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"A Consensus Study Report of the National Academies of Sciences, Engineering, Medicine."

The National Academies of Sciences, Engineering, and Medicine convened a public workshop in September 2017 to explore the evidence for achieving global harmonization of methodological approaches to establishing nutrient intake recommendations. Participants reviewed current nutrient intake recommendations, discussed the feasibility of harmonizing approaches to setting such recommendations globally, examined the development of principles by which they may be applied in diverse contexts that relate to individuals or populations, or regulatory purposes, and examined perceptions and acceptance of nutrient intake recommendations by different stakeholders. This publication summarizes the presentations and discussions from the workshop.

"A pressing challenge in the modern health care system is the gap between education and clinical practice. Emerging technologies have the potential to bridge this gap by creating the kind of team-based learning environments and clinical approaches that are increasingly necessary in the modern health care system both in the United States and around the world. To explore these technologies and their potential for improving education and practice, the National Academies of Sciences, Engineering, and Medicine hosted a workshop in November 2017. Participants explored effective use of technologies as tools for bridging identified gaps within and between health professions education and practice in order to optimize learning, performance and access in high-, middle-, and low-income areas while ensuring the well-being of the formal and informal health workforce. This publication summarizes the presentations and discussions from the workshop"--

The surface of the human body and its mucous membranes are heavily colonized by microorganisms. Our understanding of the contributions that complex microbial communities make to health and disease is advancing rapidly. Most microbiome research to date has focused on the mouse as a model organism for delineating the mechanisms that shape the assembly and dynamic operations of microbial communities. However, the mouse is not a perfect surrogate for studying different aspects of the microbiome and how it responds to various environmental and host stimuli, and as a result, researchers have been conducting microbiome studies in other animals. To examine the different animal models researchers employ in microbiome studies and to better understand the strengths and weaknesses of each of these model organisms as they relate to human and nonhuman health and disease, the Roundtable on Science and Welfare in Laboratory Animal Use of the National Academies of Sciences, Engineering, and Medicine convened a workshop in December 2016. The workshop participants explored how to improve the depth and breadth of analysis of microbial communities using various model organisms, the challenges of standardization and biological variability that are inherent in gnotobiotic animal-based research, the predictability and translatability of preclinical studies to humans, and strategies for expanding the infrastructure and tools for conducting studies in these types of models. This publication summarizes the presentations and discussions from the workshop.

"BioWatch is the Department of Homeland Security's (DHS's) system for detecting an aerosolized biological attack using collectors that are positioned strategically across the country to continuously monitor the air for biological threats. As currently deployed, BioWatch collectors draw air through filters that field technicians collect daily and transport to laboratories, where professional technicians analyze the material collected on the filter for evidence of biological threats. As part of the BioWatch program's efforts to enhance its effectiveness and capabilities, particularly with regard to detecting biological threats in challenging indoor environments, DHS requested the National Academies of Sciences, Engineering, and Medicine hold a workshop to explore alternative and effective biodetection systems for aerosolized biological agents that would meet BioWatch's technical and operational requirements, integrate into the existing system architecture and public health infrastructure, and be deployable by 2027. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

Solving the world's health challenges requires multidisciplinary collaborations that bring together the talents, experiences, resources, and ideas from multiple sectors. These collaborations in global health frequently occur through public-private partnerships (PPPs) in which public and private parties share risks, responsibilities, and decision-making processes with the objective of collectively and more effectively addressing a common goal. However, these numerous stakeholders bring varying strengths and resources to global health partnerships, but they also bring their own organizational cultures, regulations, and expectations. Managing partnerships among them is complex and requires intentional and thoughtful governance. Over the last several decades, as the number of interested stakeholders, resources invested, and initiatives launched within the global health field has grown, effective governance of global health PPPs has become increasingly critical. To explore the role of governance in PPPs for global health, the Forum on Public-Private Partnerships for Global Health and Safety convened a workshop. Participants explored best practices, common challenges, and lessons learned in the varying approaches to partnership governance. They also highlighted key issues in the governance of PPPs for global health with the goal of increasing their effectiveness in improving health outcomes. This publication summarizes the presentations and discussions from the workshop.

