Team science and the physician-scientist in the age of grand health challenges

Teaching Science to the Next Generation

Teaching science to the next generation begins with foundations laid in podiatric medical school. Interest and immersion in research continues to develop through residency as trainees prepare for cases, participate in journal clubs, present posters and articles, and attend conferences. Having adequate training is essential to production of quality research. Although challenges and barriers exist, numerous resources are available at all levels of practice to guide those who are interested in contributing to the body of literature that supports the profession. Ensuring a robust pipeline of future clinician scientists is critical to the future of the profession.

Targeting bacterial transcription factors for infection control: opportunities and challenges

The rising threat of antibiotic resistance in pathogenic bacteria emphasizes the need for new therapeutic strategies. This review focuses on bacterial transcription factors (TFs), which play crucial roles in bacterial pathogenesis. We discuss the regulatory roles of these factors through examples, and we outline potential therapeutic strategies targeting bacterial TFs. Specifically, we discuss the use of small molecules to interfere with TF function and the development of transcription factor decoys, oligonucleotides that compete with promoters for TF binding. We also cover peptides that target the interaction between the bacterial TF and other factors, such as RNA polymerase, and the targeting of sigma factors. These strategies, while promising, come with challenges, from identifying targets to designing interventions, managing side effects, and accounting for changing bacterial resistance patterns. We also delve into how Artificial Intelligence contributes to these efforts and how it may be exploited in the future, and we touch on the roles of multidisciplinary collaboration and policy to advance this research domain.Abbreviations: AI, artificial intelligence; CNN, convolutional neural networks; DTI: drug-target interaction; HTH, helix-turn-helix; IHF, integration host factor; LTTRs, LysR-type transcriptional regulators; MarR, multiple antibiotic resistance regulator; MRSA, methicillin resistant Staphylococcus aureus; MSA: multiple sequence alignment; NAP, nucleoid-associated protein; PROTACs, proteolysis targeting chimeras; RNAP, RNA polymerase; TF, transcription factor; TFD, transcription factor decoying; TFTRs, TetR-family transcriptional regulators; wHTH, winged helix-turn-helix.

Earlier First Publication Is Associated with More Future Publication

Participation in clinical research has served clinicians to develop academic careers, as well as to deepen clinical insights, implement evidence-based medicine practices, and even inspire new clinical questions. Early engagement in academic pursuits may better prepare clinicians to maintain long-term research productivity, rather than starting later in their careers.We included medical doctors who graduated from a medical university and retrospectively followed them for 10 years after graduation. The impact of at least one publication within the first 5 years on the achievement of ≥ 5 publications within 10 years was evaluated.A total of 79 medical doctors, including 60 (76%) men, were included. During the first 5 years, 21 (27%) published at least one paper. Overall, 25 (32%) achieved the primary outcome. At least one publication during the first 5 years was an independent predictor of the primary outcome (odds ratio 30.4, 95% confidence interval 2.68-251, P = 0.002). Medical doctors with at least one publication within the first 5 years had significantly higher cumulative 10-year publications compared to no publications within the first 5 years (9 [5, 13] versus 0 [0, 3], P < 0.001).In this retrospective study, we demonstrated that an early involvement in research defined by academic output was associated with higher odds of multiple publications later in a career. Prospective studies to validate our findings by involving young medical doctors in academic pursuits are needed to understand the longitudinal effects of early career academic productivity.

