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The medical research landscape in the United States is supported by a variety of organizations that spend billions of dollars in government and private funds each year to seek answers to complex medical and public health problems. The largest government funder is the National Institutes of Health (NIH), followed by the Department of Defense (DoD). Almost half of DoD's medical research funding is administered by the Congressionally Directed Medical Research Programs (CDMRP). The mission of CDMRP is to foster innovative approaches to medical research in response to the needs of its stakeholders--the U.S. military, their families, the American public, and Congress. CDMRP funds medical research to be performed by other government and nongovernmental organizations, but it does not conduct research itself. The major focus of CDMRP funded research is the improved prevention, diagnosis, and treatment of diseases, injuries, or conditions that affect service members and their families, and the general public. The hallmarks of CDMRP include reviewing applications for research funding using a two-tiered review process, and involving consumers throughout the process. Evaluation of the Congressionally Directed Medical Research Programs Review Process evaluates the CDMRP two-tiered peer review process, its coordination of research priorities with NIH and the Department of Veterans Affairs, and provides recommendations on how the process for reviewing and selecting studies can be improved.

On January 20, 2015, President Obama announced the Precision Medicine Initiative (PMI) in his State of the Union address. The PMI, by developing new approaches for detecting, measuring, and analyzing a wide range of biomedical information including molecular, genomic, cellular, clinical, behavioral, physiological, and environmental parameters, is intended to enable a new era of medicine in which researchers, providers, and patients work together to develop individualized care. Part of this effort included the creation of a national, large-scale research participant group, or cohort. The PMI Cohort Program is aimed at extending precision medicine to many diseases, including both rare and common diseases such as diabetes, heart disease, Alzheimer's disease, obesity, and mental illnesses such as depression, bipolar disorder, and schizophrenia, by building a national research cohort of 1 million or more U.S. participants. An important challenge to assembling the PMI Cohort will be to reach individuals who are socioeconomically disadvantaged. Individuals who are socioeconomically disadvantaged have lower health literacy; often belong to racial, ethnic, and minority communities; and are often less likely to participate in research studies and biorepositories. To explore possible strategies and messaging designs, the Roundtable on Health Literacy formed an ad hoc committee charged with planning and conducting a 1-day public workshop on the intersection of health literacy and precision medicine. The workshop participants discussed a variety of topics including an overview of precision medicine and its potential, the relevance of health literacy to the success of precision medicine efforts, and perspectives and understanding of different groups, such as health care providers, consumers, and insurers. This publication summarizes the presentations and discussions from the workshop.

"The Air Force (USAF) has continuously sought to improve the speed with which it develops new capabilities to accomplish its various missions in air, space, and cyberspace. Historically, innovation has been a key part of USAF strategy, and operating within an adversary's OODA loop (observe, orient, decide, act) is part of Air Force DNA. This includes the ability to deploy technological innovations faster than do our adversaries. The Air Force faces adversaries with the potential to operate within the USAF's OODA loop, and some of these adversaries are already deploying innovations faster than the USAF. The Role of Experimentation Campaigns in the Air Force Innovation Life Cycle examines the current state of innovation and experimentation in the Air Force and best practices in innovation and experimentation in industry and other government agencies. This report also explores organizational changes needed to eliminate the barriers that deter innovation and experimentation and makes recommendations for the successful implementation of robust innovation and experimentation by the Air Force"--Publisher's description.

In July 2016 The National Academies of Sciences, Engineering, and Medicine convened a workshop with the goal of bringing together industrial and organizational (I-O) psychologists, experts on personnel selection and testing, forensic scientists, and other researchers whose work has a nexus with workforce needs in the forensic science field with a focus on pattern evidence. Participants reviewed the current status of selection and training of forensic scientists who specialize in pattern evidence and discussed how tools used in I-O psychology to understand elements of a task and measure aptitude and performance could address challenges in the pattern evidence domain of the forensic sciences. This publication summarizes the presentations and discussions from the workshop.