"Chronic pain is one of the most prevalent, costly, and disabling health conditions in the United States. Estimates show that more than 11 percent of the American population suffer from chronic pain, yet the federal pain research investment has been minimal. In parallel with a gradual increased recognition of the problems of treating chronic pain, the opioid epidemic has emerged as a growing public health emergency. The intersection of these two crises lies in the fact that an unintended consequence of treating pain has been an increasing number of opioid prescriptions and diversion of drugs for illicit purposes. In May 2017, the National Institutes of Health (NIH), and the National Institute on Drug Abuse announced a public-private partnership to develop solutions to the opioid crisis and cut in half the time it takes to develop non-addictive analgesics. To advance the planning of NIH's anticipated public-private partnerships, the National Academies' Forum on Neuroscience and Nervous Systems Disorders hosted a public workshop that brought together a diverse group of stakeholders from academia, federal agencies, advocacy organizations and companies developing therapeutics for pain and opioid use disorders. Participants discussed potential strategies to accelerate development of non-addictive pain medications and treatments for opioid use disorders. This publication summarizes the presentations and discussions from the workshop"--

Oil and gas well completion and stimulation technologies to develop unconventional hydrocarbon resources in the United States have evolved over the past several decades, particularly in relation to the development of shale oil and shale gas. Shale oil and shale gas resources and the technology associated with their production are often termed "unconventional" because the oil and gas trapped inside the shale or other low-permeability rock formation cannot be extracted using conventional technologies. Since about 2005, the application of these technologies to fields in the U.S. have helped produce natural gas and oil in volumes that allowed the country to reduce its crude oil imports by more than 50% and to become a net natural gas exporter. The regional and national economic and energy advances gained through production and use of these resources have been accompanied, however, by rapid expansion of the infrastructure associated with the development of these fields and public concern over the impacts to surface- and groundwater, air, land, and communities where the resources are extracted. The intent of the first day of the workshop of the National Academies of Sciences, Engineering, and Medicine's Roundtable on Unconventional Hydrocarbon Development was to discuss onshore unconventional hydrocarbon development in the context of potential environmental impacts and the ways in which the risks of these kinds of impacts can be managed. Specifically, the workshop sought to examine the lifecycle development of these fields, including decommissioning and reclamation of wells and related surface and pipeline infrastructure, and the approaches from industry practice, scientific research, and regulation that could help to ensure management of the operations in ways that minimize impacts to the environment throughout their active lifetimes and after operations have ceased. This publication summarizes the presentations and discussions from the workshop.

Graduate medical education (GME) is critical to the career development of individual physicians, to the functioning of many teaching institutions, and to the production of our physician workforce. However, recent reports have called for substantial reform of GME. The current lack of established GME outcome measures limits our ability to assess the impact of individual graduates, the performance of residency programs and teaching institutions, and the collective contribution of GME graduates to the physician workforce. To examine the opportunities and challenges in measuring and assessing GME outcomes, the National Academies of Sciences, Engineering, and Medicine held a workshop on October 10-11, 2017, in Washington, DC. Workshop participants discussed: meaningful and measurable outcomes of GME; possible metrics that could be used to track these GME outcomes; possible mechanisms for collecting, collating, analyzing, and reporting these data; and further work to accomplish this ambitious goal. This publication summarizes the presentations and discussions from the workshop.

Prior to 2012, unmanned aircraft systems (UAS) technology had been primarily used by the military and hobbyists, but it has more recently transitioned to broader application, including commercial and scientific applications, as well as to expanded military use. These new uses encroach on existing structures for managing the nation's airspace and present significant challenges to ensure that UASs are coordinated safely and suitably with existing manned aircraft and air traffic management systems, particularly with the National Airspace System (NAS). Of particular concern is the interaction between human pilots, operators, or controllers and increasingly automated systems. Enhanced understanding of these interactions is essential to avoid unintended consequences, especially as new technologies emerge. In order to explore these issues, the National Academies of Sciences, Engineering, and Medicine organized a 2-day workshop in January 2018. This publication summarizes the presentations and discussions from the workshop.

Genomic applications are being integrated into a broad range of clinical and research activities at health care systems across the United States. This trend can be attributed to a variety of factors, including the declining cost of genome sequencing and the potential for improving health outcomes and cutting the costs of care. The goals of these genomics-based programs may be to identify individuals with clinically actionable variants as a way of preventing disease, providing diagnoses for patients with rare diseases, and advancing research on genetic contributions to health and disease. Of particular interest are genomics- based screening programs, which will, in this publication, be clinical screening programs that examine genes or variants in unselected populations in order to identify individuals who are at an increased risk for a particular health concern (e.g., diseases, adverse drug outcomes) and who might benefit from clinical interventions. On November 1, 2017, the National Academies of Sciences, Engineering, and Medicine hosted a public workshop to explore the challenges and opportunities associated with integrating genomics-based screening programs into health care systems. This workshop was developed as a way to explore the challenges and opportunities associated with integrating genomics-based programs in health care systems in the areas of evidence collection, sustainability, data sharing, infrastructure, and equity of access. This publication summarizes the presentations and discussions from the workshop.

