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During public health emergencies (PHEs) involving chemical, biological, radiological, or nuclear threats or emerging infectious diseases, medical countermeasures (MCMs) (e.g., drugs, vaccines, devices) may need to be dispensed or administered to affected populations to help mitigate the human health impact of the threat. The optimal MCMs determined for use during an emergency might be U.S. Food and Drug Administration (FDA) approved but used in unapproved ways (e.g., in a new age group or against a new agent); FDA approved using animal models because human efficacy testing is not ethical or feasible; or not yet FDA approved for any indication. As part of the United States' scientific and research preparedness enterprise, there is an imperative to go "beyond the last mile" of MCM dispensing and administration to build and maintain a national capability to monitor and assess the use of MCMs (e.g., safety, compliance, clinical benefit) after they have been dispensed during PHEs. To further the discussion on this need, the Board on Health Sciences Policy of the National Academies of Sciences, Engineering, and Medicine hosted a 2-day public workshop, Building a National Capability to Monitor and Assess Medical Countermeasure Use in Response to Public Health Emergencies. The workshop, sponsored by FDA, was held on June 6-7, 2017, in Washington, DC. Workshop participants discussed the roles and efforts of the federal government and of relevant stakeholders with an interest in building and maintaining a national PHE MCM active monitoring and assessment capability. This publication summarizes the presentations and discussions from the workshop.

On June 26, 2017, the Forum on Regenerative Medicine hosted a public workshop in Washington, DC, titled Navigating the Manufacturing Process and Ensuring the Quality of Regenerative Medicine Therapies in order to examine and discuss the challenges, opportunities, and best practices associated with defining and measuring the quality of cell and tissue products and raw materials in the research and manufacturing of regenerative medicine therapies. The goal of the workshop was to learn from existing examples of the manufacturing of early-generation regenerative medicine products and to address how progress could be made in identifying and measuring critical quality attributes. The workshop also addressed the challenges of designing and adhering to standards as a way of helping those who are working to scale up processes and techniques from a research laboratory to the manufacturing environment. This publication summarizes the presentations and discussions from the workshop.

"The field of computer science (CS) is currently experiencing a surge in undergraduate degree production and course enrollments, which is straining program resources at many institutions and causing concern among faculty and administrators about how best to respond to the rapidly growing demand. There is also significant interest about what this growth will mean for the future of CS programs, the role of computer science in academic institutions, the field as a whole, and U.S. society more broadly. Assessing and Responding to the Growth of Computer Science Undergraduate Enrollments seeks to provide a better understanding of the current trends in computing enrollments in the context of past trends. It examines drivers of the current enrollment surge, relationships between the surge and current and potential gains in diversity in the field, and the potential impacts of responses to the increased demand for computing in higher education, and it considers the likely effects of those responses on students, faculty, and institutions. This report provides recommendations for what institutions of higher education, government agencies, and the private sector can do to respond to the surge and plan for a strong and sustainable future for the field of CS in general, the health of the institutions of higher education, and the prosperity of the nation" -- Publisher's description

"Palliative care is the interdisciplinary specialty focused on improving quality of life for people with serious illness and their families. This interdisciplinary care is provided by doctors, nurses, social workers, chaplains and others who work together with the patient's other doctors to provide an extra layer of support. Such care is appropriate for people at any age and at any stage in a serious illness, and can be provided together with curative treatment to address clinical, emotional, psychosocial and spiritual concerns of the patient and their family. To better understand how the principles of palliative care can be integrated into the overall provision of care and services to those facing serious illness, the Roundtable on Quality Care for People with Serious Illness held a public workshop in April 2017. This publication summarizes the presentations and discussions from the workshop"--

