Objective: The aim of this study was to assess the contemporary trends in National Institutes of Health (NIH) grants awarded to surgical investigators, including potential disparities. Background: The NIH remains the primary public funding source for surgical research in the United States; however, the patterns for grants and grantees are poorly understood. Methods: NIH RePORTER was queried for new grants (R01, -03, -21) awarded to Departments of Surgery (DoS). Principal investigators’ (PIs) data were extracted from publicly available information from their institutions’ websites and/or professional social media accounts. Results: The NIH awarded 1101 new grants (total: $389,006,782; median: $313,030) between 2008 and 2018. Funding to DoS has doubled in the last 10 years ($22,983,500–2008 to $49,446,076–2018). Midwest/Southeast institutions and surgical oncologists accounted for majority of the grants (31.9% and 24.5%, respectively). Only 24.7% of the projects were led by female PIs, who were predominantly nonphysician PhD scientists (52% vs 37.7% PhD-only male PIs; P = 0.002). During this time, there was a significant increase from 12.4% to 31.7% in grants awarded to PIs with >15 years of experience. These grants were associated with 8215 publications; however, only 13.2% were published in high-impact journals (impact factor ≥10). 4.4% of the grants resulted in patents, and these were associated with higher award amounts ($345,801 vs $311,350; P = 0.030). On multivariate analysis, combined MD/PhD degree [odds ratio (OR) 5.98; 95% confidence interval (CI) 2.18–16.39; P < 0.001] was associated with improved odds of patent creation; conversely, practicing surgeon PIs affected patent creation negatively (OR 0.31; 95% CI 0.11–0.85; P = 0.024). Conclusion: In the last decade, a greater proportion of NIH grants in DoS were awarded to more experienced investigators. Disparities exist among grantees, and female investigators are underrepresented, especially among practicing surgeons.

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Research relating to the causes and treatment of absconding behaviour among individuals with severe neuropsychiatric disability is reviewed and a non-aversive intervention is reported. Interventions with two clients with severe neuropsychiatric disability and repetitive absconding behaviour are presented in a multiple-baseline within-client single-case format. Multiple empirical treatment approaches were applied to culminate in a successful non-aversive intervention. The effective intervention used reinforcement approaches that were congruent with the client's goals rather than increased restriction. The design of one case included reversal, indicating that it was the intervention, not other factors, that reduced the absconding behaviour. Absconding attempts and absconding incidents were reduced to zero using non-aversive interventions where more restrictive interventions had failed to have a lasting impact. A counter-intuitive non-aversive intervention was effective in eliminating dangerous absconding behaviour in two clients with severe neuropsychiatric disorders.

Objective: To assess contemporary trends in the National Institutes of Health (NIH) Career Development (K) Awards within the Departments of Surgery and its impact on the likelihood of achieving independent R01 grants. Background: The NIH provides K-type Career Development Awards to nurture young clinicians toward a productive academic career, thereby maintaining a pipeline of physician-scientists. However, the impact of K awards on career trajectory of surgeons remains unclear. Methods: The NIH grant data was queried for all new K08/K23 grants awarded to Departments of Surgery (1999–2019). Principal Investigators’ data and grant-related information was obtained. Results: The NIH awarded 298 K08/23 surgical grants ($41,893,170) over the last 2 decades. Median budget increased from $116,370 to $167,508 (P<0.001). Of grantees, 83.2% were MDs, 15.1% MD/PhD, and 1.7% PhDs, with 25.2% being women. Principal Investigators’ were mostly practicing surgeons (91.1%) with fellowship training (82.4%) and young in their careers {4 [interquartile ranges (IQR) 4] years of experience}. Vascular surgery (15.9%), Complex General Surgical Oncology (15.1%), and Trauma/Critical Care (14.6%) were the most frequent specialties. Awards were associated with 3,336 publications [median 8/project (IQR 13)]. The majority of K grantees (77.2%) currently hold an academic faculty position. Only 32.2% of awardees received independent R01 grant funding, at a median of 5.5 years (IQR 5) after their K awards. Sex (P = 0.71), previous fellowship training (P = 0.63), type of surgical specialty (P = 0.72), or MD/PhD degree (P = 0.75) were not associated with increased likelihood of achieving a subsequent R01 award. Conclusion: Although the majority of K awardees maintain an academic career, only a limited number of grantees progress to obtain NIH R01 funding. Increased mentorship, financial support, and infrastructure are needed to facilitate career development awardees opportunities to enhance their ability to achieve independent funding.

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This is a working guide for a technique for the initial interview in marital therapy. There is a discussion of the seating arrangement and the opening. The therapist lays out ground rules and suggests a theoretical framework for the couple. Each partner is asked to do a self-assessment scale aimed at assessing his or her desire to stay in the marriage. This is followed by a discussion of family behavior. The session is terminated with homework for each of the partners, and a therapeutic contract is made. Nonsystematic feedback suggests the technique is useful.Aponte, H. J., Organizing Treatment Around the Family's Problems and Their Structural Bases, Psychiat. Quart., 48, 209-222, 1974. This is a theoretical article based on the author's clinical work in a child guidance clinic (which has a "family orientation" rather than a "psycho-analytic" orientation). The symptoms of the child are reactions to pathology in the family constellation. Techniques of treatment include getting the family to agree on the problem, identifying the participants to which the problem is related, and making pledges to work on changing the structural base of the problem. Several case examples are presented in support of the usefulness of the model. Counts, R. M., Further Thoughts on Family Therapy, Contemp. Psychoanal., 10, 496-501, 1974.

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