Learning to Prioritize Our Collaborative Opportunities: Overcoming the Bright Shiny Object Syndrome

ABSTRACT

There are multiple opportunities to participate in team science, leading to long-term benefits (eg, research impact, novelty, productivity). Scholars are not well-trained in how to choose among these opportunities, often learning via trial and error. The ability to navigate collaborations is framed by several principles and considerations: (1) locus of control (what control we have over our own behavior) and how it affects academic job satisfaction; (2) the scarcity mindset that may manifest as a result of the fear of missing future opportunities; and (3) power dynamics and inequities (eg, among women and racial/ethnic minority individuals). To provide a more systematic approach to weighing academic opportunities, the authors offer 30 questions across six overlapping domains. The domains include: the big picture (eg, Is the opportunity a building block for your career?), context (eg, How much do you have on your plate?), person (eg, Who is asking?), team (eg, Is the team productive?), role (eg, Will you lead or assist?), and outcomes (eg, Might the opportunity lead to publications and/or grants?). We offer advice for decision-making. For example, when presented with an opportunity involving a significant time commitment, it is useful to allow at least 24 hours before deciding. The authors offer advice and sample language for communicating your decision. Although every situation is different, there are several fundamental issues and questions to consider when one is presented with a new opportunity-these questions are suggested for mentors and mentees.

Maximizing Training and Mentorship in Sex as a Biological Variable Research Across Different Brain-Body Disorders

The Specialized Center of Research Excellence (SCORE) on sex differences at University of California, Los Angeles (UCLA) has a long track record studying bidirectional interactions between different organs and the brain in health and disease with a strong focus on sex as a biological variable (SABV). While the initial focus was on brain-gut interactions in irritable bowel syndrome (IBS), one of the most common disorders of gut-brain interaction, the scope of our Center's research has expanded to a range of different diseases, including inflammatory bowel disease, alcohol use disorder, obesity, urological chronic pelvic pain syndrome, and vulvodynia. This expansion of research focused on the role of brain-body and brain-gut microbiome interactions in these various disorders, aligning well with the increasing importance of multidisciplinary and interdisciplinary team science. The SCORE's Career Enhancement Core (CEC) has modeled team science as applied to SABV research, with educational and training opportunities, a mentoring program, seed grant funding, and other career development experiences that enable mentees to work across the disciplines involved in brain body research. The CEC goals are: (1) To provide seed grant funds for innovative research relevant to the overall SCORE mission and research program; (2) to recruit and foster the career development of students, trainees, and junior investigators who conduct research focused on sex differences or women's health in IBS and chronic constipation and other brain-gut disorders; (3) to facilitate and promote collaboration between the UCLA SCORE and other academic programs involved in women's health education and research; and (4) to promote the importance of SABV through community outreach using collaborative and innovative approaches. These goals focus on establishing the leading research center in sex differences in basic, translational, and clinical aspects of brain-body interactions and on providing women and underrepresented individuals with research opportunities needed to become independent investigators.

Team Science: Advancing Women and Black, Indigenous, and other People of Color on the Pathway of Conducting Clinical Research

Introduction:

Innovative discovery begins with diverse perspectives; research teams should harness this model. Black, Indigenous, and other People of Color (BIPOC) and women are underrepresented as researchers. Team science leverages collaborative and cross-disciplinary approaches to diversify the research workforce, and introduces academic (and non-academic) faculty with limited research exposure/experience to clinical research.

Methods:

In 2020, two Black women academic physicians implemented an academic collaborative – COVID-19 Characteristics, Readmissions, Outcomes, and Social Determinants of Health (CROSS) – to investigate COVID-19 health inequities, with intentional recruitment of BIPOC and women. The 37 CROSS team members were of diverse races, ethnicities, sex, specialties, and disciplines, and represented eight hospitals. Team members were electronically surveyed to determine their interest, desired activities, and level of participation in research activities; concurrently, self-identified demographics (including race, ethnicity, sex, and language(s) spoken) were obtained.

Results:

All team members completed the survey: 78.4% (n = 29) were BIPOC and 78.4% (n = 29) were women. Team members spoke 18 languages (including English). Academic medical ranks included Assistant Professor (32.4%; n = 12), Associate Professor (16.2%; n = 6), and Full Professor (2.7%; n = 1). Each member identified desired activities (data collection, data analytics, manuscript development, abstract development/poster presentation, serving as a consultant) and the percentage of time they intended to allocate to each. Between June 2020 and February 2023, the team produced five original peer-reviewed manuscripts (including this article); five members served as first or senior authors. Twenty-one abstracts were presented at local conferences, and 10 at national and regional conferences. Five members achieved academic promotion, and team members were awarded three intramural grants resulting directly from team collaborations.