As the United States continues to adapt to a more digital, mobile, and interconnected world, health care and public health professionals have sought to better prepare for and respond to long-standing and emerging threats to the nation's health security. Health security is the collective effort to prevent, protect against, mitigate, respond to, and recover from the health consequences of natural, man-made, and technological disasters. Although substantial progress has been made in the past 15 years toward improving health care and public health systems and capacities for health security threats, many complex challenges persist, and often the nation's preparedness efforts are not sufficient. On March 8-9, 2017, the National Academies of Sciences, Engineering, and Medicine's Forum on Medical and Public Health Preparedness for Disasters and Emergencies hosted a two-day public workshop to acknowledge these persistent issues; to evaluate past, and perhaps inadequate, approaches to addressing them; and to discuss intentional and innovative new solutions. This publication summarizes the presentations and discussions from the workshop--

The Planning Committee on Connector Reliability for Offshore Oil and Natural Gas Operations held the Workshop on Bolting Reliability for Offshore Oil and Natural Gas Operations in Washington, D.C., on April 10-11, 2017. The workshop was designed to advance and develop a comprehensive awareness of the outstanding issues associated with fastener material failures and equipment reliability issues. Speakers and participants were also encouraged to discuss possible paths for ameliorating risks associated with fasteners used for subsea critical equipment in oil and gas operations. This publication summarizes the presentations and discussions from the workshop.

The ocean is an integral component of the Earth's climate system. It covers about 70% of the Earth's surface and acts as its primary reservoir of heat and carbon, absorbing over 90% of the surplus heat and about 30% of the carbon dioxide associated with human activities, and receiving close to 100% of fresh water lost from land ice. With the accumulation of greenhouse gases in the atmosphere, notably carbon dioxide from fossil fuel combustion, the Earth's climate is now changing more rapidly than at any time since the advent of human societies. Society will increasingly face complex decisions about how to mitigate the adverse impacts of climate change such as droughts, sea-level rise, ocean acidification, species loss, changes to growing seasons, and stronger and possibly more frequent storms. Observations play a foundational role in documenting the state and variability of components of the climate system and facilitating climate prediction and scenario development. Regular and consistent collection of ocean observations over decades to centuries would monitor the Earth's main reservoirs of heat, carbon dioxide, and water and provides a critical record of long-term change and variability over multiple time scales. Sustained high-quality observations are also needed to test and improve climate models, which provide insights into the future climate system. Sustaining Ocean Observations to Understand Future Changes in Earth's Climate considers processes for identifying priority ocean observations that will improve understanding of the Earth's climate processes, and the challenges associated with sustaining these observations over long timeframes--Publishers website.

The Superfund program of the US Environmental Protection Agency (EPA) was created in the 1980s to address human-health and environmental risks posed by abandoned or uncontrolled hazardous-waste sites. Identification of Superfund sites and their remediation is an expensive multistep process. As part of this process, EPA attempts to identify parties that are responsible for the contamination and thus financially responsible for remediation. Identification of potentially responsible parties is complicated because Superfund sites can have a long history of use and involve contaminants that can have many sources. Such is often the case for mining sites that involve metal contamination; metals occur naturally in the environment, they can be contaminants in the wastes generated at or released from the sites, and they can be used in consumer products, which can degrade and release the metals back to the environment. This report examines the extent to which various sources contribute to environmental lead contamination at Superfund sites that are near lead-mining areas and focuses on sources that contribute to lead contamination at sites near the Southeast Missouri Lead Mining District. It recommends potential improvements in approaches used for assessing sources of lead contamination at or near Superfund sites.

The Manufacturing USA initiative seeks to reinforce U.S.-based advanced manufacturing through partnerships among industry, academia, and government. Started in 2012 and established with bipartisan support by the Revitalize American Manufacturing and Innovation Act of 2014, the initiative envisages a nationwide network of research centers for manufacturing innovation. As of May 2017, 14 manufacturing innovation institutes had been established to facilitate the movement of early-stage research into proven capabilities ready for adoption by U.S. manufacturers. To better understand the role and experiences of the Manufacturing USA institutes to date, a committee of the Innovation Policy Forum of the National Academies of Sciences, Engineering, and Medicine convened a workshop on May 23, 2017 drawing together institute directors and manufacturing policy experts along with leaders from industry, academia, and government. Participants addressed the role of the manufacturing institutes in increasing advanced manufacturing in the United States, examined selected foreign programs designed to support advanced manufacturing, and reviewed recent assessments of existing institutes. This publication summarizes the presentations and discussions from the workshop.

