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In 2004, the Institute of Medicine released Health Literacy: A Prescription to End Confusion, a report on the then-underappreciated challenge of enabling patients to comprehend their condition and treatment, to make the best decisions for their care, and to take the right medications at the right time in the intended dose. That report documented the problems, origins, and consequences of the fact that tens of millions of U.S. adults are unable to read complex texts, including many health-related materials, and it proposed possible solutions to those problems. To commemorate the anniversary of the release of the 2004 health literacy report, the Institute of Medicine's Roundtable on Health Literacy convened a 1-day public workshop to assess the progress made in the field of health literacy over the past decade, the current state of the field, and the future of health literacy at the local, national, and international levels. Health Literacy: Past, Present, and Future summarizes the presentation and discussion of the workshop.

Fractured rock is the host or foundation for innumerable engineered structures related to energy, water, waste, and transportation. Characterizing, modeling, and monitoring fractured rock sites is critical to the functioning of those infrastructure, as well as to optimizing resource recovery and contaminant management. Characterization, Modeling, Monitoring, and Remediation of Fractured Rock examines the state of practice and state of art in the characterization of fractured rock and the chemical and biological processes related to subsurface contaminant fate and transport. This report examines new developments, knowledge, and approaches to engineering at fractured rock sites since the publication of the 1996 National Research Council report Rock Fractures and Fluid Flow: Contemporary Understanding and Fluid Flow. Fundamental understanding of the physical nature of fractured rock has changed little since 1996, but many new characterization tools have been developed, and there is now greater appreciation for the importance of chemical and biological processes that can occur in the fractured rock environment. The findings of Characterization, Modeling, Monitoring, and Remediation of Fractured Rock can be applied to all types of engineered infrastructure, but especially to engineered repositories for buried or stored waste and to fractured rock sites that have been contaminated as a result of past disposal or other practices. The recommendations of this report are intended to help the practitioner, researcher, and decision maker take a more interdisciplinary approach to engineering in the fractured rock environment. This report describes how existing tools--some only recently developed--can be used to increase the accuracy and reliability of engineering design and management given the interacting forces of nature. With an interdisciplinary approach, it is possible to conceptualize and model the fractured rock environment with acceptable levels of uncertainty and reliability, and to design systems that maximize remediation and long-term performance. Better scientific understanding could inform regulations, policies, and implementation guidelines related to infrastructure development and operations. The recommendations for research and applications to enhance practice of this book make it a valuable resource for students and practitioners in this field.

The United States prides itself on being a nation of immigrants, and the country has a long history of successfully absorbing people from across the globe. The integration of immigrants and their children contributes to our economic vitality and our vibrant and ever changing culture. We have offered opportunities to immigrants and their children to better themselves and to be fully incorporated into our society and in exchange immigrants have become Americans - embracing an American identity and citizenship, protecting our country through service in our military, fostering technological innovation, harvesting its crops, and enriching everything from the nation's cuisine to its universities, music, and art. Today, the 41 million immigrants in the United States represent 13.1 percent of the U.S. population. The U.S.-born children of immigrants, the second generation, represent another 37.1 million people, or 12 percent of the population. Thus, together the first and second generations account for one out of four members of the U.S. population. Whether they are successfully integrating is therefore a pressing and important question. Are new immigrants and their children being well integrated into American society, within and across generations? Do current policies and practices facilitate their integration? How is American society being transformed by the millions of immigrants who have arrived in recent decades? To answer these questions, this new report from the National Academies of Sciences, Engineering, and Medicine summarizes what we know about how immigrants and their descendants are integrating into American society in a range of areas such as education, occupations, health, and language.