Conclusion:

Intentional recruitment and assessment of team members’ desired levels of participation in an integrated clinical research team is an effective strategy to engage BIPOC and women. The CROSS Collaborative is a model for diversity and inclusion in team science and clinical research.

Learning to make a difference for chILD: Value creation through network collaboration and team science

Addressing the recognized challenges and inequalities in providing high quality healthcare for rare diseases such as children's interstitial lung disease (chILD) requires collaboration across institutional, geographical, discipline, and system boundaries. The Children's Interstitial Lung Disease Respiratory Network of Australia and New Zealand (chILDRANZ) is an example of a clinical network that brings together multidisciplinary health professionals for collaboration, peer learning, and advocacy with the goal of improving the diagnosis and management of this group of rare and ultra-rare conditions. This narrative review explores the multifaceted benefits arising from social learning spaces within rare disease clinical networks by applying the value creation framework. The operation of the chILDRANZ network is used as an example across the framework to highlight how value is generated, realized, and transferred within such collaborative clinical and research networks. The community of practice formed in the chILDRANZ multidisciplinary meetings provides a strong example of social learning that engages with the uncertainty inherent in rare disease diagnosis and management and pays attention to generate new knowledge and best practice to make a difference for children and families living with chILD. This review underscores international calls for further investment in, and support of, collaborative clinical networks and virtual centers of excellence for rare disease.

Research in orthopaedic trauma surgery: approaches of basic scientists and clinicians and the relevance of interprofessional research teams

BACKGROUND

An increasing clinical workload and growing financial, administrative and legal burdens as well as changing demands regarding work-life balance have resulted in an increased emphasis on clinical practice at the expense of research activities by orthopaedic trauma surgeons. This has led to an overall decrease in the number of scientifically active clinicians in orthopaedic trauma surgery, which represents a serious burden on research in this field. In order to guarantee that the clinical relevance of this discipline is also mirrored in the scientific field, new concepts are needed to keep clinicians involved in research.

METHODS

Literature review and discussion of the results of a survey.

RESULTS/CONCLUSION

An interdisciplinary and -professional team approach involving clinicians and basic scientists with different fields of expertise appears to be a promising method. Although differences regarding motivation, research focuses, funding rates and sources as well as inhibitory factors for research activities between basic scientists and clinicians exist, successful and long-lasting collaborations have already proven fruitful. For further implementation of the team approach, diverse prerequisites are necessary. Among those measures, institutions (e.g. societies, universities etc.) must shift the focus of their support mechanisms from independent scientist models to research team performances.

Physician-Scientists: Fixing the Leaking Pipeline - A Scoping Review

Introduction

This scoping review was undertaken to assess the current status of physician-scientists, including the challenges associated with their enrollment and retention, measures of success, and determinants of their satisfaction, all of which contribute to the dwindling numbers of physician-scientists aptly referred to as a "leaking pipeline" of physician-scientists.

Methods

A total of 2555 research documents from three databases, viz. Scopus, Web of Science, and PubMed, were selected. A total of 40 documents were considered for final analysis following the 5-stage framework of Arksey and O'Malle.

Results

Medical institutions should promote and sustain enrollments by addressing various perceived parameters of success and satisfaction. The challenge of attrition due to individual, regulatory, and sociocultural considerations also needs to be addressed.

