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Digital health encompasses a broad array of tools and strategies with the goals of advancing research, increasing health care access and quality, and making care more personalized. It encompasses health content, digital health interventions, and digital applications, such as communication tools connecting patients and clinicians (e.g., secure email in the patient portal, text, chat, video visit), remote monitoring tools, clinical decision support tools, and systems for exchanging health information. Patient-facing tools, tools for clinicians, and systems to facilitate research and care improvement are all part of this diverse landscape, and each raises unique opportunities and potential challenges. To examine key policy issues for the effective and safe development, implementation, and use of digital health technologies in oncology research and care, the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine held a virtual workshop in collaboration with the Forum on Cyber Resilience. The workshop, Opportunities and Challenges for Using Digital Health Applications in Oncology, held on July 13-14, 2020, convened a broad group of experts, including clinicians and researchers; patient advocates; and representatives of federal agencies, health professional societies, health care organizations, insurers, and the pharmaceutical and health technology industries. Many workshop speakers found the opportunities presented by digital health tools to be particularly compelling for oncology; however, capitalizing on these opportunities necessitates careful attention to the design, implementation, and use of digital health technologies. This publication summarizes the presentations and discussions from the workshop.

"The opioid overdose epidemic combined with the need to reduce the burden of acute pain poses a public health challenge. To address how evidence-based clinical practice guidelines for prescribing opioids for acute pain might help meet this challenge, Framing Opioid Prescribing Guidelines for Acute Pain: Developing the Evidence develops a framework to evaluate existing clinical practice guidelines for prescribing opioids for acute pain indications, recommends indications for which new evidence-based guidelines should be developed, and recommends a future research agenda to inform and enable specialty organizations to develop and disseminate evidence-based clinical practice guidelines for prescribing opioids to treat acute pain indications. The recommendations of this study will assist professional societies, health care organizations, and local, state, and national agencies to develop clinical practice guidelines for opioid prescribing for acute pain. Such a framework could inform the development of opioid prescribing guidelines and ensure systematic and standardized methods for evaluating evidence, translating knowledge, and formulating recommendations for practice"--

The evolution of health care is expanding the possibilities for integration of clinical research into the continuum of clinical care; new approaches are enabling the collection of data in real-world settings; and new modalities, such as digital health technologies and artificial intelligence applications, are being leveraged to overcome challenges and advance clinical research. At the same time, the clinical research enterprise is strained by rising costs, varying global regulatory and economic landscapes, increasing complexity of clinical trials, barriers to recruitment and retention of research participants, and a clinical research workforce that is under tremendous demands. Looking ahead to 2030, the Forum on Drug Discovery, Development, and Translation of the National Academies of Sciences, Engineering, and Medicine convened a public workshop for stakeholders from across the drug research and development life cycle to reflect on the lessons learned over the past 10 years and consider opportunities for the future. The workshop was designed to consider goals and priority action items that could advance the vision of a 2030 clinical trials enterprise that is more efficient, effective, person-centered, inclusive, and integrated into the health care delivery system so that outcomes and experiences for all stakeholders are improved. This Proceedings of a Workshop summarizes the presentations and discussions that took place during the four-part virtual public workshop held on January 26, February 9, March 24, and May 11, 2021.

To take stock of lessons learned from COVID-19 around the world and in the United States, the Forum on Microbial Threats held two virtual workshops during 2021. The first workshop focused on what it means to frame the response to COVID-19 through a "syndemic" approach, and what the implications would be for global recovery. The second workshop focused more broadly on key lessons and emerging data from ongoing pandemic response efforts that can be incorporated into current health systems to improve resilience and preparedness for future outbreaks. This workshop explored the long-term effects of COVID-19 on health equity, including considerations for mental health and social determinants of health. It also addressed uncertainties during a pandemic, such as trust, communication, and engagement and explored approaches to systematize recovery efforts to improve the ongoing responses and prepare for the next pandemic. Experts discussed possibilities for a post-pandemic world and a response strategy for stakeholders that ensures sustained community partnerships and prioritization of health equity. This Proceedings of a Workshop summarizes the presentations and discussions from the second workshop.