With the worst human refugee crisis since World War II as the backdrop, from March 16 through March 18, 2016, the National Academies of Sciences, Engineering, and Medicine, in partnership with UNICEF and the King Abdullah Bin Abdulaziz International Center for Inter-religious and Intercultural Dialogue (KAICIID), held a workshop in Amman, Jordan, to explore topics related to investing in young children for peaceful societies. Over the course of the workshop, researchers, policy makers, program practitioners, funders, youth, and other experts came together to understand the effects of conflict and violence on children, women, and youth across areas of health, education, nutrition, social protection, and other domains. The goal of the workshop was to continue to fill in gaps in knowledge and explore opportunities for discourse through a process of highlighting the science and practice. This publication summarizes the presentations and discussions from the workshop.

The Office of the Under Secretary of Defense (Personnel & Readiness), referred to throughout this report as P&R, is responsible for the total force management of all Department of Defense (DoD) components including the recruitment, readiness, and retention of personnel. Its work and policies are supported by a number of organizations both within DoD, including the Defense Manpower Data Center (DMDC), and externally, including the federally funded research and development centers (FFRDCs) that work for DoD. P&R must be able to answer questions for the Secretary of Defense such as how to recruit people with an aptitude for and interest in various specialties and along particular career tracks and how to assess on an ongoing basis service members' career satisfaction and their ability to meet new challenges. P&R must also address larger-scale questions, such as how the current realignment of forces to the Asia-Pacific area and other regions will affect recruitment, readiness, and retention. While DoD makes use of large-scale data and mathematical analysis in intelligence, surveillance, reconnaissance, and elsewhere--exploiting techniques such as complex network analysis, machine learning, streaming social media analysis, and anomaly detection--these skills and capabilities have not been applied as well to the personnel and readiness enterprise. Strengthening Data Science Methods for Department of Defense Personnel and Readiness Missions offers and roadmap and implementation plan for the integration of data analysis in support of decisions within the purview of P&R.

Description based on online resource (NAP website, viewed Dec. 13, 2016).

Extremely hazardous substances can be released accidentally as a result of chemical spills, industrial explosions, fires, or accidents involving railroad cars and trucks transporting EHSs. Workers and residents in communities surrounding industrial facilities where these substances are manufactured, used, or stored and in communities along the nation's railways and highways are potentially at risk of being exposed to airborne EHSs during accidental releases or intentional releases by terrorists. Pursuant to the Superfund Amendments and Reauthorization Act of 1986, the U.S. Environmental Protection Agency (EPA) has identified approximately 400 EHSs on the basis of acute lethality data in rodents. Acute Exposure Guideline Levels for Selected Airborne Chemicals, Volume 20 reviews and updates the technical support document on acute exposure guideline levels (AEGLs) for selected chloroformates. This update focuses on establishing AEGL-3 values for n-propyl chloroformate and isopropyl chloroformate, but will also consider whether any new data are available that would affect the proposed values for the other 10 chloroformates. AEGLs represent threshold exposure limits (exposure levels below which adverse health effects are not likely to occur) for the general public and are applicable to emergency exposures ranging from 10 minutes (min) to 8 h. Three levels - AEGL-1, AEGL-2, and AEGL-3 - are developed for each of five exposure periods (10 min, 30 min, 1 h, 4 h, and 8 h) and are distinguished by varying degrees of severity of toxic effects. This report will inform planning, response, and prevention in the community, the workplace, transportation, the military, and the remediation of Superfund sites.

The purpose of accreditation is to build a competent health workforce by ensuring the quality of training taking place within those institutions that have met certain criteria. It is the combination of institution or program accreditation with individual licensure--for confirming practitioner competence--that governments and professions use to reassure the public of the capability of its health workforce. Accreditation offers educational quality assurance to students, governments, ministries, and society. Given the rapid changes in society, health, and health care, the National Academies of Sciences, Engineering, and Medicine hosted a workshop in April 2016, aimed to explore global shifts in society, health, health care, and education, and their potential effects on general principles of program accreditation across the continuum of health professional education. Participants explored the effect of societal shifts on new and evolving health professional learning opportunities to best ensure quality education is offered by institutions regardless of the program or delivery platform. This publication summarizes the presentations and discussions from the workshop.