Conclusions

Medical institutions should focus on establishing well-documented career tracks with provisions for career advancement, promotion of team science, raising mentors, giving preference to students with peer-reviewed publications for post graduate (PG) admissions, and establishing a separate office for career development and guidance for physician-scientist. It is equally important to address the factors which promote retention and prevent attrition, viz. measures of success and determinants of satisfaction. Additional measures include creating a cadre of physician-scientists in government organizations, fostering collaboration of physician-scientists with incubation centers and startups, and adding additional mandatory curriculum components focused on project-based training.

Clinician-Scientist Faculty Mentoring Program (FAME) - A New Inclusive Training Model at Penn State Increases Scholarly Productivity and Extramural Grant Funding

PURPOSE

Clinician-scientists have a high attrition rate at the junior-faculty level, before they gain independent funding. We identified the lack of skill set, clinician-scientist community and collaboration between clinician-scientists and clinicians with predominantly clinical duties, as key problems in our medium-size college of medicine.

METHODS

We designed a novel two-year educational program, the Clinician-scientist Faculty Mentoring program (FAME) specifically to target junior clinician-scientists. The program enrollment included both lab-based, "traditional" and "non-traditional" clinician-scientists, with predominantly clinical duties and limited time for research. The curriculum included the novel educational tools: Emerging technology seminars and mentored work-in-progress research seminars, integrated with mock grant review.

RESULTS

The first class enrolled 17 clinician-scientists with diverse clinical subspecialty, previous research training, and protected research time. After two years in the program, the self-assessment of FAME scholars demonstrated strong improvement in grantsmanship skills, career development, emerging technologies, and the sense of community and collaboration. Compared to the period before initiating FAME, scholars increased annual scholarly output by 65% and new extramural funding by >20-fold ($0.189 vs $4.0 million) following completion of FAME. The "traditional" clinician-scientists, who had >50% research time, increased new extramural funding by ~25-fold ($0.134 vs $3.336 million), whereas "non-traditional" clinician-scientists who had ≤50% research time increased new extramural funding by >13-fold.

CONCLUSION

Results suggest that a training program tailored specifically to clinician-scientists leads to increased scholarly productivity and grant funding regardless of research background. Implementing this type of training program nationally, with inclusion of clinician-scientists with various amounts of protected time for research, will help both "traditional" and "non-traditional" clinician-scientists to obtain a substantial independent extramural funding, fulfill their scholarly potential, and enhance their sense of community. Our model would be particularly useful for small-to-medium sized academic institutions, who have a limited clinician-scientist workforce facing competing health care system needs.

Equity, diversity and inclusion of pediatric clinician-scientists in Canada: a thematic analysis

BACKGROUND

Underrepresented voices and perspectives are missing from academic and clinical health sciences. We aimed to define the unique opportunities and challenges of pediatric clinician-scientists related to equity, diversity and inclusion; and to identify key components of training needed to support people from equity-seeking groups as emerging and early-career pediatric clinician-scientists to generate diverse health research leaders in knowledge generation, implementation and translation.

METHODS

Using a qualitative descriptive approach, we examined the experiences of clinician stakeholders. Semistructured interviews were conducted with pediatric clinician-scientist stakeholders. Thematic analysis was performed.

RESULTS

We interviewed a total of 39 individuals. Our analysis resulted in 4 interrelated themes: the pervasiveness and invisibility of sexism; the invisibility and visibility of racism; proposed individual-level solutions to the sexism and racism; and proposed institutional and system-level changes to address the porous and leaky pipeline. These themes acknowledged that, ultimately, system change is required for addressing equity, diversity and inclusion in clinical and academic training environments.

INTERPRETATION

These findings highlight the importance of addressing systemic biases that limit the inclusion of women and racialized individuals in pediatric clinician-scientist careers. Further research is needed to explore the problem of exclusion, which will, in turn, inform education of pediatric clinician-scientists and inform better ways to promote equity, diversity and inclusivity; these steps are needed to foster systemic change in the cultures that perpetuate exclusivity in both academic and clinical communities.