"Autoimmune diseases occur when the body's immune system malfunctions and mistakenly attacks healthy cells, tissues, and organs. Strong data on the incidence and prevalence of autoimmune diseases are limited, but a 2009 study estimated the prevalence of autoimmune diseases in the U.S. to be 7.6 to 9.4 percent, or 25 to 31 million people today. This estimate, however, includes only 29 autoimmune diseases, and it does not account for increases in prevalence in the last decade. By some counts, there are around 150 autoimmune diseases, which are lifelong chronic illnesses with no known cures. The National Academies of Sciences, Engineering, and Medicine was asked to assess the autoimmune disease research portfolio of the National Institutes of Health (NIH). Enhancing NIH Research on Autoimmune Disease finds that while NIH has made impressive contributions to research on autoimmune diseases, there is an absence of a strategic NIH-wide autoimmune disease research plan and a need for greater coordination across the institutes and centers to optimize opportunities for collaboration. To meet these challenges, this report calls for the creation of an Office of Autoimmune Disease/Autoimmunity Research in the Office of the Director of NIH. The Office could facilitate NIH-wide collaboration, and engage in prioritizing, budgeting, and evaluating research. Enhancing NIH Research on Autoimmune Disease also calls for the establishment of long term systems to collect epidemiologic and surveillance data and long term studies (20+ years) to study disease across the life course. Finally, the report provides an agenda that highlights research needs that crosscut many autoimmune diseases, such as understanding the effect of environmental factors in initiating disease"--

The needs and demands placed on science to address a range of urgent problems are growing. The world is faced with complex, interrelated challenges in which the way forward lies hidden or dispersed across disciplines and organizations. For centuries, scientific research has progressed through iteration of a workflow built on experimentation or observation and analysis of the resulting data. While computers and automation technologies have played a central role in research workflows for decades to acquire, process, and analyze data, these same computing and automation technologies can now also control the acquisition of data, for example, through the design of new experiments or decision making about new observations. The term automated research workflow (ARW) describes scientific research processes that are emerging across a variety of disciplines and fields. ARWs integrate computation, laboratory automation, and tools from artificial intelligence in the performance of tasks that make up the research process, such as designing experiments, observations, and simulations; collecting and analyzing data; and learning from the results to inform further experiments, observations, and simulations. The common goal of researchers implementing ARWs is to accelerate scientific knowledge generation, potentially by orders of magnitude, while achieving greater control and reproducibility in the scientific process. Automated Research Workflows for Accelerated Discovery: Closing the Knowledge Discovery Loop examines current efforts to develop advanced and automated workflows to accelerate research progress, including wider use of artificial intelligence. This report identifies research needs and priorities in the use of advanced and automated workflows for scientific research. Automated Research Workflows for Accelerated Discovery is intended to create awareness, momentum, and synergies to realize the potential of ARWs in scholarly discovery.

The U.S. Department of Defense is pursuing an improved ability to more closely integrate and operate jointly against agile adversaries through Joint All-Domain Command and Control (JADC2). This framework will seamlessly integrate sensors, networks, platforms, commanders, operators, and weapon systems for rapid information collection, decision-making, and projection of joint and multinational forces. The Department of the Air Force's contribution to JADC2 is the Advanced Battle Management System (ABMS). As an evolving system in the early stages of definition, ABMS architecture and its supporting elements remain dynamic. Advanced Battle Management System assesses the technical approach being employed by ABMS and its ability to effectively support the range of system integration desired, while also supporting operational and development agility; and the governance being applied by ABMS and if it is appropriate and sufficient to enable quick development and evolution of capabilities while maintaining appropriate government control over the output.

