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Ensuring the safety of food and the quality and safety of medicines in a country is an important role of government, made more complicated by global manufacturing and international trade. By recent estimates, unsafe food kills over 400,000 people a year, a third of them children under 5, mostly in low- and middle-income countries; every year poor quality medicines cause about 70,000 excess deaths from childhood pneumonia and roughly 8,500 to 20,000 malaria deaths in sub-Saharan Africa alone. The Federal Drug Administration (FDA) Office of Global Policy and Strategy is charged with improving capacity of the agency's foreign counterpart offices and increasing understanding of the importance of regulatory systems for public health, development, and trade. At the request of the FDA, this study sets out a strategy to support good quality, wholesome food and safe, effective medical products around the world. Its goal is to build on the momentum for strengthening regulatory systems and to set a course for sustainability and continued progress. The 2012 report Ensuring Safe Food and Medical Products Through Stronger Regulatory Systems Abroad outlined strategies to secure international supply chains, emphasized capacity building and support for surveillance in low- and middle-income countries, and explored ways to facilitate work sharing among food and medical product regulatory agencies. This new study assess progress made and the current regulatory landscape.

Resilient supply chains are crucial to maintaining the consistent delivery of goods and services to the American people. The modern economy has made supply chains more interconnected than ever, while also expanding both their range and fragility. In the third quarter of 2017, Hurricanes Harvey, Irma and Maria revealed some significant vulnerabilities in the national and regional supply chains of Texas, Florida, the U.S. Virgin Islands, and Puerto Rico. The broad impacts and quick succession of these three hurricanes also shed light on the effectiveness of the nation's disaster logistics efforts during response through recovery. Drawing on lessons learned during the 2017 hurricanes, this report explores future strategies to improve supply chain management in disaster situations. This report makes recommendations to strengthen the roles of continuity planning, partnerships between civic leaders with small businesses, and infrastructure investment to ensure that essential supply chains will remain operational in the next major disaster. Focusing on the supply chains food, fuel, water, pharmaceutical, and medical supplies, the recommendations of this report will assist the Federal Emergency Management Agency as well as state and local officials, private sector decision makers, civic leaders, and others who can help ensure that supply chains remain robust and resilient in the face of natural disasters.

Leadership in gas turbine technologies is of continuing importance as the value of gas turbine production is projected to grow substantially by 2030 and beyond. Power generation, aviation, and the oil and gas industries rely on advanced technologies for gas turbines. Market trends including world demographics, energy security and resilience, decarbonization, and customer profiles are rapidly changing and influencing the future of these industries and gas turbine technologies. Technology trends that define the technological environment in which gas turbine research and development will take place are also changing - including inexpensive, large scale computational capabilities, highly autonomous systems, additive manufacturing, and cybersecurity. It is important to evaluate how these changes influence the gas turbine industry and how to manage these changes moving forward. Advanced Technologies for Gas Turbines identifies high-priority opportunities for improving and creating advanced technologies that can be introduced into the design and manufacture of gas turbines to enhance their performance. The goals of this report are to assess the 2030 gas turbine global landscape via analysis of global leadership, market trends, and technology trends that impact gas turbine applications, develop a prioritization process, define high-priority research goals, identify high-priority research areas and topics to achieve the specified goals, and direct future research. Findings and recommendations from this report are important in guiding research within the gas turbine industry and advancing electrical power generation, commercial and military aviation, and oil and gas production.

"The Veterans Health Administration (VHA) is America's largest integrated health care system, providing care at 1,243 health care facilities, including 172 medical centers and 1,063 outpatient sites of care of varying complexity, serving 9 million enrolled Veterans each year. In addition, VHA has opened outpatient clinics and established telemedicine and other services to accommodate a diverse veteran population and continues to cultivate ongoing medical research and innovation. Facilities specific to VHA fulfill clinical, operational, research laboratory, and administrative functions. Each site is designed to serve a geographical location with specific health care needs. VHA's building inventory has sites of different ages, and often there is a mix of building size and age at each site or campus. At the request of the VHA, this study presents a comprehensive resource planning and staffing methodology guidebook for VHA Facility Management Programs by reviewing the tasks of VHA building facilities staff and recommending actions for the VHA to meet the mission goals of delivering patient care, research, and effective operations."--