Childhood cancer is an area of oncology that has seen both remarkable progress as well as substantial continuing challenges. While survival rates for some pediatric cancers present a story of success, for many types of pediatric cancers, little progress has been made. Many cancer treatments are known to cause not only significant acute side effects, but also lead to numerous long-term health risks and reduced quality of life. Even in cases where the cancer is considered curable, the consequences of treatment present substantial long-term health and psychosocial concerns for children, their families, their communities, and our health system. To examine specific opportunities and suggestions for driving optimal care delivery supporting survival with high quality of life, the National Cancer Policy Forum of the Institute of Medicine and the American Cancer Society co-hosted a workshop which convened experts and members of the public on March 9 and 10, 2015. At this workshop, clinicians and researchers in pediatric oncology, palliative, and psychosocial care, along with representatives from the U.S. Food and Drug Administration, National Cancer Institute, Children's Oncology Group, pharmaceutical companies, and patient advocacy organizations, discussed and developed a menu of options for action to improve research, quality of care, and outcomes for pediatric cancer patients and their families. In addition, parents of children with cancer and pediatric cancer survivors shared their experiences with care and provided poignant personal perspectives on specific quality of life concerns and support needs for children and families across the life spectrum. This report summarizes the presentations and discussion of the workshop.

Summary of Enabling Discovery, Development, and Translation of Treatments for Cognitive Dysfunction in Depression: a workshop, held on February 24, 2015 in Washington, D.C.

Active remote sensing is the principal tool used to study and to predict short- and long-term changes in the environment of Earth - the atmosphere, the oceans and the land surfaces - as well as the near space environment of Earth. All of these measurements are essential to understanding terrestrial weather, climate change, space weather hazards, and threats from asteroids. Active remote sensing measurements are of inestimable benefit to society, as we pursue the development of a technological civilization that is economically viable, and seek to maintain the quality of our life. A Strategy for Active Remote Sensing Amid Increased Demand for Spectrum describes the threats, both current and future, to the effective use of the electromagnetic spectrum required for active remote sensing. This report offers specific recommendations for protecting and making effective use of the spectrum required for active remote sensing.

"On February 26, 2020, the Board on Health Sciences Policy of the National Academies of Sciences, Engineering, and Medicine hosted a 1-day public workshop in Washington, DC, to examine current and emerging bioethical issues that might arise in the context of biomedical research and to consider research topics in bioethics that could benefit from further attention. The scope of bioethical issues in research is broad, but this workshop focused on issues related to the development and use of digital technologies, artificial intelligence, and machine learning in research and clinical practice; issues emerging as nontraditional approaches to health research become more widespread; the role of bioethics in addressing racial and structural inequalities in health; and enhancing the capacity and diversity of the bioethics workforce. This publication summarizes the presentations and discussions from the workshop."--

Business structures, employment relationships, job characteristics, and worker outcomes have changed in the United States over the last few decades--in some ways unpredictably. A high level of interest exists among policy makers and researchers in addressing concerns about the future of work in the United States. These concerns are heightened by the perceived fracturing of relationships between workers and employers, the loss of safety net protections and benefits to workers, the growing importance of access to skills and education as the impacts of new technologies and automation are felt, and the market-based pressure that companies face to produce short-term profits, sometimes at the expense of long-term value. These issues, as well as related ones such as wage stagnation and job quality, are often associated with alternative work arrangements (AWAs)--which include independent-contractor and other nonemployee jobs, work through intermediaries such as temporary help agencies and other contract companies, and work with unpredictable schedules--although they also pertain to many standard jobs. A better understanding of the magnitude of and trends in AWAs, along with the implications for job quality, is needed to develop appropriate policies in response to the changing nature of work. Measuring Alternative Work Arrangements for Research and Policy reviews the Contigent Worker Supplement (CWS) of the Current Population Survey (CPS) for the Bureau of Labor Statistics (BLS) in the U.S. Department of Labor. The CWS provides key measures of temporary (contingent) work, alternative work arrangements, and the "gig" economy. Disagreements, however, exist among researchers, policy makers, and other stakeholders about the definitions and measures of these concepts and priorities for future data collection. The report also reviews measures of employment, earnings, and worker well-being in temporary and alternative work arrangements that can be estimated using household survey data, such as those generated by the CWS, as well as measures that can be produced using administrative, commercial, and combined data sources. The comparative advantages and complementarities of different data sources will be assessed, as well as methodological issues underpinning BLS's measurement objectives.