"To derive statistics about crime - to estimate its levels and trends, assess its costs to and impacts on society, and inform law enforcement approaches to prevent it - a conceptual framework for defining and thinking about crime is virtually a prerequisite. Developing and maintaining such a framework is no easy task, because the mechanics of crime are ever evolving and shifting: tied to shifts and development in technology, society, and legislation. Interest in understanding crime surged in the 1920s, which proved to be a pivotal decade for the collection of nationwide crime statistics. Now established as a permanent agency, the Census Bureau commissioned the drafting of a manual for preparing crime statistics--intended for use by the police, corrections departments, and courts alike. The new manual sought to solve a perennial problem by suggesting a standard taxonomy of crime. Shortly after the Census Bureau issued its manual, the International Association of Chiefs of Police in convention adopted a resolution to create a Committee on Uniform Crime Records --to begin the process of describing what a national system of data on crimes known to the police might look like. Report 1 performed a comprehensive reassessment of what is meant by crime in U.S. crime statistics and recommends a new classification of crime to organize measurement efforts. This second report examines methodological and implementation issues and presents a conceptual blueprint for modernizing crime statistics"--Publisher's description.

The National Climate Assessment, coordinated by the U.S. Global Change Research Program, is a mandated report intended to inform response decisions. These reports are developed every four years.

"Many different groups of people are subject to stereotypes. Positive stereotypes (e.g., "older and wiser") may provide a benefit to the relevant groups. However, negative stereotypes of aging and of disability continue to persist and, in some cases, remain socially acceptable. Research has shown that when exposed to negative images of aging, older persons demonstrate poor physical and cognitive performance and function, while those who are exposed to positive images of aging (or who have positive self-perceptions of aging) demonstrate better performance and function. Furthermore, an individual's expectations about and perceptions of aging can predict future health outcomes. To better understand how stereotypes affect older adults and individuals with disabilities, the National Academies of Sciences, Engineering, and Medicine, with support from AARP, convened a public workshop on October 10, 2017. This publication summarizes the presentations and discussions from the workshop"--

"Abortion is a legal medical procedure that has been provided to millions of American women. Since the Institute of Medicine first reviewed the health implications of national legalized abortion in 1975, there has been a plethora of related scientific research, including well-designed randomized clinical trials, systematic reviews, and epidemiological studies examining abortion care. This research has focused on examining the relative safety of abortion methods and the appropriateness of methods for different clinical circumstances. With this growing body of research, earlier abortion methods have been refined, discontinued, and new approaches have been developed. The Safety and Quality of Abortion Care in the United States offers a comprehensive review of the current state of the science related to the provision of safe, high-quality abortion services in the United States. This report considers 8 research questions and presents conclusions, including gaps in research"--Publisher's description.

"Commercially significant amounts of crude oil and natural gas lie under the continental shelf of the United States. Advances in locating deposits, and improvements in drilling and recovery technology, have made it technically and economically feasible to extract these resources under harsh conditions. But extracting these offshore petroleum resources involves the possibility, however remote, of oil spills, with resulting damage to the ocean and the coastline ecosystems and risks to life and limb of those performing the extraction. The environmental consequences of an oil spill can be more severe underwater than on land because sea currents can quickly disperse the oil over a large area and, thus, cleanup can be problematic. Bolted connections are an integral feature of deep-water well operations. High-Performance Bolting Technology for Offshore Oil and Natural Gas Operations summarizes strategies for improving the reliability of fasteners used in offshore oil exploration equipment, as well as best practices from other industrial sectors. It focuses on critical bolting--bolts, studs, nuts, and fasteners used on critical connections"--Publisher's description

"In its landmark report, Health Literacy: A Prescription to End Confusion, the Institute of Medicine noted that there are 90 million adults in the United States with limited health literacy who cannot fully benefit from what the health and health care systems have to offer. Since the release of that report, health literacy has become a vibrant research field that has developed and disseminated a wide range of tools and practices that have helped organizations, ranging in size from large health care systems to individual health care providers and pharmacists, to engage in health literate discussions with and provide health literate materials for patients and family members. Improving the health literacy of organizations can be an important component of addressing the social determinants of health and achieving the triple aim of improving the patient experience, improving the health of populations, and reducing the cost of care. However, the focus on organizations does not address the larger issue of how to improve health literacy across the U.S. population. To get a better understanding of the state of community-based health literacy interventions, the Roundtable on Health Literacy hosted a workshop on July 19, 2017 on community-based health literacy interventions. It featured examples of community-based health literacy programs, discussions on how to evaluate such programs, and the actions the field can take to embrace this larger view of health literacy. This publication summarizes the presentations and discussions from the workshop." --