While progress has been made in the development of decarbonization technologies, much work remains in scale-up and deployment. For decarbonization technologies to reach meaningful scale, real-world constraints, societal, economic, and political, must be considered. To identify the primary challenges and opportunities to deploying decarbonization technologies at scale across major sectors of the U.S. economy, the Board on Energy and Environmental Systems of the National Academies of Sciences, Engineering, and Medicine convened a workshop on July 22-23, 2019. In addition to technology-specific and sector-specific studies, the workshop considered the types of societal transformations required, as well as potential policy drivers for carbon dioxide emissions reductions. This publication summarizes the presentations and discussion of the workshop.

Exposures at low doses of radiation, generally taken to mean doses below 100 millisieverts, are of primary interest for setting standards for protecting individuals against the adverse effects of ionizing radiation. However, there are considerable uncertainties associated with current best estimates of risks and gaps in knowledge on critical scientific issues that relate to low dose radiation. The Nuclear and Radiation Studies Board of the National Academies hosted the symposium on The Future of Low Dose Radiation Research in the United States on May 8 and 9, 2019. The goal of the symposium was to provide an open forum for a national discussion on the need for a long-term strategy to guide a low dose radiation research program in the United States. The symposium featured presentations on low dose radiation programs around the world, panel discussions with representatives from governmental and nongovernmental organizations about the need for a low dose radiation research program, reviews of low dose radiation research in epidemiology and radiation biology including new directions, and lessons to be learned from setting up large research programs in non-radiation research fields. This publication summarizes the presentation and discussion of the symposium.

Human trafficking has many names and can take many forms - pimp control, commercial sex, exploitation, forced labor, modern slavery, child labor, and several others - and the definitions vary greatly across countries and cultures, as well as among researchers. In the United States, the Trafficking Victims Protection Act (TVPA) is the cornerstone of counter-trafficking efforts. It provides guidance for identifying and defining human trafficking, and it authorizes legislation and appropriations for subsequent counter-trafficking measures both within and outside of the federal government. First enacted in 2000, the TVPA has since been reauthorized by three administrations, and it includes a directive for the President to establish an Interagency Task Force to Monitor and Combat Trafficking. The subsequent Frederick Douglass Trafficking Victims Prevention and Protection Reauthorization Act of 2018 also includes provisions for victim services and plans to enhance collaboration efforts to fight trafficking abroad. To explore current and innovative sampling methods, technological approaches, and analytical strategies for estimating the prevalence of sex and labor trafficking in vulnerable populations, a 2-day public workshop, Approaches to Estimating the Prevalence of Human Trafficking in the United States, was held in Washington, D.C. in April 2019. The workshop brought together statisticians, survey methodologists, researchers, public health practitioners, and other experts who work closely with human trafficking data or with the survivors of trafficking. Participants addressed the current state of research on human trafficking, advancements in data collection, and gaps in the data. They discussed international practices and global trends in human trafficking prevalence estimation and considered ways in which collaborations across agencies and among the U.S. government and private-sector organizations have advanced counter-trafficking efforts. This proceedings summarizes the presentations and discussions of the workshop.

Water of appropriate quantity and quality is essential for drinking, sanitation, and food, energy, and industrial production for any society and is derived for most needs from surface- or groundwater sources. Studies suggest that groundwater use in irrigation globally is increasing in total volume as well as a percentage of all water used for irrigation, with the demand for groundwater resources increasing as available primary surface water supplies are depleted. Particularly in arid regions, groundwater may be the most accessible water supply for any purpose, leaving groundwater withdrawals concentrated in areas that are already experiencing water stress. Even in the presence of direct ground observations and measurements of the water table, quantitative evaluation of groundwater storage, flow, or recharge at different scales requires remotely sensed data and observations applied to groundwater models. Resolving the interaction of groundwater storage, flow, and recharge at a scale at which basins are managed requires remotely sensed data and proxy data. In June 2019, the Water Science and Technology Board of the National Academies of Sciences, Engineering, and Medicine convened a workshop to identify scientific and technological research frontiers in monitoring and modeling groundwater recharge and flow in various regions of the world. The goals of the workshop were to assess regional freshwater budgets under major use scenarios, including agriculture, industry, and municipal; examine state of the art research frontiers in characterizing groundwater aquifers, including residence time, quantity, flow, depletion, and recharge, using remotely sensed observations and proxy data; discuss groundwater model uncertainties and methods for mitigating them using sparse ground observations or data and other approaches; and consider our ability to detect which water management strategies that affect groundwater flow and recharge are being used and any changes in their use over time. This publication summarizes workshop presentations and plenary discussions.