Opportunities for Organ Donor Intervention Research focuses on the ethical, legal, regulatory, policy, and organizational issues relevant to the conduct of research in the United States involving deceased organ donors. This report provides recommendations for how to conduct organ donor intervention research in a manner that maintains high ethical standards, that ensures dignity and respect for deceased organ donors and their families, that provides transparency and information for transplant candidates who might receive a research organ, and that supports and sustains the public's trust in the process of organ donation and transplantation--

In 2010, the National Research Council published the report U.S-Iran Engagement in Science, Engineering, and Medicine (2000-2009). The review of the program described in detail the National Academies' science, technology, and health cooperation program carried out jointly with partners in Iran (otherwise known as science-engagement). The purpose of this new publication is to document the history and details of the National Academies' program of science-engagement from 2010 through 2016, while providing a perspective in considering future science-engagement. A variety of cooperative activities, and particularly workshops that dominated science-engagement during that period, are highlighted.

The National Agricultural Statistics Service (NASS) is the primary statistical data collection agency within the U.S. Department of Agriculture (USDA). NASS conducts hundreds of surveys each year and prepares reports covering virtually every aspect of U.S. agriculture. Among the small-area estimates produced by NASS are county-level estimates for crops (planted acres, harvested acres, production, and yield by commodity) and for cash rental rates for irrigated cropland, nonirrigated cropland, and permanent pastureland. Key users of these county-level estimates include USDA's Farm Services Agency (FSA) and Risk Management Agency (RMA), which use the estimates as part of their processes for distributing farm subsidies and providing farm insurance, respectively. Improving Crop Estimates by Integrating Multiple Data Sources assesses county-level crop and cash rents estimates, and offers recommendations on methods for integrating data sources to provide more precise county-level estimates of acreage and yield for major crops and of cash rents by land use. This report considers technical issues involved in using the available data sources, such as methods for integrating the data, the assumptions underpinning the use of each source, the robustness of the resulting estimates, and the properties of desirable estimates of uncertainty.

"This is the second Consensus Study Report of the Panel on Improving Federal Statistics for Policy and Social Science Research Using Multiple Data Sources and State-of-the-Art Estimation Methods. Our first report, Innovations in Federal Statistics: Combining Data Sources While Protecting Privacy, was released in January 2017. In that report, the panel noted that there has been increasing attention in recent years to using data already collected by government entities for statistical purposes, such as evaluation of government programs. These data include such records as employment and earnings information on state unemployment insurance, income reported on federal tax forms, Social Security earnings and benefits, medical conditions and payments made for services from Medicare and Medicaid records, and food assistance program benefits"--Page ix.

On March 13, 2017, the Roundtable on Environmental Health Sciences, Research, and Medicine and the Roundtable on Population Health Improvement jointly convened a 1-day public workshop in Washington, DC, to explore potential strategies for public health, environmental health, health care, and related stakeholders to help communities and regions to address and mitigate the health effects of climate change. Participants discussed the perspectives of civic, government, business, and health-sector leaders, and existing research, best practices, and examples that inform stakeholders and practitioners on approaches to support mitigation of and adaptation to climate change and its effects on population health. This publication summarizes the presentations and discussions from the workshop.