"The aging population of the United States has significant implications for the workforce - challenging what it means to work and to retire in the U.S. In fact, by 2030, one-fifth of the population will be over age 65. This shift has significant repercussions for the economy and key social programs. Due to medical advancements and public health improvements, recent cohorts of older adults have experienced better health and increasing longevity compared to earlier cohorts. These improvements in health enable many older adults to extend their working lives. While higher labor market participation from this older workforce could soften the potential negative impacts of the aging population over the long term on economic growth and the funding of Social Security and other social programs, these trends have also occurred amidst a complicating backdrop of widening economic and social inequality that has meant that the gains in health, improvements in mortality, and access to later-life employment have been distributed unequally. Understanding the Aging Workforce: Defining a Research Agenda offers a multidisciplinary framework for conceptualizing pathways between work and nonwork at older ages. This report outlines a research agenda that highlights the need for a better understanding of the relationship between employers and older employees; how work and resource inequalities in later adulthood shape opportunities in later life; and the interface between work, health, and caregiving. The research agenda also identifies the need for research that addresses the role of workplaces in shaping work at older ages, including the role of workplace policies and practices and age discrimination in enabling or discouraging older workers to continue working or retire."--Publisher's website.

"The Consumer Price Index (CPI), produced by the Bureau of Labor Statistics (BLS), is the most widely used measure of inflation in the U.S. It is used to determine cost-of-living allowances and, among many other important private- and public-sector applications, influences monetary policy. The CPI has traditionally relied on field-generated data, such as prices observed in person at grocery stores or retailers. However, as these data have become more challenging and expensive to collect in a way that reflects an increasingly dynamic marketplace, statistical agencies and researchers have begun turning to opportunities created by the vast digital sources of consumer price data that have emerged. The enormous economic disruption of the COVID-19 pandemic, including major shifts in consumers' shopping patterns, presents a perfect case study for the need to rapidly employ new data sources for the CPI. Modernizing the Consumer Price Index presents guidance to BLS as the agency embarks on a strategy of accelerating and enhancing the use of scanner, web-scraped, and digital data directly from retailers in compiling the CPI. The report also recommends strategies for BLS to more accurately estimate the composition of households' expenditures - or market basket shares - by updating this information more frequently and using innovative survey techniques and alternative data sources where possible. The report provides targeted guidance for integrating new data sources to improve the CPI's estimation of changes in the prices of housing and medical care, two consumer expenditure categories that are traditionally difficult to measure. Because of the urgency of issues related to income and wealth inequality, the report also recommends that BLS identify data sources that would allow it to estimate price indexes defined by income quintile or decile"--

Nearly 600,000 people are released from state and federal prisons annually. Whether these individuals will successfully reintegrate into their communities has been identified as a critical measure of the effectiveness of the criminal legal system. However, evaluating the successful reentry of individuals released from prison is a challenging process, particularly given limitations of currently available data and the complex set of factors that shape reentry experiences. The Limits of Recidivism: Measuring Success After Prison finds that the current measures of success for individuals released from prison are inadequate. The use of recidivism rates to evaluate post-release success ignores significant research on how and why individuals cease to commit crimes, as well as the important role of structural factors in shaping post-release outcomes. The emphasis on recidivism as the primary metric to evaluate post-release success also ignores progress in other domains essential to the success of individuals returning to communities, including education, health, family, and employment. In addition, the report highlights the unique and essential insights held by those who have experienced incarceration and proposes that the development and implementation of new measures of post-release success would significantly benefit from active engagement with individuals with this lived experience. Despite significant challenges, the report outlines numerous opportunities to improve the measurement of success among individuals released from prison and the report's recommendations, if implemented, will contribute to policies that increase the health, safety, and security of formerly incarcerated persons and the communities to which they return.