The Intelligence Community (IC) is no stranger to the valuable contributions made by research in the social and behavioral sciences (SBS) to the work of intelligence analysis. Likewise, researchers in many SBS disciplines have benefited from opportunities to work with the IC and conduct research on countless topics related to intelligence. But in an age when both technologies and national security concerns are evolving at lightening speed, the IC has recognized the critical need to more systematically take advantage of cutting-edge research from diverse SBS fields. In this context, the Office of the Director of National Intelligence (ODNI) turned to the National Academies of Science, Engineering, and Medicine (the National Academies) to explore opportunities for research from the SBS disciplines to support the work of intelligence analysts and enhance national security. ODNI requested that The National Academies conduct a decadal survey that would support the IC in developing a 10-year agenda for SBS research with applications to intelligence analysis. --

"The early to mid-1990s saw a large surge in U.S. cigar consumption, including premium cigars. Based on recent import data, premium cigar use may be increasing, though they currently make up a small percent of the total U.S. cigar market. Premium cigars have also been the subject of legal and regulatory efforts for the past decade. In 1998, the National Cancer Institute undertook a comprehensive review of available knowledge about cigars - the only one to date. The resulting research recommendations have largely not been addressed, and many of the identified information gaps persist. Furthermore, there is no single, consistent definition of premium cigars, making research challenging. In response, the Food and Drug Administration (FDA) and the National Institutes of Health commissioned the National Academies of Sciences, Engineering, and Medicine to convene a committee of experts to address this issue. The resulting report, Premium Cigars: Patterns of Use, Marketing, and Health Effects, includes 13 findings, 24 conclusions, and nine priority research recommendations and assesses the state of evidence on premium cigar characteristics, current patterns of use, marketing and perceptions of the product, and short- long-term health effects" --

In response to the coronavirus disease 2019 (COVID-19) pandemic and the societal disruption it has brought, national governments and the international community have invested billions of dollars and immense amounts of human resources to develop a safe and effective vaccine in an unprecedented time frame. Vaccination against this novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), offers the possibility of significantly reducing severe morbidity and mortality and transmission when deployed alongside other public health strategies and improved therapies. Health equity is intertwined with the impact of COVID-19 and there are certain populations that are at increased risk of severe illness or death from COVID-19. In the United States and worldwide, the pandemic is having a disproportionate impact on people who are already disadvantaged by virtue of their race and ethnicity, age, health status, residence, occupation, socioeconomic condition, or other contributing factors. Framework for Equitable Allocation of COVID-19 Vaccine offers an overarching framework for vaccine allocation to assist policy makers in the domestic and global health communities. Built on widely accepted foundational principles and recognizing the distinctive characteristics of COVID-19, this report's recommendations address the commitments needed to implement equitable allocation policies for COVID-19 vaccine.

Participants in this workshop, which took place on January 17, 2020, considered whether embryo model systems - especially those that use nonhuman primate cells - can be used to predict the function of systems made with human cells. Presentations provided an overview of the current state of the science of in vitro development of human trophoblast--The National Academies of Sciences, Engineering, Medicine website (viewed September 18, 2020)

The National Assessment of Educational Progress (NAEP) - often called "The Nation's Report Card" - is the largest nationally representative and continuing assessment of what students in public and private schools in the United States know and can do in various subjects and has provided policy makers and the public with invaluable information on U.S. students for more than 50 years. Unique in the information it provides, NAEP is the nation's only mechanism for tracking student achievement over time and comparing trends across states and districts for all students and important student groups (e.g., by race, sex, English learner status, disability status, family poverty status). While the program helps educators, policymakers, and the public understand these educational outcomes, the program has incurred substantially increased costs in recent years and now costs about $175.2 million per year. A Pragmatic Future for NAEP: Containing Costs and Updating Technologies recommends changes to bolster the future success of the program by identifying areas where federal administrators could take advantage of savings, such as new technological tools and platforms as well as efforts to use local administration and deployment for the tests. Additionally, the report recommends areas where the program should clearly communicate about spending and undertake efforts to streamline management. The report also provides recommendations to increase the visibility and coherence of NAEP's research activities.