"The field of atomic, molecular, and optical (AMO) science underpins many technologies and continues to progress at an exciting pace for both scientific discoveries and technological innovations. AMO physics studies the fundamental building blocks of functioning matter to help advance the understanding of the universe. It is a foundational discipline within the physical sciences, relating to atoms and their constituents, to molecules, and to light at the quantum level. AMO physics combines fundamental research with practical application, coupling fundamental scientific discovery to rapidly evolving technological advances, innovation and commercialization. Due to the wide-reaching intellectual, societal, and economical impact of AMO, it is important to review recent advances and future opportunities in AMO physics. Manipulating Quantum Systems: An Assessment of Atomic, Molecular, and Optical Physics in the United States assesses opportunities in AMO science and technology over the coming decade. Key topics in this report include tools made of light; emerging phenomena from few- to many-body systems; the foundations of quantum information science and technologies; quantum dynamics in the time and frequency domains; precision and the nature of the universe, and the broader impact of AMO science."--

"In 2018, the United Nations High Commissioner for Refugees estimated 70.8 million people could be considered forced migrants, which is nearly double their estimation just one decade ago. This includes internally displaced persons, refugees, asylum seekers, and stateless people. This drastic increase in forced migrants exacerbates the already urgent need for a systematic policy-related review of the available data and analyses on forced migration and refugee movements. To explore the causes and impacts of forced migration and population displacement, the National Academies convened a two-day workshop on May 21-22, 2019. The workshop discussed new approaches in social demographic theory, methodology, data collection and analysis, and practice as well as applications to the community of researchers and practitioners who are concerned with better understanding and assisting forced migrant populations. This workshop brought together stakeholders and experts in demography, public health, and policy analysis to review and address some of the domestic implications of international migration and refugee flows for the United States. This publication summarizes the presentations and discussions from the workshop" --Publisher's description.

To explore value proposition for different sectors that engage in global health - including industry, government, philanthropy, and civil society - and innovative models for multi-sectoral collaboration, the Forum on Public-Private Partnerships for Global Health and Safety of the National Academies of Sciences, Engineering, and Medicine convened a 2-day workshop on November 15 and 16, 2018. With a specific focus on industry engagement, the workshop examined how stakeholders within industry define and measure value relative to global health as well as how and why other sectors in the global health community engage with industry. This publication summarizes the presentation and discussion of the workshop.

"Adolescence is a critical growth period in which youth develop essential skills that prepare them for adulthood. Prevention and intervention programs are designed to meet the needs of adolescents who require additional support and promote healthy behaviors and outcomes. To ensure the success of these efforts, it is essential that they include reliably identifiable techniques, strategies, or practices that have been proven effective. Promoting Positive Adolescent Health Behaviors and Outcomes: Thriving in the 21st Century identifies key program factors that can improve health outcomes related to adolescent behavior and provides evidence-based recommendations toward effective implementation of federal programming initiatives. This study explores normative adolescent development, the current landscape of adolescent risk behavior, core components of effective programs focused on optimal health, and recommendations for research, programs, and policies."--

High-entropy materials, ultra-strong molecules, and nanoelectronics have become a focus of active research because of their unique potential and applications. Global research is rapidly accelerating and unlocking major recent breakthroughs. It is important to highlight these recent developments and explore possibilities for future research and applications. The National Academies convened a workshop on February 10-11, 2016 to discuss issues in defense materials, manufacturing, and infrastructure. Key topics of discussion included emerging capabilities and research objectives for ultra-strong molecules, high-entropy materials, and nanoelectronics. This publication summarizes the presentations and discussions from the workshop.