Historically Black Colleges and Universities (HBCUs) and other minority institutions (MIs) represent a valuable resource to expand the Department of Defense's (DoD) government and extramural workforce and science and technology enterprise. The more than 400 public and private HBCUs, Tribal Colleges and Universities, Hispanic-Serving Institutions, and other two- and four-year MIs are positioned to make strong and uniquely important contributions to the defense research enterprise, offering DoD an opportunity to widen its talent pool and diversify STEM research and ultimately strengthen its ability to support national security. Defense Research Capacity at Historically Black Colleges and Universities and Other Minority Institutions examines the status of DoD research at HBCUs and MIs, including the methods and means necessary to advance research capacity at these institutions in order to comprehensively address the national security and defense needs of the United States. This report offers recommendations to guide DoD, Congress, HBCU/MIs, and partnering entities in supporting and strengthening the role of these institutions in defense research. A strategic commitment will translate into increased opportunities for HBCU/MIs to diversify the future American academic, industrial, and government STEM workforce upon which DoD will depend.

"In November 2020, the National Academies of Sciences, Engineering, and Medicine convened a multi-day virtual symposium on imaging the future of undergraduate STEM education. Speakers and participants pondered the future and the past and shared their goals, priorities, and dreams for improving undergraduate STEM education. Expert speakers presented information about today's students and approaches to undergraduate STEM education, as well as the history of transformation in higher education. Thoughtful discussions explored ideas for the future, how student-centered learning experiences could be created, and what issues to consider to facilitate a successful transformation. This publication summarizes the presentation and discussion of the symposium."--

To better understand the inequalities facing lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth and the promising interventions being used to address these inequalities, the National Academies of Sciences, Engineering, and Medicine's Board on Children, Youth, and Families hosted a virtual public workshop titled Reducing Inequalities Between LGBTQ Adolescents and Cisgender, Heterosexual Adolescents, which convened on August 25-27, 2021. The workshop was developed by a planning committee composed of experts from the fields of sociology, medicine, public health, psychology, social work, policy, and direct-service provision. This Proceedings of a Workshop summarizes the presentations and discussions from that workshop.

The U.S. Environmental Protection Agency's (EPA) Integrated Risk Information System (IRIS) program develops human health assessments that focus on hazard identification and dose-response analyses for chemicals in the environment. The ORD Staff Handbook for Developing IRIS Assessments (the handbook) provides guidance to scientists who perform the IRIS assessments in order to foster consistency in the assessments and enhance transparency about the IRIS assessment process. At the request of the EPA, this report reviews the procedures and considerations for operationalizing the principles of systematic reviews and the methods described in the handbook for determining the scope of the IRIS assessments, evidence integration, extrapolation techniques, dose-response analyses, and characterization of uncertainties.

More than a decade after the Deepwater Horizon disaster, the Gulf Research Program convened a diverse group of 60 experts in a virtual event to inform its efforts to enhance resilience to future offshore oil disasters in the Gulf of Mexico region. The event, Offshore Situation Room, took place over three half-days during June 15-17, 2021, and had four main objectives: 1) develop a concise, prioritized list of questions that need to be addressed to support successful prevention, response, and recovery that would minimize the impacts of an offshore oil disaster; 2) provide a collaborative atmosphere where participants can share ideas, capabilities, and information, and build a community dedicated to the successful prevention of, response to, and recovery from an offshore oil spill disaster; 3) explore capabilities for and impediments to prevention, response, recovery, and understanding impacts of an offshore oil disaster in the Gulf of Mexico; and 4) highlight how changes in policy, response, resilience, and restoration efforts may affect outcomes of a major offshore incident. This publication summarizes the presentations and discussion of the event.

The U.S. medical countermeasures (MCMs) enterprise is interconnected, complex, and dynamic. It includes public and private entities that develop and manufacture new and existing MCMs, ensure procurement, storage, and distribution of MCMs, and administer, monitor, and evaluate MCMs. The interagency group known as the Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) is the nation's sole coordinating body, responsible for ensuring end-to-end MCM preparedness and response. Ensuring an Effective Public Health Emergency Medical Countermeasures Enterprise provides recommendations from an expert committee for a re-envisioned PHEMCE. Four priority areas of improvement emerged from committee deliberations: (1) articulating PHEMCE's mission and role and explicating the principles guiding PHEMCE's operating principles and processes, (2) revising PHEMCE operations and processes, (3) collaborating more effectively with external public and private partners, and (4) navigating legal and policy issues.