Fusion energy offers the prospect of addressing the nation's energy needs and contributing to the transition to a low-carbon emission electrical generation infrastructure. Technology and research results from U.S. investments in the major fusion burning plasma experiment known as ITER, coupled with a strong foundation of research funded by the Department of Energy (DOE), position the United States to begin planning for its first fusion pilot plant. Strong interest from the private sector is an additional motivating factor, as the process of decarbonizing and modernizing the nation's electric infrastructure accelerates and companies seek to lead the way. At the request of DOE, Bringing Fusion to the U.S. Grid builds upon the work of the 2019 report Final Report of the Committee on a Strategic Plan for U.S. Burning Plasma Research to identify the key goals and innovations - independent of confinement concept - that are needed to support the development of a U.S. fusion pilot plant that can serve as a model for producing electricity at the lowest possible capital cost.

"Information technology (IT) is widely understood to be the enabling technology of the 21st century. IT has transformed, and continues to transform, all aspects of our lives: commerce and finance, education, energy, health care, manufacturing, government, national security, transportation, communications, entertainment, science, and engineering. IT and its impact on the U.S. economy--both directly (the IT sector itself) and indirectly (other sectors that are powered by advances in IT)--continue to grow in size and importance. IT's impacts on the U.S. economy--both directly (the IT sector itself) and indirectly (other sectors that are powered by advances in IT)--continue to grow. IT enabled innovation and advances in IT products and services draw on a deep tradition of research and rely on sustained investment and a uniquely strong partnership in the United States among government, industry, and universities. Past returns on federal investments in IT research have been extraordinary for both U.S. society and the U.S. economy. This IT innovation ecosystem fuels a virtuous cycle of innovation with growing economic impact. Building on previous National Academies work, this report describes key features of the IT research ecosystem that fuel IT innovation and foster widespread and longstanding impact across the U.S. economy. In addition to presenting established computing research areas and industry sectors, it also considers emerging candidates in both categories."--

"This Proceedings of a Workshop summarizes the presentations and discussions at the Workshop on the Implications of Convergence for How the National Center for Science and Engineering Statistics (NCSES) Measures the Science and Engineering Workforce, which was held virtually and livestreamed on October 22-23, 2020. The workshop was convened by the Committee on National Statistics to help NCSES, a division of the National Science Foundation, set an agenda to inform its methodological research and better measure and assess the implications of convergence for the science and engineering workforce and enterprise. The workshop brought together scientists and researchers from multiple disciplines, along with experts in science policy, university administration, and other stakeholders to review and provide input on defining and measuring convergence and its impact on science and scientists." --

The Roundtable on Population Health Improvement, a convening activity of the National Academies of Sciences, Engineering, and Medicine, held a workshop on March 15-16, 2021, to explore issues related to increasing health care spending in the United States. The workshop, U.S. Health Care Expenditures: Costs, Lessons, and Opportunities, was organized to highlight the persisting challenge of health care expenditures that are not commensurate with the health outcomes they produce. This publication summarizes the presentation and discussion of the workshop.

Marine recreational fishing is a popular activity enjoyed by more than 9 million Americans annually and is a driver of the American ocean-or blue-economy. To ensure that fish populations are not overexploited, the NOAA Fisheries' Marine Recreational Information Program (MRIP) monitors recreational catch through a variety of in-person, telephone, mail-in, and other surveys. NOAA Fisheries' management of recreational catch also must take into account annual catch limits (ACLs) established to prevent overfishing for all managed species in federal waters. While MRIP has worked to improve recreational catch surveys over the past decade, the surveys were never designed to meet the demands of in-season management of ACLs. In some cases, estimates of harvest have triggered accountability measures such as early season closures and reductions in future recreational ACLs, which have been a source of contention with the recreational fishing community. This report presents approaches for optimizing MRIP data and complementary data for in-season management and considers alternatives for managing recreational fisheries with ACLs to better serve both social and economic management objectives.

Antimicrobial resistance is a health problem that threatens to undermine almost a century of medical progress. Moreover, it is a global problem that requires action both in the United States and internationally. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine discusses ways to improve detection of resistant infections in the United States and abroad, including monitoring environmental reservoirs of resistance. This report sets out a strategy for improving stewardship and preventing infections in humans and animals. The report also discusses the strength of the pipeline for new antimicrobial medicines and steps that could be taken to bring a range of preventive and therapeutic products for humans and animals to the market.