"Legionnaires' disease, a pneumonia caused by the Legionella bacterium, is the leading cause of reported waterborne disease outbreaks in the United States. Legionella occur naturally in water from many different environmental sources, but grow rapidly in the warm, stagnant conditions that can be found in engineered water systems such as cooling towers, building plumbing, and hot tubs. Humans are primarily exposed to Legionella through inhalation of contaminated aerosols into the respiratory system. Legionnaires' disease can be fatal, with between 3 and 33 percent of Legionella infections leading to death, and studies show the incidence of Legionnaires' disease in the United States increased five-fold from 2000 to 2017. Management of Legionella in Water Systems reviews the state of science on Legionella contamination of water systems, specifically the ecology and diagnosis. This report explores the process of transmission via water systems, quantification, prevention and control, and policy and training issues that affect the incidence of Legionnaires' disease. It also analyzes existing knowledge gaps and recommends research priorities moving forward"--Publisher's description

Globalization is rapidly changing lives and industries around the world. Drug development, authorization, and regulatory supervision have become international endeavors, with most medicines becoming global commodities. Drug companies utilize global supply chains that often include facilities in countries with inconsistent regulations from those of the United States, perform pivotal trials in multiple countries to support registration submissions in various jurisdictions, and subsequently market their medicines throughout most of the world. These companies operate across borders and require individual national regulators to ensure that drugs authorized for use in their countries are safe and effective, and appropriate for their health care system and their population. This process involves significant resources and often duplicative work. It is important to consider how this process can be improved in order to better allocate resources, time, and efforts to improve public health. Regulating Medicines in a Globalized World: The Need for Increased Reliance Among Regulators considers the role of mutual recognition and other reliance activities among regulators in contributing to enhancing public health. This report identifies opportunities for leveraging reliance activities more broadly in order to potentially impact public health globally. Key topics in this report include the job of medicines regulators in today's world, what policy makers need to know about today's regulatory environment, stakeholder views of recognition and reliance, as well as removing impediments and facilitating action for greater recognition and reliance among regulatory authorities.

"Recent advancements in quantum-enabled systems present a variety of new opportunities and challenges. These technologies are important developments for a variety of computing, communications, and sensing applications. However, many materials and components relevant to quantum-enabled systems exist outside of the United States, and it is important to promote the development of assured domestic sources of materials, manufacturing capabilities, and expertise. The National Academies of Sciences, Engineering, and Medicine convened a 2-day workshop to explore implications and concerns related to the application of quantum-enabled systems in the United States. This workshop focused on quantum-enabled computing systems, quantum communications and networks, and quantum sensing opportunities. Participants explored the path to quantum computing, communications, and networks, opportunities for collaboration, as well as key gaps, supply chain concerns, and security issues. This publication summarizes the presentations and discussions from the workshop"--

"To explore the role of the National Institutes of Health (NIH) in innovative drug development and its impact on patient access, the Board on Health Care Services and the Board on Health Sciences Policy of the National Academies jointly hosted a public workshop on July 24-25, 2019, in Washington, DC. Workshop speakers and participants discussed the ways in which federal investments in biomedical research are translated into innovative therapies and considered approaches to ensure that the public has affordable access to the resulting new drugs. This publication summarizes the presentations and discussions from the workshop"--

Trichloroethylene (TCE) is a solvent that is used as a degreasing agent, a chemical intermediate in refrigerant manufacture, and a component of spot removers and adhesives. It is produced in mass quantities but creates dangerous vapors and is an environmental contaminant at many industrial and government facilities, including facilities run by the U.S. Department of Defense (DoD). It is important to determine the safe occupational exposure level (OEL) for the solvent in order to protect the health of workers who are exposed to its vapors. However, there are concerns that the current occupational standards insufficiently protect workers from these health threats. Review of DOD's Approach to Deriving an Occupational Exposure Level for Trichloroethylene makes recommendations to improve the DoD's approach to developing an OEL for TCE, strengthen transparency of the process, and improve confidence in the final OEL value. This report reviews the DoD's approach using a literature review, evidence synthesis based on weight of evidence [WOE], point-of-departure derivation, physiologically based pharmacokinetic modeling, extrapolation tools, and explores other elements of the process of deriving an OEL for TCE. It examines scientific approaches to developing exposure values and cancer risk levels, defining the scope of the problem, and improving hazard identification.