"The Antarctic's unique environment and position on the globe make it a prime location to gain insights into how Earth and the universe operate. This report assesses National Science Foundation (NSF) progress in addressing three priority research areas identified in a 2015 National Academies report: (1) understanding the linkages between ice sheets and sea-level rise, including both a focus on current rates of ice sheet change and studies of past major ice sheet retreat episodes; (2) understanding biological adaptations to the extreme and changing Antarctic environment; and (3) establishing a next-generation cosmic microwave background (CMB) program, partly located in Antarctica, to study the origins of the universe. NSF has made important progress understanding the impacts of current ice sheet change, particularly through studies focused on the ice sheet and ocean interactions driving ongoing ice mass loss at the Thwaites Glacier and Amundsen Sea region in West Antarctica. Less progress has been made on studies of past major ice sheet retreat episodes. Progress is also strong on CMB research to understand the origins of the universe. Progress has lagged on understanding biological adaptations, in part because of limited community organization and collaboration toward the priority. To accelerate progress during the second half of the initiative, NSF could issue specific calls for proposals, develop strategies to foster collaborations and partnerships, and commission a transparent review of logistical capacity to help illuminate strategies and priorities for addressing resource constraints. Such efforts would also help optimize science and proposal development in an environment of inherently constrained logistics." --

Since the 1980s, national and international planetary protection policies have sought to avoid contamination by terrestrial organisms that could compromise future investigations regarding the origin or presence of Martian life. Over the last decade, the number of national space agencies planning, participating in, and undertaking missions to Mars has increased, and private-sector enterprises are engaged in activities designed to enable commercial missions to Mars. The nature of missions to Mars is also evolving to feature more diversity in purposes and technologies. As missions to Mars increase and diversify, national and international processes for developing planetary protection measures recognize the need to consider the interests of scientific discovery, commercial activity, and human exploration. The implications of these changes for planetary protection should be considered in the context of how much science has learned about Mars, and about terrestrial life, in recent years. At the request of NASA, this report identifies criteria for determining locations on Mars potentially suitable for landed robotic missions that satisfy less stringent bioburden requirements, which are intended to manage the risk of forward contamination.

"To better support the need for timely, effective manufacturing technology development and transition, the Department of Defense (DoD) has established nine Manufacturing Innovation Institutes (MIIs) through its Defense-wide Manufacturing Science and Technology program element within the DoD Manufacturing Technology program. The institutes are considered by DoD to be important facilitators that bring together innovative ecosystems in key technology and market sectors in the United States. DoD MIIs are industry-led public private partnerships, with dual, public and private benefit, providing large commercial market potential while also meeting key U.S. defense industrial needs. The mission of the nine DoD-established institutes addresses both defense and commercial manufacturing needs within specific, defense-relevant technology areas. DoD Engagement with Its Manufacturing Innovation Institutes Phase 2 Study provides strategic guidance on protocols for conducting long term engagement assessments of the MIIs including evaluation metrics; best practices for MII education and workforce development programs; and development of strategies for better connecting MIIs to the broader DoD community and to other federal agencies. An interim report focused on the MII assessment protocol topic was published in April 2021 and is also included in this report, in appendixes C and D. This final report provides findings and recommendations relevant to education and workforce development best practices and DoD and other federal agency engagement strategies." --