There is a void in evidence-based information for making informed decisions on how to optimize care for older adults, particularly those 80 years and over. Because older adults are vastly underrepresented in clinical trials, there is a dearth of information about the appropriate use of drugs in this population. Yet older adults have higher rates of comorbidities and simultaneous use of multiple medications than the general population, and are the majority users of many medications. Additionally, age-related physiological and pathological changes, particularly for adults 80 years of age and older, can lead to significant differences in the pharmacokinetics (PK)2 and pharmacodynamics (PD)3 of a given drug compared to the general population. On August 5 and 6, 2020, the National Academies of Sciences, Engineering, and Medicine hosted a workshop titled Drug Research and Development for Adults Across the Older Age Span. The workshop was designed to examine the challenges and opportunities in drug research and development for older adult populations, explore barriers that impede safety and efficacy studies in these populations, and share lessons learned for better understanding clinical pharmacology for populations over age 65. This publication summarizes the presentation and discussion of the workshop.

Earthquake-induced soil liquefaction (liquefaction) is a leading cause of earthquake damage worldwide. Liquefaction is often described in the literature as the phenomena of seismic generation of excess porewater pressures and consequent softening of granular soils. Many regions in the United States have been witness to liquefaction and its consequences, not just those in the west that people associate with earthquake hazards. Past damage and destruction caused by liquefaction underline the importance of accurate assessments of where liquefaction is likely and of what the consequences of liquefaction may be. Such assessments are needed to protect life and safety and to mitigate economic, environmental, and societal impacts of liquefaction in a cost-effective manner. Assessment methods exist, but methods to assess the potential for liquefaction triggering are more mature than are those to predict liquefaction consequences, and the earthquake engineering community wrestles with the differences among the various assessment methods for both liquefaction triggering and consequences. State of the Art and Practice in the Assessment of Earthquake-Induced Soil Liquefaction and Its Consequences evaluates these various methods, focusing on those developed within the past 20 years, and recommends strategies to minimize uncertainties in the short term and to develop improved methods to assess liquefaction and its consequences in the long term. This report represents a first attempt within the geotechnical earthquake engineering community to consider, in such a manner, the various methods to assess liquefaction consequences.

Valued for its ecological richness and economic value, the U.S. Gulf of Mexico is under substantial pressure from human activities. The Deepwater Horizon platform explosion and oil spill significantly damaged Gulf ecosystems and led to the largest ecological restoration investment in history. The unprecedented number and diversity of restoration activities provide valuable information for future restoration efforts, but assessment efforts are hampered by many factors, including the need to evaluate the interaction of multiple stressors and consider long-term environmental trends such as sea level rise, increasing hurricane intensity, and rising water temperatures. This report offers a comprehensive approach to assess restoration activities beyond the project scale in the face of a changing environment. A main component of this approach is using different types of scientific evidence to develop "multiple lines of evidence" to evaluate restoration efforts at regional scales and beyond, especially for projects that may be mutually reinforcing (synergistic) or in conflict (antagonistic). Because Gulf of Mexico ecosystems cross political boundaries, increased coordination and collaboration is needed, especially to develop standardized data collection, analysis, synthesis, and reporting. With these improvements, program-level adaptive management approaches can be used more effectively to assess restoration strategies against the backdrop of long-term environmental trends.

The United States faces an alarmingly high rate of maternal morbidity and mortality, distinguishing it from other high-income countries that have achieved decreases in these rates in recent years. U.S. maternal morbidity and mortality rates are disproportionate across racial, ethnic, socioeconomic, and geographic groups. Statistics on maternal health outcomes reveal that there are challenges to protecting both the lives and future health of birthing people and their children. Recognizing the urgency of this growing problem, the National Academies Board on Population Health and Public Health Practice convened a 2-day virtual workshop, Advancing Maternal Health Equity and Reducing Maternal Mortality. The workshop examined the current state of maternal health in the United States and explored the factors needed to help communities and health care systems become more effective in reducing maternal morbidity and mortality and improving health outcomes through the fourth trimester. This publication summarizes the presentations and discussions of the workshop.--Publisher's website.