Evidence from the public health sector demonstrates that health care is only one of the determinants of health, which also include genes, behavior, social factors, and the built environment. These contextual elements are key to understanding why health care organizations are motivated to focus beyond their walls and to consider and respond in unprecedented ways to the social needs of patients, including transportation needs. In June 2016 the National Academies of Sciences, Engineering, and Medicine held a joint workshop to explore partnerships, data, and measurement at the intersection of the health care and transportation sectors. This publication summarizes the presentations and discussions from the workshop.

"Cities have experienced an unprecedented rate of growth in the last decade. More than half the world's population lives in urban areas, with the U.S. percentage at 80 percent. Cities have captured more than 80 percent of the globe's economic activity and offered social mobility and economic prosperity to millions by clustering creative, innovative, and educated individuals and organizations. Clustering populations, however, can compound both positive and negative conditions, with many modern urban areas experiencing growing inequality, debility, and environmental degradation. The spread and continued growth of urban areas presents a number of concerns for a sustainable future, particularly if cities cannot adequately address the rise of poverty, hunger, resource consumption, and biodiversity loss in their borders. Intended as a comparative illustration of the types of urban sustainability pathways and subsequent lessons learned existing in urban areas, this study examines specific examples that cut across geographies and scales and that feature a range of urban sustainability challenges and opportunities for collaborative learning across metropolitan regions. It focuses on nine cities across the United States and Canada (Los Angeles, CA, New York City, NY, Philadelphia, PA, Pittsburgh, PA, Grand Rapids, MI, Flint, MI, Cedar Rapids, IA, Chattanooga, TN, and Vancouver, Canada), chosen to represent a variety of metropolitan regions, with consideration given to city size, proximity to coastal and other waterways, susceptibility to hazards, primary industry, and several other factors"--Publisher's description.

"A report of The National Academies of Sciences, Engineering, Medicine."

Marine mammals face a large array of stressors, including loss of habitat, chemical and noise pollution, and bycatch in fishing, which alone kills hundreds of thousands of marine mammals per year globally. To discern the factors contributing to population trends, scientists must consider the full complement of threats faced by marine mammals. Once populations or ecosystems are found to be at risk of adverse impacts, it is critical to decide which combination of stressors to reduce to bring the population or ecosystem into a more favorable state. Assessing all stressors facing a marine mammal population also provides the environmental context for evaluating whether an additional activity could threaten it. Approaches to Understanding the Cumulative Effects of Stressors on Marine Mammals builds upon previous reports to assess current methodologies used for evaluating cumulative effects and identify new approaches that could improve these assessments. This review focuses on ways to quantify exposure-related changes in the behavior, health, or body condition of individual marine mammals and makes recommendations for future research initiatives.

"While there are examples of successful weapon systems acquisition programs within the U.S. Air Force (USAF), many of the programs are still incurring cost growth, schedule delays, and performance problems. The USAF now faces serious challenges in acquiring and maintaining its weapons systems as it strives to maintain its current programs; add new capabilities to counter evolving threats; and reduce its overall program expenditures. Owning the technical baseline is a critical component of the Air Forces ability to regain and maintain acquisition excellence. Owning the technical baseline allows the government acquisition team to manage and respond knowledgeably and effectively to systems development, operations, and execution, thereby avoiding technical and other programmatic barriers to mission success. Additionally, owning the technical baseline ensures that government personnel understand the user requirements, why a particular design and its various features have been selected over competing designs, and what the options are to pursue alternative paths to the final product given unanticipated cost, schedule, and performance challenges. Owning the Technical Baseline for Acquisition Programs in the U.S. Air Force discusses the strategic value to the Air Force of owning the technical baseline and the risk of not owning it and highlights key aspects of how agencies other than the Air Force own the technical baseline for their acquisition programs. This report identifies specific barriers to owning the technical baseline for the Air Force and makes recommendations to help guide the Air Force in overcoming those barriers"--Publisher's description.

Because of the role of innovation as a driver of economic productivity and growth and as a mechanism for improving people's well-being in other ways, understanding the nature, determinants, and impacts of innovation has become increasingly important to policy makers. To be effective, investment in innovation requires this understanding, which, in turn, requires measurement of the underlying inputs and subsequent outcomes of innovation processes. In May 2016, at the request of the National Center for Science and Engineering Statistics of the National Science Foundation, the Committee on National Statistics of the National Academies of Sciences, Engineering, and Medicine convened a workshop - bringing together academic researchers, private and public sector experts, and representatives from public policy agencies - to develop strategies for broadening and modernizing innovation information systems.This publication summarizes the presentation and discussion of the event.