"Rigorous operational testing (OT) of weapon systems procured by the U.S. Department of Defense (DoD) is fundamental to ensuring that these sophisticated systems not only meet their stated requirements, but also perform under realistic operational conditions when faced by determined adversaries employing their own highly capable offensive and defensive weaponry. DoD's test and training range enterprise provides the geography, infrastructure, technology, expertise, processes, and management that make safe, secure, and comprehensive OT possible. The challenges facing the nation's range infrastructure are both increasing and accelerating. Limited test capacity in physical resources and workforce, the age of test infrastructure, the capability to test advanced technologies, and encroachment impact the ability to inform system performance, integrated system performance and the overall pace of testing. Necessary DoD Range Capabilities to Ensure Operational Superiority of U.S. Defense Systems assesses the physical and technical suitability of DoD test and evaluation ranges, infrastructure, and tools for determining the operational effectiveness, suitability, survivability, and lethality of military systems. This report explores modernization, sustainment, operations, and resource challenges for test and evaluation ranges, and makes recommendations to put the DoD range enterprise on a modernization trajectory to meet the needs of OT in the years ahead."--Publisher's website.

The U.S. Food and Drug Administration (FDA) has approved dozens of hormone therapy products for men and women, including estrogen, progesterone, testosterone, and related compounds. These products have been reviewed for safety and efficacy and are indicated for treatment of symptoms resulting from hormonal changes associated with menopause or other endocrine-based disorders. In recent decades, an increasing number of health care providers and patients have turned to custom-formulated, or compounded, drug preparations as an alternative to FDA-approved drug products for hormone-related health concerns. These compounded hormone preparations are often marketed as "bioidentical" or "natural" and are commonly referred to as compounded bioidentical hormone therapy (cBHT). In light of the fast-growing popularity of cBHT preparations, the clinical utility of these compounded preparations is a substantial public health concern for various stakeholders, including medical practitioners, patients, health advocacy organizations, and federal and state public health agencies. This report examines the clinical utility and uses of cBHT drug preparations and reviews the available evidence that would support marketing claims of the safety and effectiveness of cBHT preparations. It also assesses whether the available evidence suggests that these preparations have clinical utility and safety profiles warranting their clinical use and identifies patient populations that might benefit from cBHT preparations in lieu of FDA-approved BHT.

Workshop information found on publisher's Web site.

The Food Forum of the National Academies of Sciences, Engineering, and Medicine convened a virtual workshop, Challenges and Opportunities for Precision and Personalized Nutrition, on August 10-12, 2021. The workshop explored potential challenges and opportunities in the application of precision and personalized nutrition approaches to optimize dietary guidance and improve nutritional status. Workshops presenters discussed current precision and personalized nutrition research methodologies, limitations in data and design, adapting technologies for utilization, and policy and regulatory challenges. This Proceedings of a Workshop summarizes the presentations and discussions of the workshop.

Science, technology, engineering and mathematics (STEM) professionals generate a stream of scientific discoveries and technological innovations that fuel job creation and national economic growth. Ensuring a robust supply of these professionals is critical for sustaining growth and creating jobs growth at a time of intense global competition. Undergraduate STEM education prepares the STEM professionals of today and those of tomorrow, while also helping all students develop knowledge and skills they can draw on in a variety of occupations and as individual citizens. However, many capable students intending to major in STEM later switch to another field or drop out of higher education altogether, partly because of documented weaknesses in STEM teaching, learning and student supports. Improving undergraduate STEM education to address these weaknesses is a national imperative. Many initiatives are now underway to improve the quality of undergraduate STEM teaching and learning. Some focus on the national level, others involve multi-institution collaborations, and others take place on individual campuses. At present, however, policymakers and the public do not know whether these various initiatives are accomplishing their goals and leading to nationwide improvement in undergraduate STEM education. Indicators for Monitoring Undergraduate STEM Education outlines a framework and a set of indicators that document the status and quality of undergraduate STEM education at the national level over multiple years. It also indicates areas where additional research is needed in order to develop appropriate measures. This publication will be valuable to government agencies that make investments in higher education, institutions of higher education, private funders of higher education programs, and industry stakeholders. It will also be of interest to researchers who study higher education.