From daily commutes to cross-country road trips, millions of light-duty vehicles are on the road every day. The transportation sector is one of the United States' largest sources of greenhouse gas emissions, and fuel is an important cost for drivers. The period from 2025-2035 could bring the most fundamental transformation in the 100-plus year history of the automobile. Battery electric vehicle costs are likely to fall and reach parity with internal combustion engine vehicles. New generations of fuel cell vehicles will be produced. Connected and automated vehicle technologies will become more common, including likely deployment of some fully automated vehicles. These new categories of vehicles will for the first time assume a major portion of new vehicle sales, while internal combustion engine vehicles with improved powertrain, design, and aerodynamics will continue to be an important part of new vehicle sales and fuel economy improvement. This study is a technical evaluation of the potential for internal combustion engine, hybrid, battery electric, fuel cell, nonpowertrain, and connected and automated vehicle technologies to contribute to efficiency in 2025-2035. In addition to making findings and recommendations related to technology cost and capabilities, Assessment of Technologies for Improving Light-Duty Vehicle Fuel Economy - 2025-2035 considers the impacts of changes in consumer behavior and regulatory regimes.

The National Academies of Sciences, Engineering, and Medicine convened a workshop on February 4th and 5th, 2021 to review the issues related to safety of passengers and employees in commercial air transportation, for domestic and international travel, during the COVID-19 pandemic. The workshop explored best practices to assess and mitigate COVID-19 transmission risks experienced during the travel chain, from the departure airport entrance to the destination airport exit. The workshop also identified areas where more research is needed to address gaps in understanding. This publication documents the presentations and discussions held during the workshop, and is presented as a synthesis of the workshop.

The National Institutes of Health (NIH) asked the National Academies of Sciences, Engineering, and Medicine to conduct a quadrennial review of its Small Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) programs, in accordance with a legislative mandate. Using quantitative and qualitative analyses of data, this report reviews the operations and outcomes stemming from NIH's SBIR/STTR awards. Drawing on published research and conducting new analyses based on both publicly available data and applicant data provided by NIH, Assessment of the SBIR and STTR Programs at the National Institutes of Health analyzes (1) the effectiveness of NIH's processes and procedures for selecting SBIR and STTR awardees; (2) the effectiveness of NIH's outreach to increase SBIR and STTR applications from small businesses that are new to the programs, from underrepresented states, and from woman-owned and minority-owned businesses; (3) collaborations between small businesses and research institutions resulting from the programs; and (4) a range of direct economic and health care impacts attributable to the programs.

"Retail trade has experienced dramatic changes over the past several decades in the United States, with changes in the types of outlets where goods are sold, the nature of the transactions that provide goods to consumers, and the structure of retail operations behind the scenes. The recent changes include the rise of warehouse stores and e-commerce and the further growth of imports and large retail chains. These changes highlight and typify many aspects of the broader evolution of the economy as a whole in recent years - with the growing role of large firms and information technology - while taking place in a sector that directly serves the vast majority of the American population and provides substantial employment. Despite the everyday experience of these dramatic changes in retail, there is concern that the most transformational aspects of those changes may not be captured well by the economic indicators about the sector. In order to develop appropriate economic policies, we need to be able to capture more detailed data, including data about changes to productivity. At the request of the U.S. Bureau of Labor Statistics, this report evaluates changes in the retail trade sector, assesses measures of employment and labor productivity for the sector, and recommends a new satellite account that could measure retail-related employment and labor productivity in ways that would better capture the transformation."--

The USAir Force human capital management (HCM) system is not easily defined or mapped. It affects virtually every part of the Air Force because workforce policies, procedures, and processes impact all offices and organizations that include Airmen and responsibilities and relationships change regularly. To ensure the readiness of Airmen to fulfill the mission of the Air Force, strategic approaches are developed and issued through guidance and actions of the Office of the Deputy Chief of Staff for Manpower, Personnel and Services and the Office of the Assistant Secretary of the Air Force for Manpower and Reserve Affairs. Strengthening US Air Force Human Capital Management assesses and strengthens the various U.S. Air Force initiatives and programs working to improve person-job match and human capital management in coordinated support of optimal mission capability. This report considers the opportunities and challenges associated with related interests and needs across the USAF HCM system as a whole, and makes recommendations to inform improvements to USAF personnel selection and classification and other critical system components across career trajectories. Strengthening US Air Force Human Capital Management offers the Air Force a strategic approach, across a connected HCM system, to develop 21st century human capital capabilities essential for the success of 21st century Airmen.