"Neuroinflammation is a burgeoning area of interest in academia and biopharma, with a broadly acknowledged role in many central nervous system (CNS) disorders. However, there is little agreement on the pathophysiological mechanisms that underlie the manifestations of neuroinflammation in the CNS compartment and how neuroinflammation operates as a driver and also as a consequence of disease in the brain. Moreover, another unclear area is how to translate increased understanding of the mechanisms that underlie neuroinflammation and its manifestations in the CNS to therapeutics. To address these gaps in understanding mechanisms and how to translate that understanding into therapeutics, the Forum on Neuroscience and Nervous System Disorders of the National Academies of Sciences, Engineering, and Medicine convened a workshop on March 20-21, 2017, bringing together key leaders in the field from industry, academia, and governmental agencies to explore the role and mechanisms of neuroinflammation in a variety of CNS diseases. The workshop also considered strategies to advance the identification and validation of biomarkers of neuroinflammation that could accelerate development of therapies, bringing much-needed treatments to patients with disorders ranging from neuroinflammatory diseases such as multiple sclerosis (MS) to neuropsychiatric disorders such as depression. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

"The search for life is one of the most active fields in space science and involves a wide variety of scientific disciplines, including planetary science, astronomy and astrophysics, chemistry, biology, chemistry, and geoscience. In December 2016, the Space Studies Board hosted a workshop to explore the possibility of habitable environments in the solar system and in exoplanets, techniques for detecting life, and the instrumentation used. This publication summarizes the presentations and discussions from the workshop"--

What foods should Americans eat to promote their health, and in what amounts? What is the scientific evidence that supports specific recommendations for dietary intake to reduce the risk of multifactorial chronic disease? These questions are critically important because dietary intake has been recognized to have a role as a key determinant of health. As the primary federal source of consistent, evidence-based information on dietary practices for optimal nutrition, the Dietary Guidelines for Americans (DGA) have the promise to empower Americans to make informed decisions about what and how much they eat to improve health and reduce the risk of chronic disease. The adoption and widespread translation of the DGA requires that they be universally viewed as valid, evidence-based, and free of bias and conflicts of interest to the extent possible. However, this has not routinely been the case. A first short report meant to inform the 2020 review cycle explored how the advisory committee selection process can be improved to provide more transparency, eliminate bias, and include committee members with a range of viewpoints. This second and final report recommends changes to the DGA process to reduce and manage sources of bias and conflicts of interest, improve timely opportunities for engagement by all interested parties, enhance transparency, and strengthen the science base of the process.

"The Forum on Cyber Resilience of the National Academies of Sciences, Engineering, and Medicine hosted a Workshop on Software Update at its Winter 2017 meeting on February 6, 2017, in Washington, D.C."--Page 1.

Research conducted over the past two decades has shown that poor patient understanding of medication instructions is an important contributor to the more than 1 million medication errors and adverse drug events that lead to office and emergency room visits, hospitalizations, and even death. Patients who have limited literacy skills, who have multiple comorbidities, and who are elderly face the greatest risk, and limited literacy skills are significantly associated with inadequate understanding and use of prescription instructions and precautions. The Agency for Healthcare Research and Quality notes that only 12 percent of U.S. adults have proficient health literacy that allows them to interpret a prescription label correctly. Given the importance of health literacy to the proper use of medications, and the apparent lack of progress in improving medication adherence, the Roundtable on Health Literacy formed an ad hoc committee to plan and conduct a 1-day public workshop that featured invited presentations and discussion of the role and challenges regarding clarity of communication on medication. Participants focused on using health literacy principles to address clarity of materials, decision aids, and other supportive tools and technologies regarding risks, benefits, alternatives, and health plan coverage. This publication summarizes the presentations and discussions from the workshop.

Increasing numbers of evidence-based interventions have proven effective in preventing and treating behavioral disorders in children. However, the adoption of these interventions in the health care system and other systems that affect the lives of children has been slow. Moreover, with few exceptions, current training in many fields that involve the behavioral health of children falls short of meeting the needs that exist. In general, this training fails to recognize that behavioral health disorders are among the largest challenges in child health and that changing cognitive, affective, and behavioral health outcomes for children will require new and more integrated forms of care at a population level in the United States. To examine the need for workforce development across the range of health care professions working with children and families, as well as to identify innovative training models and levers to enhance training, the Forum on Promoting Children's Cognitive, Affective, and Behavioral Health held a workshop in November 2016. Workshop panelists and participants discussed the needs for workforce development across the range of health care professions working with children, youth, and families, and identified innovative training models and levers for change to enhance training. This publication summarizes the presentations and discussions from the workshop.