Fostering student and faculty scholarship in an accelerated three-year medical school

Background: In acknowledgement of the importance of research competency in academic medicine, an extracurricular student research program and faculty development researcher pathway was developed to promote scholarly productivity at New York University (NYU) Long Island School of Medicine (LISOM), a three-year accelerated Liaison Committee on Medical Education (LCME)-accredited medical school. The aim was to enhance medical students’ and faculty scholarly productivity, by creating new training programs targeting research skills and academic collaboration. Impact was assessed by initial review of the extracurricular student research program and faculty development researcher pathway. Methods: Electronic surveys via Google were sent out to all current (n = 72) students on 9/20/2021 and the faculty identified based on their primary appointment to NYU LISOM in the learning management system on 9/17/2021 to determine participation in research, presentation of research findings, satisfaction with the program, and research opportunities for students.  Student scholarly productivity was tracked using PubMed, restricted to search years 2020 through 2022.  For the faculty development researcher pathway, publications were tracked for each participant before and after completion of the program, with pre- and post-completion dates ranging from 2012 through 2020.  Results: Student survey results (29 responses out of 72) indicated 28% of students were involved in research with institutional faculty and 59% were interested in starting a research project. Most students involved in extracurricular research were satisfied with their experience and eight students have publications with faculty.  For the faculty development researcher pathway, 35% of the participants increased publications after program graduation. Conclusions: Outcomes from the student research program and faculty researcher pathway were positive regarding student research engagement and faculty scholarly productivity, though long-term outcomes are yet to be evaluated. Progress will be tracked as students continue through undergraduate and graduate medical education, and as both students and faculty progress throughout their career.

Future Objectivity Requires Perspective and Forward Combinatorial Meta-Analyses

This manuscript contributes to a future definition of objectivity by bringing together recent statements in epistemology and methodology. It outlines how improved objectivity can be achieved by systematically incorporating multiple perspectives, thereby improving the validity of science. The more result-biasing perspectives are known, the more a phenomenon of interest can be disentangled from these perspectives. Approaches that call for the integration of perspective into objectivity at the epistemological level or that systematically incorporate different perspectives at the statistical level already exist and are brought together in the manuscript. Recent developments in research methodology, such as transparency, reproducibility of research processes, pre-registration of studies, or free access to raw data, analysis strategies, and syntax, promote the explication of perspectives because they make the entire research process visible. How the explication of perspectives can be done practically is outlined in the manuscript. As a result, future research programs can be organized in such a way that meta-analyses and meta-meta-analyses can be conducted not only backward but forward and prospectively as a regular and thus well-prepared part of objectification and validation processes.

Rethinking Health Professionals’ Motivation to Do Research: A Systematic Review

Background

Health professionals’ engagement in translational health and medical research (HMR) is fundamental to evidence-based practice leading to better patient health outcomes. However, there is a decline in the number of health professionals undertaking research which has implications for patient health and the economy. Informed by the motivation-based expectancy-value-cost (EVC) and self determination theories (SDT), this systematic literature review examined the barriers and facilitators of health professionals’ (HPs) motivation to undertake research.

Methods

The literature was searched between 2011 and 2021 for relevant peer-reviewed articles written in English, using CINAHL Complete, Informit, Medline Ovid, Medline (PubMed), Scopus, Web of Science and Google Scholar databases. This systematic review was performed and reported in accordance with the PRISMA guidelines.

Results

Identified barriers to HPs’ engagement with research included the lack of knowledge, skills, and competence to conduct research, lack of protected research time, lack of funding and lack of organisational support. Integration of the findings of this review based on the EVC and SDT theories indicate that research capacity, ie, expectancy and competence is highly influenced by attitude, ie, the type of value (attainment, intrinsic or utility) and connection attributed to research. HPs who had very positive attitude towards research demonstrated all three values and were keen to take up research despite the barriers. Those who had a positive attitude were only motivated to do research because of its utility value and did not necessarily see it as having personal relevance for themselves. HPs who were unmotivated did not see any personal connection or relatedness to the research experience and saw no value in research.