"A report of the National Academies of Sciences, Engineering, Medicine"

Although people in the United States have historically been reasonably supportive of federal censuses and surveys, they are increasingly unavailable for or not willing to respond to interview requests from federal--as well as private--sources. Moreover, even when people agree to respond to a survey, they increasingly decline to complete all questions, and both survey and item nonresponse are growing problems. In March 2016, the National Academies of Sciences, Engineering, and Medicine convened a workshop to consider the respondent burden and its challenges and opportunities of the American Community Survey, which is conducted by the U.S. Census Bureau. This publication summarizes the presentations and discussions from the workshop.

The decay product of the medical isotope molybdenum-99 (Mo-99), technetium-99m (Tc-99m), and associated medical isotopes iodine-131 (I-131) and xenon-133 (Xe-133) are used worldwide for medical diagnostic imaging or therapy. The United States consumes about half of the world's supply of Mo-99, but there has been no domestic (i.e., U.S.-based) production of this isotope since the late 1980s. The United States imports Mo-99 for domestic use from Australia, Canada, Europe, and South Africa. Mo-99 and Tc-99m cannot be stockpiled for use because of their short half-lives. Consequently, they must be routinely produced and delivered to medical imaging centers. Almost all Mo-99 for medical use is produced by irradiating highly enriched uranium (HEU) targets in research reactors, several of which are over 50 years old and are approaching the end of their operating lives. Unanticipated and extended shutdowns of some of these old reactors have resulted in severe Mo-99 supply shortages in the United States and other countries. Some of these shortages have disrupted the delivery of medical care. Molybdenum-99 for Medical Imaging examines the production and utilization of Mo-99 and associated medical isotopes, and provides recommendations for medical use.

The process of discovering and developing a new drug or therapy is extremely costly and time consuming, and recently, it has been estimated that the creation of a new medicine costs on average more than $2 billion and takes 10 years to reach patients. The challenges associated with bringing new medicines to market have led many pharmaceutical companies to seek out innovative methods for streamlining their drug discovery research. One way to increase the odds of success for compounds in the drug development pipeline is to adopt genetically guided strategies for drug discovery, and recognizing the potential benefits of collecting genetic and phenotypic information across specific populations, pharmaceutical companies have started collaborating with healthcare systems and private companies that have curated genetic bioresources, or large databases of genomic information. Large-scale cohort studies offer an effective way to collect and store information that can be used to assess gene-environment interactions, identify new potential drug targets, understand the role of certain genetic variants in the drug response, and further elucidate the underlying mechanisms of disease onset and progression. To examine how genetic bioresources could be used to improve drug discovery and target validation, the National Academies of Sciences, Engineering, and Medicine hosted a workshop in March 2016. Participants at the workshop explored the current landscape of genomics-enabled drug discovery activities in industry, academia, and government; examined enabling partnerships and business models; and considered gaps and best practices for collecting population data for the purpose of improving the drug discovery process. This publication summarizes the presentations and discussions from the workshop.

"A report of the National Academies of Sciences, Engineering, Medicine"

NASA operates a large number of space science missions, approximately three-quarters of which are currently in their extended operations phase. They represent not only a majority of operational space science missions, but a substantial national investment and vital national assets. They are tremendously scientifically productive, making many of the major discoveries that are reported in the media and that rewrite textbooks. Extending Science - NASA's Space Science Mission Extensions and the Senior Review Process evaluates the scientific benefits of missions extensions, the current process for extending missions, the current biennial requirement for senior reviews of mission extensions, the balance between starting new missions and extending operating missions, and potential innovative cost-reduction proposals for extended missions, and makes recommendations based on this review.

