cross-sectional study found an increasing number of women surgeon-scientists receiving NIH funding in 2020 vs 2010 as well as increases in the median grant amounts awarded. Although these results are promising, a discrepancy remains in the proportion of women in the surgical workforce compared with those funded by the NIH and the total grant amounts awarded to them.

Objective: National Institutes of Health (NIH) funding for academic (noncardiac) thoracic surgeons at the top-140 NIH-funded institutes in the United States was assessed. We hypothesized that thoracic surgeons have difficulty in obtaining NIH funding in a difficult funding climate., Methods: The top-140 NIH-funded institutes' faculty pages were searched for noncardiac thoracic surgeons. Surgeon data, including gender, academic rank, and postfellowship training were recorded. These surgeons were then queried in NIH Research Portfolio Online Reporting Tools Expenditures and Results for their funding history. Analysis of the resulting grants (1980-2019) included grant type, funding amount, project start/end dates, publications, and a citation-based Grant Impact Metric to evaluate productivity., Results: A total of 395 general thoracic surgeons were evaluated with 63 (16%) receiving NIH funding. These 63 surgeons received 136 grants totaling $228 million, resulting in 1772 publications, and generating more than 50,000 citations. Thoracic surgeons have obtained NIH funding at an increasing rate (1980-2019); however, they have a low percentage of R01 renewal (17.3%). NIH-funded thoracic surgeons were more likely to have a higher professorship level. Thoracic surgeons perform similarly to other physician-scientists in converting K-Awards into R01 funding., Conclusions: Contrary to our hypothesis, thoracic surgeons have received more NIH funding over time. Thoracic surgeons are able to fill the roles of modern surgeon-scientists by obtaining NIH funding during an era of increasing clinical demands. The NIH should continue to support this mission., (Copyright © 2021 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

In the scheme of developing an application for funding from any federal or foundation source, it is reasonable to place significant attention on the science. However, it is also imperative to remember that your budget is what will provide the resources to make sure you can complete your proposed investigations and, as such, deserves appropriate consideration. In the competitive arena of extramural funding, funding agencies are incentivized to ensure that the funds committed to research will yield maximum impact. A well-thought-out budget demonstrates to the funding agency 2 key factors: (1) that you understand the needs of the project and (2) you have a realistic expectation of the project costs. When these 2 things are communicated to the funding agency, in addition to the significance of your science, it is more likely that you will receive the budget you request. Herein, we put forth the fundamentals for preparing your budget and the nuances that may help you not only be in compliance but also improve your chances of success. This article will discuss issues to consider when designing a budget for large research grants, using the NIH R&R Budget as a prototype., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Competing Interests: Financial support for the Oral Health in America: Advances and Challenges was provided by NIH. BAD and JA served as lead editors for Oral Health in America: Advances and Challenges and were involved in the writing of the executive summary, introduction, and conclusions sections of the reports and also in the review and editing of each of the report's six sections. RNDS is director of the NIH National Institute of Dental and Craniofacial Research and coordinated the preparation, review, and publication of the Oral Health in America: Advances and Challenges report. We declare no other competing interests.

Importance: Despite the rapid growth of interest and diversity in applications of artificial intelligence (AI) to biomedical research, there are limited objective ways to characterize the potential for use of AI in clinical practice., Objective: To examine what types of medical AI have the greatest estimated translational impact (ie, ability to lead to development that has measurable value for human health) potential., Design, Setting, and Participants: In this cohort study, research grants related to AI awarded between January 1, 1985, and December 31, 2020, were identified from a National Institutes of Health (NIH) award database. The text content for each award was entered into a Natural Language Processing (NLP) clustering algorithm. An NIH database was also used to extract citation data, including the number of citations and approximate potential to translate (APT) score for published articles associated with the granted awards to create proxies for translatability., Exposures: Unsupervised assignment of AI-related research awards to application topics using NLP., Main Outcomes and Measures: Annualized citations per $1 million funding (ACOF) and average APT score for award-associated articles, grouped by application topic. The APT score is a machine-learning based metric created by the NIH Office of Portfolio Analysis that quantifies the likelihood of future citation by a clinical article., Results: A total of 16 629 NIH awards related to AI were included in the analysis, and 75 applications of AI were identified. Total annual funding for AI grew from $17.4 million in 1985 to $1.43 billion in 2020. By average APT, interpersonal communication technologies (0.488; 95% CI, 0.472-0.504) and population genetics (0.463; 95% CI, 0.453-0.472) had the highest translatability; environmental health (ACOF, 1038) and applications focused on the electronic health record (ACOF, 489) also had high translatability. The category of applications related to biochemical analysis was found to have low translatability by both metrics (average APT, 0.393; 95% CI, 0.388-0.398; ACOF, 246)., Conclusions and Relevance: Based on this study's findings, data on grants from the NIH can apparently be used to identify and characterize medical applications of AI to understand changes in academic productivity, funding support, and potential for translational impact. This method may be extended to characterize other research domains.

