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Reducing the Burden of Injury: Advancing Prevention and Treatment
The total level of injury-related funding at NIH was about $194 million in FY 1995 (NCIPC, 1997a). Injury funding constitutes less than 2 percent of the NIH budget. NIH supports three relatively small programs with injury or rehabilitation as the sole focus. These three programs, which are described below, represent about two-thirds of the total NIH injury expenditures. They are located within three separate institutes: the National Institute of General Medical Sciences (NIGMS), the National Institute of Neurological Disorders and Stroke (NINDS), and the National Institute of Child Health and Human Development (NICHD). Even though the remaining institutes and centers at NIH sponsor some small degree of injury research related to their particular mission, these three institutes have the most concentrated and identifiable programs. All are extramural programs, meaning that the research and training are conducted via grants and other funding instruments awarded mostly to universities, medical centers, and other academic institutions after a peer-review process. The competitive peer-review process is considered responsible for NIH's reputation for scientific excellence.
NIGMS has the most broad-based program. Its program on trauma and burns, funded at approximately $48 million in FY 1998, supports investigator-initiated grants, center grants, and training grants that span the spectrum of basic and clinical research, including treatment of acute trauma. 9 The NINDS program on trauma, regeneration, and pain—funded at approximately $60 million annually—is almost exclusively focused on neurotrauma. Finally, a center within the NICHD—the National Center for Medical Rehabilitation Research—funds about $20 million annually in rehabilitation research. Yet not all rehabilitation research is injury related, because injury is but one of a constellation of diseases and conditions responsible for functional disability. These three extramural programs (within NIGMS, NINDS, and NICHD) are administered by a total of 3–5 FTEs.
NIH's largest research training program in injury is supported by NIGMS. Under this institute's trauma and burn program, an estimated $3 million is spent annually on about 19 training grants to institutions nationwide. These grants pay
The NIGMS program focuses on the following topics: organ, tissue, cellular, and molecular responses to injury; mechanisms of cellular and organ failure; pathophysiologic changes following injury and factors or therapies influencing recovery; factors involved in wound healing, tissue repair, and wound infection; mechanisms of electrolyte and solute transport across cell membranes and mechanisms of resuscitation therapy; cryopreservation of cells and organs; and behavioral consequences of trauma and burn injury (among other areas).