"Nanoscale science, engineering, and technology, often referred to simply as "nanotechnology," is the understanding, characterization, and control of matter at the scale of nanometers, the dimension of atoms and molecules. Advances in nanotechnology promise new materials and structures that are the basis of solutions, for example, for improving human health, optimizing available energy and water resources, supporting a vibrant economy, raising the standard of living, and increasing national security. Established in 2001, the National Nanotechnology Initiative (NNI) is a coordinated, multiagency effort with the mission to expedite the discovery, development, and deployment of nanoscale science and technology to serve the public good. This report is the latest triennial review of the NNI called for by the 21st Century Nanotechnology Research and Development Act of 2003. It examines and comments on the mechanisms in use by the NNI to advance focused areas of nanotechnology towards advanced development and commercialization and on the physical and human infrastructure needs for successful realization in the United States of the benefits of nanotechnology development"--Publisher's description.

"It is not yet 60 years since the first artificial satellite was placed into Earth orbit. In just over a half century, mankind has gone from no presence in outer space to a condition of high dependence on orbiting satellites. These sensors, receivers, transmitters, and other such devices, as well as the satellites that carry them, are components of complex space systems that include terrestrial elements, electronic links between and among components, organizations to provide the management, care and feeding, and launch systems that put satellites into orbit. In many instances, these space systems connect with and otherwise interact with terrestrial systems; for example, a very long list of Earth-based systems cannot function properly without information from the Global Positioning System (GPS). Space systems are fundamental to the information business, and the modern world is an information-driven one. In addition to navigation (and associated timing), space systems provide communications and imagery and other Earth-sensing functions. Among these systems are many that support military, intelligence, and other national security functions of the United States and many other nations. Some of these are unique government, national security systems; however, functions to support national security are also provided by commercial and civil-government space systems."--

Even as the U.S. population becomes steadily more diverse, minorities and women remain underrepresented in clinical trials to develop new drugs and medical devices. Although progress in increasing minority participation in clinical trials has occurred, participation rates do not fully represent the overall population of minorities in the United States. This underrepresentation threatens the health of both these populations and the general population, since greater minority representation could reveal factors that affect health in all populations. Federal legislation has sought to increase the representation of minorities and women in clinical trials, but legislation by itself has not been sufficient to overcome the many barriers to greater participation. Only much broader changes will bring about the meaningful participation of all population groups in the clinical research needed to improve health. To examine the barriers to participation in clinical trials and ways of overcoming those barriers, the National Academies of Sciences, Engineering, and Medicine held a workshop in April 2015. This publication summarizes the presentations and discussions from the workshop.

"Our world is changing at an accelerating rate. The global human population has grown from 6.1 billion to 7.1 billion in the last 15 years and is projected to reach 11.2 billion by the end of the century. The distribution of humans across the globe has also shifted, with more than 50 percent of the global population now living in urban areas, compared to 29 percent in 1950. Along with these trends, increasing energy demands, expanding industrial activities, and intensification of agricultural activities worldwide have in turn led to changes in emissions that have altered the composition of the atmosphere. The Future of Atmospheric Chemistry Research: Remembering Yesterday, Understanding Today, Anticipating Tomorrow summarizes the rationale and need for supporting a comprehensive U.S. research program in atmospheric chemistry; comments on the broad trends in laboratory, field, satellite, and modeling studies of atmospheric chemistry; determines the priority areas of research for advancing the basic science of atmospheric chemistry; and identifies the highest priority needs for improvements in the research infrastructure to address those priority research topics. This report describes the scientific advances over the past decade in six core areas of atmospheric chemistry: emissions, chemical transformation, oxidants, atmospheric dynamics and circulation, aerosol particles and clouds, and biogeochemical cycles and deposition. This material was developed for the NSF's Atmospheric Chemistry Program; however, the findings will be of interest to other agencies and programs that support atmospheric chemistry research"--

An estimated 90 percent of oncology patients in the United States receive treatment in outpatient cancer centers and clinics. This change from the older model of inpatient care has important implications for overall quality of care for oncology patients and nutritional care in particular. Amidst growing concern about access to oncology nutrition services, combined with growing recognition of the importance of providing nutritional care to optimize oncology treatment outcomes and maximize quality of life among both patients and survivors of cancer, the National Academies of Sciences, Engineering, and Medicine convened a public workshop in March 2016 to explore evolving interactions between nutritional care, cancer, and health outcomes. Participants explored how health outcomes and survival of cancer patients in outpatient cancer centers are affected by current standards for nutritional services, nutritional interventions, and benefits associated with oncology patient access to medical nutrition therapy. They also studied the cost of outpatient nutritional care and assessed cost-benefit relationships between oncology nutrition services and health outcomes and survival. This publication summarizes the presentations and discussions from the workshop.