Background: The National Institutes of Health (NIH) supports mentored research career development awards (K awards) to increase the pipeline of independently funded scientists. This study analyzed the portfolio of K grants that were awarded to orthopaedic surgery departments and characterized the factors that were associated with successful transition to independent NIH research funding, including R01 grants., Methods: This was a retrospective cohort study of K-award recipients in orthopaedic surgery departments in the United States from 1996 to 2018. A query was performed on the NIH Research Portfolio Online Reporting Tools (RePORT) database for NIH grants that were awarded to departments of orthopaedic surgery, general surgery, otolaryngology, obstetrics and gynecology, ophthalmology, and urology. Rates of transition to independent research funding were compared by specialty for K grants that were awarded from 1996 to 2011. The percentage of faculty with mentored research career development awards and the return on investment (ROI) were calculated. An internet and Scopus (Elsevier) database search determined the investigator characteristics. The factors that were associated with successful transition to independent funding were determined via chi-square and unpaired t tests., Results: Sixty K-award recipients were identified in orthopaedic surgery departments. Most were men (77%) and research scientists (53%). Fifty percent of the K-award recipients transitioned to independent research funding. Research scientists had the highest rate of transition to independent research funding (71%, p = 0.016) relative to clinicians (0%) and orthopaedic surgeons (40%). Higher levels of publication productivity were associated with successful transition to independent research funding. Similar rates of transition to independent research funding existed among surgical specialties (p = 0.107). Orthopaedic surgery had the lowest percentage of faculty with a K award (1.4%) but had the highest ROI (198%) of these awards., Conclusions: Orthopaedic surgery had similar rates of transition to independent research funding when compared with other surgical specialties but had a lower prevalence of K awards among faculty. Orthopaedic surgeon-scientists have lower rates of transition to independent research funding when compared with their research-scientist colleagues. These findings highlight a need for greater support to foster the pipeline of future NIH-funded orthopaedic investigators., Clinical Relevance: As the largest support of biomedical research in the U.S., the NIH is an important stakeholder in orthopaedic innovations and discoveries. This study highlights barriers in the procurement of NIH funding across surgical specialties and affirms the need for greater resources toward supporting NIH funding in orthopaedic surgery., Competing Interests: Disclosure: The authors indicated that no external funding was received for any aspect of this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G510)., (Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated.)

Background: Over time, NIH funding has become increasingly competitive. In addition, academic surgeons' research competes with time required for patient care, operating, and administrative work. Due to these competing interests for surgeons, we hypothesize that the percentage of NIH grants awarded to researchers from departments of surgery is decreasing., Methods: The NIH Research Portfolio Online Reporting Tool was queried for the number and value of new and renewal R01 grants, and career development awards noting which surgery departments received awards from 1998 to -2018. Statistical analysis was performed using univariate and multivariable logistic regression., Results: The number of career development awards granted to researchers from departments of surgery decreased significantly over time (P = 0.007) while new R01's and R01 renewal awards were stable. The number of grants awarded to researchers from all procedural departments were compared to non-procedural departments and again, career development awards decreased significantly (P = 0.005) over time but new R01's and R01 renewals stayed stable. Looking at the difference in average dollar amount received for new R01, renewal R01, or career development awards between department of surgery awardees and non-surgery over time, there was no significant difference., Conclusions: NIH funding is becoming increasingly competitive and surgeons have many competing interests. Our study found that there has been a significant decrease in career development awards to department of surgery awardees and procedural specialists. The decrease in receipt of these awards is particularly concerning given that they are meant to provide protected time for developing researchers and thus have potential consequences for future research., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Previous reports have described worsening inequalities of National Institutes of Health (NIH) funding. We analyzed Research Project Grant data through the end of Fiscal Year 2020, confirming worsening inequalities beginning at the time of the NIH budget doubling (1998-2003), while finding that trends in recent years have reversed for both investigators and institutions, but only to a modest degree. We also find that career-stage trends have stabilized, with equivalent proportions of early-, mid-, and late-career investigators funded from 2017 to 2020. The fraction of women among funded PIs continues to increase, but they are still not at parity. Analyses of funding inequalities show that inequalities for investigators, and to a lesser degree for institutions, have consistently been greater within groups (i.e. within groups by career stage, gender, race, and degree) than between groups., Competing Interests: ML, DR No competing interests declared