"The Survey of Income and Program Participation (SIPP) is a national, longitudinal household survey conducted by the Census Bureau. SIPP serves as a tool to evaluate the effectiveness of government-sponsored social programs and to analyze the impacts of actual or proposed modifications to those programs. SIPP was designed to fill a need for data that would give policy makers and researchers a much better grasp of how effectively government programs were reaching their target populations, how participation in different programs overlapped, and to what extent and under what circumstances people transitioned into and out of these programs. SIPP was also designed to answer questions about the short-term dynamics of employment, living arrangements, and economic well-being"--Page 1.

"Although ecosystems, humans, and fire have coexisted for millennia, changes in geology, ecology, hydrology, and climate as well as sociocultural, regulatory, and economic factors have converged to make wildland fire management exceptionally challenging for U.S. federal, state, and local authorities. Given the mounting, unsustainable costs and difficulty translating existing wildland fire science into policy, the National Academies of Sciences, Engineering, and Medicine organized a 1-day workshop to focus on how a century of wildland fire research can contribute to improving wildland fire management. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

"NASA's Science Mission Directorate (SMD) currently operates over five dozen missions, with approximately two dozen additional missions in development. These missions span the scientific fields associated with SMD's four divisions--Astrophysics, Earth Science, Heliophysics, and Planetary Sciences. Because a single mission can consist of multiple spacecraft, NASA-SMD is responsible for nearly 100 operational spacecraft. The most high profile of these are the large strategic missions, often referred to as "flagships." Large strategic missions are essential to maintaining the global leadership of the United States in space exploration and in science because only the United States has the budget, technology, and trained personnel in multiple scientific fields to conduct missions that attract a range of international partners. This report examines the role of large, strategic missions within a balanced program across NASA-SMD space and Earth sciences programs. It considers the role and scientific productivity of such missions in advancing science, technology and the long-term health of the field, and provides guidance that NASA can use to help set the priority of larger missions within a properly balanced program containing a range of mission classes"--Publisher's description.

Introduction. The current policy environment. Managing dual use research of concern. Committee findings -- Appendixes. Biographical information of committee and staff. Committee meeting agendas. Acronyms and abbreviations.--

"The obligation to treat animals used in research ethically and humanely extends beyond their lives in the laboratory to include their transportation from place to place. Yet transporting animals is a highly regulated and complex process that raises many difficult issues. To examine these issues, the Roundtable on Science and Welfare in Laboratory Animal Use held a workshop on September 3-4, 2014, in Washington, DC. More than 200 people participated in the workshop in person and online, including representatives of academic research institutions, pharmaceutical and consumer product companies, government agencies, research advocacy groups, professional associations, and the public. The workshop was designed to draw attention to the essential thoughtful journey planning behind each transport of laboratory animals"--

People's desire to understand the environments in which they live is a natural one. People spend most of their time in spaces and structures designed, built, and managed by humans, and it is estimated that people in developed countries now spend 90 percent of their lives indoors. As people move from homes to workplaces, traveling in cars and on transit systems, microorganisms are continually with and around them. The human-associated microbes that are shed, along with the human behaviors that affect their transport and removal, make significant contributions to the diversity of the indoor microbiome. The characteristics of "healthy" indoor environments cannot yet be defined, nor do microbial, clinical, and building researchers yet understand how to modify features of indoor environments--such as building ventilation systems and the chemistry of building materials--in ways that would have predictable impacts on microbial communities to promote health and prevent disease. The factors that affect the environments within buildings, the ways in which building characteristics influence the composition and function of indoor microbial communities, and the ways in which these microbial communities relate to human health and well-being are extraordinarily complex and can be explored only as a dynamic, interconnected ecosystem by engaging the fields of microbial biology and ecology, chemistry, building science, and human physiology. This report reviews what is known about the intersection of these disciplines, and how new tools may facilitate advances in understanding the ecosystem of built environments, indoor microbiomes, and effects on human health and well-being. It offers a research agenda to generate the information needed so that stakeholders with an interest in understanding the impacts of built environments will be able to make more informed decisions.