In recent years, interest and progress in the area of artificial intelligence (AI) and machine learning (ML) have boomed, with new applications vigorously pursued across many sectors. At the same time, the computing and communications technologies on which we have come to rely present serious security concerns: cyberattacks have escalated in number, frequency, and impact, drawing increased attention to the vulnerabilities of cyber systems and the need to increase their security. In the face of this changing landscape, there is significant concern and interest among policymakers, security practitioners, technologists, researchers, and the public about the potential implications of AI and ML for cybersecurity. The National Academies of Sciences, Engineering, and Medicine convened a workshop on March 12-13, 2019 to discuss and explore these concerns. This publication summarizes the presentations and discussions from the workshop.

On March 21, 2019, the Roundtable on Population Health Improvement of the National Academies of Sciences, Engineering, and Medicine convened a 1-day workshop to explore the broad and multidisciplinary nature of the population health workforce. Workshop participants explored methods for facilitating a population health orientation/perspective among public health and health care leaders and professionals; framing the work of personnel such as community health workers (CHWs), health navigators, and peer-to-peer chronic disease management educators within the context of population health; and leveraging the competencies of public and private sector workforces, such as education, transportation, and planning, that are working to include a "health in all policies," community livability, or well-being orientation in their activities. This publication summarizes the presentations and discussions from the workshop.--

"The National Aeronautics and Space Administration (NASA) is one of the United States' leading federal science, technology, engineering, and mathematics (STEM) agencies and plays an important role in the landscape of STEM education. In 2015, NASA's Science Mission Directorate (SMD) created the Science Activation (SciAct) program to increase the overall coherence of SMD's education efforts, to support more effective, sustainable, and efficient use of SMD science discoveries for education, and to enable NASA scientists and engineers to engage more effectively and efficiently in the STEM learning environment with learners of all ages. SciAct is now transitioning into its second round of funding, and it is beneficial to review the program's portfolio and identify opportunities for improvement. NASA's Science Activation Program: Achievements and Opportunities assesses SciAct's efforts towards meeting its goals. The key objectives of SciAct are to enable STEM education, improve U.S. scientific literacy, advance national education goals, and leverage efforts through partnerships. This report describes and assesses the history, current status, and vision of the program and its projects. It also provides recommendations to enhance NASA's efforts through the SciAct program."--

"Mentorship is a catalyst capable of unleashing one's potential for discovery, curiosity, and participation in STEMM and subsequently improving the training environment in which that STEMM potential is fostered. Mentoring relationships provide developmental spaces in which students' STEMM skills are honed and pathways into STEMM fields can be discovered. Because mentorship can be so influential in shaping the future STEMM workforce, its occurrence should not be left to chance or idiosyncratic implementation. There is a gap between what we know about effective mentoring and how it is practiced in higher education. The Science of Effective Mentorship in STEMM studies mentoring programs and practices at the undergraduate and graduate levels. It explores the importance of mentorship, the science of mentoring relationships, mentorship of underrepresented students in STEMM, mentorship structures and behaviors, and institutional cultures that support mentorship. This report and its complementary interactive guide present insights on effective programs and practices that can be adopted and adapted by institutions, departments, and individual faculty members"--

"On June 11 and June 12, 2019, the National Academies convened a workshop to explore the growing understanding of how the interplay between humans and microbes affects host physiology and causes noncommunicable diseases. Discussions included an overview of colliding epidemics, emerging research on associations between infectious and noncommunicable diseases, risks posed by chronic diseases to the development and severity of infectious diseases, and the influence of the microbiome. Workshop participants also examined the challenges and opportunities of convergence, the integration of health care delivery models and interventions, potential approaches for research, policy, and practice in the immediate-term, and potential directions for the long-term. This publication summarizes the presentations and discussions from the workshop"--Publisher's description