Conclusion

The attitude HPs hold in their value of research is a catalyst for motivation or amotivation to engage in research as it directly influences the relevance of barriers. Facilitators that expedite the research journey have been attributed to research training, mentorship programs and supportive organisational research culture. Motivation of HPs explored through EVC and SDT is critical to the maintenance of a research culture and the clinician-researcher development pipeline.

The Rockefeller Team Science Leadership training program: Curriculum, standardized assessment of competencies, and impact of returning assessments

The ability to effectively lead an interdisciplinary translational team is a crucial component of team science success. Most KL2 Clinical Scholars have been members of scientific teams, but few have been team science leaders. There is a dearth of literature and outcome measures of effective Team Science Leadership in clinical and translational research. We focused our curriculum to emphasize Team Science Leadership, developed a list of Team Science Leadership competencies for translational investigators using a modified Delphi method, and incorporated the competencies into a quantitative evaluation survey. The survey is completed on entry and annually thereafter by the Scholar; the Scholar's primary mentor and senior staff who educate and interact with the Scholar rate the Scholar at the end of each year. The program leaders and mentor review the results with each Scholar. The survey scales had high internal consistency and good factor structure. Overall ratings by mentors and senior staff were generally high, but ratings by Scholars tended to be lower, offering opportunities for discussion and career planning. Scholars rated the process favorably. A Team Science Leadership curriculum and periodic survey of attained competencies can inform individual career development and guide team science curriculum development.

Clinician-Scientists: Can They Survive in the Modern Era?

Clinician-scientists are commonly characterized as health care professionals who are proficient in both research and clinical practice. Their dual expertise positions them to play a vital role in translating research outcomes to clinical practice. However, economic changes in the past few decades are threatening their very survival. The purposes of this article are to review some of the economic forces that pose the greatest risks to clinician-scientists in the modern era and to glean lessons from the business world in overcoming these challenges. Health care consolidation and decreasing reimbursements are putting increasing financial pressure on academic institutions, leaving them more inclined to cut back on departmental research support. Innovative companies commit a certain percentage of their revenue to research and discovery. Academic institutions should similarly view their research budget as research and discovery that will sustain the future growth of radiology. They should quantify and define expectations for academic productivity, focus on return on investment, and bolster the infrastructure to foster commercial partnerships that can provide additional revenue to support the research mission. Success in academics does not occur by accident. It requires more than individual talent and hard work. It also requires institutional leaders who are committed to developing future academic leaders and supporting innovation.

Impact of a Respiratory Disease Young Investigators' Forum on the Career Development of Physician-Scientists

Background: To reverse the dramatic decline in the U.S. physician-scientist workforce, interventions are necessary to retain physicians in research careers.

Objective: To evaluate the impact of an annual 3-day symposium, the Respiratory Disease Young Investigators' Forum (RDYIF), designed to guide fellows and junior faculty into successful physician-scientist careers.

Methods: In this retrospective, observational study, a questionnaire was e-mailed to 308 physicians who participated in the RDYIF between 2005 and 2018. The questionnaire was administered by National Jewish Health study personnel in the spring of 2019. Responses were primarily analyzed using descriptive and qualitative approaches.

Results: The response rate was 39.3% (n = 121), with 107 of responders (88.4%) completing the full survey. The majority of survey completers currently worked as physician-scientists (76.6%; n = 82), held faculty positions (88.8%; n = 95) in an academic center (90.6%; n = 97), and were currently involved in research (93.4%; n = 100). The majority had been an author on ≥10 peer-reviewed publications (61.3%, n = 65) and had been awarded research grants (71.7%; n = 76). Thirty completers (28.3%) had served as a principal investigator on one or more clinical trials. Completers indicated that participation in the RDYIF had a "strong impact" or "very strong impact" on their career development as physician-scientists.