"Since 1938 and 1941, nutrient intake recommendations have been issued to the public in Canada and the United States, respectively. Currently defined as the Dietary Reference Intakes (DRIs), these values are a set of standards established by consensus committees under the National Academies of Sciences, Engineering, and Medicine and used for planning and assessing diets of apparently healthy individuals and groups. In 2015, a multidisciplinary working group sponsored by the Canadian and U.S. government DRI steering committees convened to identify key scientific challenges encountered in the use of chronic disease endpoints to establish DRI values. Their report, Options for Basing Dietary Reference Intakes (DRIs) on Chronic Disease: Report from a Joint US-/Canadian-Sponsored Working Group, outlined and proposed ways to address conceptual and methodological challenges related to the work of future DRI Committees. This report assesses the options presented in the previous report and determines guiding principles for including chronic disease endpoints for food substances that will be used by future National Academies committees in establishing DRIs"--Publishers website.

The academic biomedical research community is a hub of employment, economic productivity, and scientific progress. Academic research institutions are drivers of economic development in their local and state economies and, by extension, the national economy. Beyond the economic input that the academic biomedical research community both receives and provides, it generates knowledge that in turn affects society in myriad ways. The United States has experienced and continues to face the threat of disasters, and, like all entities, the academic biomedical research community can be affected. Recent disasters, from hurricanes to cyber-attacks, and their consequences have shown that the investments of the federal government and of the many other entities that sponsor academic research are not uniformly secure. First and foremost, events that damage biomedical laboratories and the institutions that house them can have impacts on the safety and well-being of humans and research animals. Furthermore, disasters can affect career trajectories, scientific progress, and financial stability at the individual and institutional levels. Strengthening the Disaster Resilience of the Academic Biomedical Research Community offers recommendations and guidance to enhance the disaster resilience of the academic biomedical research community, with a special focus on the potential actions researchers, academic research institutions, and research sponsors can take to mitigate the impact of future disasters.

The 21st century has witnessed a complete revolution in the understanding and description of bacteria in eco- systems and microbial assemblages, and how they are regulated by complex interactions among microbes, hosts, and environments. The human organism is no longer considered a monolithic assembly of tissues, but is instead a true ecosystem composed of human cells, bacteria, fungi, algae, and viruses. As such, humans are not unlike other complex ecosystems containing microbial assemblages observed in the marine and earth environments. They all share a basic functional principle: Chemical communication is the universal language that allows such groups to properly function together. These chemical networks regulate interactions like metabolic exchange, antibiosis and symbiosis, and communication. The National Academies of Sciences, Engineering, and Medicine's Chemical Sciences Roundtable organized a series of four seminars in the autumn of 2016 to explore the current advances, opportunities, and challenges toward unveiling this "chemical dark matter" and its role in the regulation and function of different ecosystems. The first three focused on specific ecosystems--earth, marine, and human--and the last on all microbiome systems. This publication summarizes the presentations and discussions from the seminars.

"In October 2016, the National Academies of Sciences, Engineering, and Medicine's Roundtable on Population Health Improvement hosted a workshop to explore sustainable financing structures that reflect a recognition of the health and non-health factors that shape the well-being of U.S. communities. The goals of the workshop were to learn from the long-term, sustainable financing strategies used in other sectors, to explore how those approaches could be applied to population health, and to consider structures that work across sectors. This publication summarizes the presentations and discussions from the workshop"--