"A critical component of the nation's economic vitality is ensuring that all Americans can contribute and prosper. Such contributions presuppose an intentional focus on achieving the highest levels of health possible, which requires that conditions in communities, schools, workplaces, and other settings promote health and address the social determinants of health for all community members. Many organizations, in both the private and public sectors, have been establishing partnerships to further healthy workplaces and health equity in general. Many are taking the lead in producing economic growth that is inclusive and responsive to the nation's diverse needs and populations. Increasingly, private-public partnerships are emerging as ways of doing business. Additionally, a variety of new developments in health, health care, and community benefits obligations that are part of the Affordable Care Act have contributed to this interest in economic growth and health and in the creation of new partnerships. To examine past successes and future opportunities, the National Academies of Sciences, Engineering, and Medicine held a workshop in November 2015. The workshop focused on the potential of the private sector to produce a triple bottom line: economic opportunity (including workforce development) and growth, healthy work and community environments, and improved employee health. At the same time, participants looked beyond the private sector to public-private partnerships and to public-sector actions that combine opportunities for economic growth and good health for all. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

On March 3-4, 2016, the National Academies of Sciences, Engineering, and Medicine's Forum on Neuroscience and Nervous System Disorders held a workshop in Washington, DC, bringing together key stakeholders to discuss opportunities for improving the integrity, efficiency, and validity of clinical trials for nervous system disorders. Participants in the workshop represented a range of diverse perspectives, including individuals not normally associated with traditional clinical trials. The purpose of this workshop was to generate discussion about not only what is feasible now, but what may be possible with the implementation of cutting-edge technologies in the future.

Science is a way of knowing about the world. At once a process, a product, and an institution, science enables people to both engage in the construction of new knowledge as well as use information to achieve desired ends. Access to science--whether using knowledge or creating it--necessitates some level of familiarity with the enterprise and practice of science: we refer to this as science literacy. Science literacy is desirable not only for individuals, but also for the health and well- being of communities and society. More than just basic knowledge of science facts, contemporary definitions of science literacy have expanded to include understandings of scientific processes and practices, familiarity with how science and scientists work, a capacity to weigh and evaluate the products of science, and an ability to engage in civic decisions about the value of science. Although science literacy has traditionally been seen as the responsibility of individuals, individuals are nested within communities that are nested within societies--and, as a result, individual science literacy is limited or enhanced by the circumstances of that nesting. Science Literacy studies the role of science literacy in public support of science. This report synthesizes the available research literature on science literacy, makes recommendations on the need to improve the understanding of science and scientific research in the United States, and considers the relationship between scientific literacy and support for and use of science and research.

Children with disabilities and complex medical and educational needs present a special challenge for policy makers and practitioners. These children exhibit tremendous heterogeneity in their conditions and needs, requiring a varied array of services to meet those needs. Uneven public and professional awareness of their conditions and a research base marked by significant gaps have led to programs, practices, and policies that are inconsistent in quality and coverage. Parents often have to navigate and coordinate, largely on their own, a variety of social, medical, and educational support services, adding to the already daunting financial, logistical, and emotional challenges of raising children with special needs. The unmet needs of children with disabilities and complex medical and educational needs can cause great suffering for these children and for those who love and care for them. To examine how systems can be configured to meet the needs of children and families as they struggle with disabilities and complex health and educational needs, the National Academies of Sciences, Engineering, and Medicine held a workshop in December 2015. The goal of the workshop was to highlight the main barriers and promising solutions for improving care and outcome of children with complex medical and educational needs. Workshop participants examined prevention, care, service coordination, and other topics relevant to children with disabilities and complex health and educational needs, along with their families and caregivers. More broadly, the workshop seeks actionable understanding on key research questions for enhancing the evidence base; promoting and sustaining the quality, accessibility, and use of relevant programs and services; and informing relevant policy development and implementation. By engaging in dialogue to connect the prevention, treatment, and implementation sciences with settings where children are seen and cared for, the forum seeks to improve the lives of children by improving the systems that affect those children and their families. This publications summarizes the presentations and discussions from the workshop.