Conclusion: Participation in the RDYIF strengthened participants' interest in physician-scientist careers and appeared to track with successful career development. Young Investigator Forums such as the RDYIF may be an effective intervention to support the declining supply of physician-scientists in North America.

Promoting interdisciplinary research to respond to public health crises: The response of the Columbia University CTSA to the opioid crisis

Effectively addressing public health crises requires dynamic and nimble interdisciplinary collaborations across the translational spectrum, from bench to clinic to community. The Clinical and Translational Science Award (CTSA) Program hubs are uniquely suited to facilitate interdisciplinary collaborations across universities and academic medical centers. This paper describes the activities at the Columbia University CTSA Program hub to address a current public health crisis, the opioid epidemic. Columbia's CTSA Program hub led a three-phase approach, based on the Conceptual Model of Transdisciplinary Scientific Collaboration as described by Stokols et al.: (1) a university-wide planning and brainstorming phase to identify key leaders across many domains who are influential in addressing the opioid epidemic, (2) a campus-wide and community outreach to identify all interested parties, and (3) ongoing targeted support for collaboration development. Preliminary metrics of success are interdisciplinary collaborations and grant funding. We describe recent examples of how interdisciplinary collaboration, academic-community partnership, and pilot funding contributed to the development and funding of innovative interdisciplinary research, including the New York site of the HEALing Communities initiative. The processes are now being used to support interdisciplinary approaches for other translational public health issues.

Different sliding mechanics in space closure of lingual orthodontics: a translational study by three-dimensional finite element method

Lingual orthodontics have become popular in modern society as they do not cause aesthetic impairment. From the translational medicine point of view, the use of biomechanical analysis to solve a clinical problem has rarely been reported. Here, we combined the clinical trial and 3-D finite element (FE) method to translate the clinical problem to the FE analysis and back to clinic. Twenty upper premolar extraction cases treated with customized lingual appliances were recruited in this study. Cephalometric films and cast records analysis showed that the "bowing effect", which is a major side effect in lingual orthodontics, occurred during the first treatment stage with single lingual cable retraction. In order to translate the problem to biomechanical research, we introduced the 3-D finite element (FE) model of a customized lingual orthodontic system. The 3-D FE model including the maxilla, periodontal ligament (PDL), and dentition was constructed from human computed tomography data. The tendency of tooth movements in three dimensions and stress distribution in the PDL were analyzed by different mechanical loading methods. 3-D FE analysis confirmed the "bowing effects" and unexpected tooth movements with application of single lingual retraction force. Interestingly, we found that applying forces on both buccal and lingual sides, called "double cable" mechanics, could prevent the "bowing effect". For the clinical trial, we applied the "double cable" force during space closure stage for 4 months, and confirmed "double cable" mechanics could correct and prevent the "bowing effect" clinically. Based on our results, both buccal and lingual forces should be used during space closure in lingual orthodontics to prevent and correct the "bowing effect". Moreover, the magnitude of buccal force should not be lower than the force on the lingual side.

So You Want to Be a Principal Investigator

Therapeutic trials represent the front line of clinical progress, where the rubber meets the road. The conduct of clinical trials requires unique skills, innate as well as learned, on the part of the investigators who conduct these studies. Often such skills are acquired on the job and are passed on from mentor to junior investigator. However, over the years, the role of the principal investigator (PI) has evolved into a vast list of roles and responsibilities that cannot readily be conveyed through a hands-on approach alone. The fast-paced tempo of drug discovery and development, and the ever-increasing numbers of therapeutic trials being conducted in the United States, combined with a decline in the number of new clinical investigators, have exposed a gap between the expectations placed on the PI and the training and experience of today's young clinicians, who are being asked to take on the responsibilities outlined in Food and Drug Administration Form 1572. This article aims to begin an exploration of the role and increasing responsibilities of a PI and the growing need for structured investigator training. We propose options to better equip the PI to achieve compliance with Good Clinical Practice.