"Health literacy, cultural competence, and language access services are distinct but inextricably linked concepts for delivering equitable care to all members of the increasingly diverse population of the United States. These concepts are linked, but they developed via different paths, and each has its own unique focus with regard to enabling every individual to obtain the ability to process and understand basic health information and services needed to make appropriate health care decisions. Fragmentation of these disciplines has impeded implementation of relevant measures for quality improvement and accountability. To foster an integrated approach to health literacy, cultural competency, and language access services, the Roundtable on Health Literacy initiated a project with three components: a commissioned paper to propose a framework for integrating measurements of health literacy, cultural competency, and language access; a workshop to review and discuss the framework; and a second commissioned paper that will provide a roadmap for integrating health literacy, cultural competency, and language access services as well as a revised measurement framework. Held on May 4, 2017, the workshop explored the quality performance measures for integration of health literacy, cultural competence, and language access services. This publication summarizes the presentations and discussions from the workshop"--

For the past 17 years, the U.S. National Commission on Mathematics Instruction (USNC/MI) has held workshops with mathematics educators from countries that typically perform well on international assessments and have a history of strong mathematics education programs, such as Japan, China, and South Korea. Finland is among this group. Even though its mathematics education system has some common characteristics with other top-performing nations, such as a great social respect for the teaching profession, it also has unique characteristics. The USNC/MI, a standing committee of the National Academies of Sciences, Engineering, and Medicine, planned a workshop at which U.S. and Finnish mathematics educators could exchange information and ideas about the preparation of new mathematics teachers and the means of providing them with support and professional development throughout their careers. While this is not the first time U.S. and Finnish mathematics educators have discussed educational practices, this workshop focused primarily on teacher development in both nations in the context of mathematics education. This publication summarizes the presentations and discussions from the workshop.

"Encryption protects information stored on smartphones, laptops, and other devices - in some cases by default. Encrypted communications are provided by widely used computing devices and services - such as smartphones, laptops, and messaging applications - that are used by hundreds of millions of users. Individuals, organizations, and governments rely on encryption to counter threats from a wide range of actors, including unsophisticated and sophisticated criminals, foreign intelligence agencies, and repressive governments. Encryption on its own does not solve the challenge of providing effective security for data and systems, but it is an important tool. At the same time, encryption is relied on by criminals to avoid investigation and prosecution, including criminals who may unknowingly benefit from default settings as well as those who deliberately use encryption. Thus, encryption complicates law enforcement and intelligence investigations. When communications are encrypted "end-to-end," intercepted messages cannot be understood. When a smartphone is locked and encrypted, the contents cannot be read if the phone is seized by investigators. Decrypting the Encryption Debate reviews how encryption is used, including its applications to cybersecurity; its role in protecting privacy and civil liberties; the needs of law enforcement and the intelligence community for information; technical and policy options for accessing plaintext; and the international landscape. This book describes the context in which decisions about providing authorized government agencies access to the plaintext version of encrypted information would be made and identifies and characterizes possible mechanisms and alternative means of obtaining information"--

The National Academies of Sciences, Engineering, and Medicine's Army Research Laboratory Technical Assessment Board (ARLTAB) provides biennial assessments of the scientific and technical quality of the research, development, and analysis programs at the Army Research Laboratory (ARL), focusing on ballistics sciences, human sciences, information sciences, materials sciences, and mechanical sciences. This interim report summarizes the findings of the ARLTAB for the first year of this biennial assessment; the current report addresses approximately half the portfolio for each campaign; the remainder will be assessed in 2018.

"The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience"--

"A Consensus Study Report of the National Academies of Sciences, Engineering, Medicine."

Participants of the July 17-18, 2017, symposium titled Opportunities and Approaches for Supplying Molybdenum-99 and Associated Medical Isotopes to Global Markets examined current trends in molybdenum-99 production, prospects for new global supplies, and technical, economic, regulatory, and other considerations for supplying molybdenum-99 to global markets. This publication summarizes the presentations and discussions from the symposium.