Medium- and heavy-duty trucks, motor coaches, and transit buses - collectively, "medium- and heavy-duty vehicles", or MHDVs - are used in every sector of the economy. The fuel consumption and greenhouse gas emissions of MHDVs have become a focus of legislative and regulatory action in the past few years. This study is a follow-on to the National Research Council's 2010 report, Technologies and Approaches to Reducing the Fuel Consumption of Medium-and Heavy-Duty Vehicles. That report provided a series of findings and recommendations on the development of regulations for reducing fuel consumption of MHDVs. On September 15, 2011, NHTSA and EPA finalized joint Phase I rules to establish a comprehensive Heavy-Duty National Program to reduce greenhouse gas emissions and fuel consumption for on-road medium- and heavy-duty vehicles. As NHTSA and EPA began working on a second round of standards, the National Academies issued another report, Reducing the Fuel Consumption and Greenhouse Gas Emissions of Medium- and Heavy-Duty Vehicles, Phase Two: First Report, providing recommendations for the Phase II standards. This third and final report focuses on a possible third phase of regulations to be promulgated by these agencies in the next decade.

"Patient-centered, high-quality health care relies on the well-being, health, and safety of health care clinicians. However, alarmingly high rates of clinician burnout in the United States are detrimental to the quality of care being provided, harmful to individuals in the workforce, and costly. It is important to take a systemic approach to address burnout that focuses on the structure, organization, and culture of health care. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being builds upon two groundbreaking reports from the past twenty years, To Err Is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century, which both called attention to the issues around patient safety and quality of care. This report explores the extent, consequences, and contributing factors of clinician burnout and provides a framework for a systems approach to clinician burnout and professional well-being, a research agenda to advance clinician well-being, and recommendations for the field"--

The U.S. Geological Survey (USGS) mission is to provide reliable and impartial scientific information to understand Earth, minimize loss of life and property from natural disasters, and manage water, biological, energy, and mineral resources. Data collection, analysis, interpretation, and dissemination are central to everything the USGS does. Among other activities, the USGS operates some 250 laboratories across the country to analyze physical and biological samples, including water, sediment, rock, plants, invertebrates, fish, and wildlife. The data generated in the laboratories help answer pressing scientific and societal questions or support regulation, resource management, or commercial applications. At the request of the USGS, this study reviews a representative sample of USGS laboratories to examine quality management systems and other approaches for assuring the quality of laboratory results and recommends best practices and procedures for USGS laboratories.

The increasing prevalence and burden of obesity transcends borders, straining populations worldwide. Data shows that 50 million girls, 74 million boys, 390 million women, and 281 million men were estimated to have obesity in 2016 (NCD-RisC, 2017). The National Academies of Sciences, Engineering, and Medicine convened a workshop on October 9, 2018 to address the status of the global obesity pandemic and discuss diverse approaches to manage this problem. Speakers examined the collective prevalence, costs, and drivers of obesity around the world using cross-cultural comparisons. Panels and group discussions emphasized the need to reduce disparities in prevention and treatment efforts and to generate new policy and system initiatives related to nutrition and physical activity worldwide. This publication summarizes the presentations and discussions from the workshop. --

Additive manufacturing (AM) is the process in which a three-dimensional object is built by adding subsequent layers of materials. AM enables novel material compositions and shapes, often without the need for specialized tooling. This technology has the potential to revolutionize how mechanical parts are created, tested, and certified. However, successful real-time AM design requires the integration of complex systems and often necessitates expertise across domains. Simulation-based design approaches, such as those applied in engineering product design and material design, have the potential to improve AM predictive modeling capabilities, particularly when combined with existing knowledge of the underlying mechanics. These predictive models have the potential to reduce the cost of and time for concept-to-final-product development and can be used to supplement experimental tests. The National Academies convened a workshop on October 24-26, 2018 to discuss the frontiers of mechanistic data-driven modeling for AM of metals. Topics of discussion included measuring and modeling process monitoring and control, developing models to represent microstructure evolution, alloy design, and part suitability, modeling phases of process and machine design, and accelerating product and process qualification and certification. These topics then led to the assessment of short-, immediate-, and long-term challenges in AM. This publication summarizes the presentations and discussions from the workshop.

"The Minerva Research Initiative is a Department of Defense (DoD) social science grant program that funds unclassified basic research relevant to national security. The goal of the program is to make use of the intellectual capital of university-based social scientists to inform understanding of issues important to DoD and the broader national security community. Evaluation of the Minerva Research Initiative discusses the program's successes and challenges over its first decade of operation, and highlights ways to strengthen the program's foundations and take advantage of opportunities for broadening its reach and usefulness."--