Instructional materials are a key means to achieving the goals of science education--an enterprise that yields unique and worthwhile benefits to individuals and society. As states and districts move forward with adoption and implementation of the Next Generation Science Standards (NGSS) or work on improving their instruction to align with A Framework for K-12 Science Education (the Framework), instructional materials that align with this new vision for science education have emerged as one of the key mechanisms for creating high-quality learning experiences for students. In response to the need for more coordination across the ongoing efforts to support the design and implementation of instructional materials for science education, the National Academies of Sciences, Engineering, and Medicine convened a public workshop in June 2017. The workshop focused on the development of instructional materials that reflect the principles of the Framework and the NGSS. This publication summarizes the presentations and discussions from the workshop.

Spacecraft depend on electronic components that must perform reliably over missions measured in years and decades. Space radiation is a primary source of degradation, reliability issues, and potentially failure for these electronic components. Although simulation and modeling are valuable for understanding the radiation risk to microelectronics, there is no substitute for testing, and an increased use of commercial-off-the- shelf parts in spacecraft may actually increase requirements for testing, as opposed to simulation and modeling. Testing at the Speed of Light evaluates the nation's current capabilities and future needs for testing the effects of space radiation on microelectronics to ensure mission success and makes recommendations on how to provide effective stewardship of the necessary radiation test infrastructure for the foreseeable future.

Approximately 4 million U.S. service members took part in the wars in Afghanistan and Iraq. Shortly after troops started returning from their deployments, some active-duty service members and veterans began experiencing mental health problems. Given the stressors associated with war, it is not surprising that some service members developed such mental health conditions as posttraumatic stress disorder, depression, and substance use disorder. Subsequent epidemiologic studies conducted on military and veteran populations that served in the operations in Afghanistan and Iraq provided scientific evidence that those who fought were in fact being diagnosed with mental illnesses and experiencing mental health-related outcomes--in particular, suicide--at a higher rate than the general population. This report provides a comprehensive assessment of the quality, capacity, and access to mental health care services for veterans who served in the Armed Forces in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn. It includes an analysis of not only the quality and capacity of mental health care services within the Department of Veterans Affairs, but also barriers faced by patients in utilizing those services.

Alcohol-impaired driving is an important health and social issue as it remains a major risk to Americans' health today, surpassing deaths per year of certain cancers, HIV/AIDS, and drownings, among others, and contributing to long-term disabilities from head and spinal injuries. Progress has been made over the past decades towards reducing these trends, but that progress has been incremental and has stagnated more recently. Getting to Zero Alcohol-Impaired Driving Fatalities examines which interventions (programs, systems, and policies) are most promising to prevent injuries and death from alcohol-impaired driving, the barriers to action and approaches to overcome them, and which interventions need to be changed or adopted. This report makes broad-reaching recommendations that will serve as a blueprint for the nation to accelerate the progress in reducing alcohol-impaired driving fatalities.

"Decades of continuous efforts to address known hazards in the national airspace system (NAS) and to respond to issues illuminated by analysis of incidents and accidents have made commercial airlines the safest mode of transportation. The task of maintaining a high level of safety for commercial airlines is complicated by the dynamic nature of the NAS. The number of flights by commercial transports is increasing; air traffic control systems and procedures are being modernized to increase the capacity and efficiency of the NAS; increasingly autonomous systems are being developed for aircraft and ground systems, and small aircraft--most notably unmanned aircraft systems--are becoming much more prevalent. As the NAS evolves to accommodate these changes, aviation safety programs will also need to evolve to ensure that changes to the NAS do not inadvertently introduce new risks. Real-time system-wide safety assurance (RSSA) is one of six focus areas for the National Aeronautics and Space Administration (NASA) aeronautics program. NASA envisions that an RSSA system would provide a continuum of information, analysis, and assessment that supports awareness and action to mitigate risks to safety. Maintaining the safety of the NAS as it evolves will require a wide range of safety systems and practices, some of which are already in place and many of which need to be developed. This report identifies challenges to establishing an RSSA system and the high-priority research that should be implemented by NASA and other interested parties in government, industry, and academia to expedite development of such a system"--Publisher's description.

The National Science Foundation's National Center for Science and Engineering Statistics (NCSES), one of the nation's principal statistical agencies, is charged to collect, acquire, analyze, report, and disseminate statistical data related to the science and engineering enterprise in the United States and other nations that is relevant and useful to practitioners, researchers, policymakers, and to the public. NCSES data, based primarily on several flagship surveys, have become the major evidence base for American science and technology policy, and the agency is well respected globally for these data. This report assesses and provides guidance on NCSES's approach to measuring the science and engineering workforce population in the United States. It also proposes a framework for measuring the science and engineering workforce in the next decade and beyond, with flexibility to examine emerging issues related to this unique population while at the same time allowing for stability in the estimation of key trends