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"Protecting the health and safety of health care workers is vital to the health of each of us. Preparing for and responding to a future influenza pandemic or to a sustained outbreak of an airborne transmissible disease requires a high-level commitment to respiratory protection for health care workers across the wide range of settings in which they work and the jobs that they perform. Keeping health care workers healthy is an ethical commitment both in terms of addressing the occupational risks faced by health care workers and of providing for the continuity of patient care and services needed to maintain the health of individuals and communities. During a public health emergency, challenges will arise concerning the availability of respiratory protective devices (i.e., respirators). Reusable respirators (specifically, reusable half-facepiece elastomeric respirators) are the standard respiratory protection device used in many industries, and they provide an option for use in health care that has to date not been fully explored. The durability and reusability of elastomeric respirators make them desirable for stockpiling for emergencies, where the need for large volumes of respirators can be anticipated. However, they are used infrequently in health care. Reusable Elastomeric Respirators in Health Care explores the potential for the use of elastomeric respirators in the U.S. health care system with a focus on the economic, policy, and implementation challenges and opportunities. This report examines the practicability of elastomeric use in health care on a routine basis and during an influenza pandemic or other large aerosol-transmissible outbreak, when demand for respiratory protective devices by U.S. health care personnel may be larger than domestic supplies. The report also addresses the issues regarding emergency stockpile management of elastomeric respiratory protective devices"--Publisher's description.

On March 22, 2018, the National Academies of Sciences, Engineering, and Medicine convened a workshop to examine the collaboration between the faith and health sectors, and to highlight the unique opportunities these collaborations offer to help improve population health outcomes. This publication summarizes the presentations and discussions from the workshop.

"Coral reefs are critical to ocean and human life because they provide food, living area, storm protection, tourism income, and more. However, human-induced stressors, such as overfishing, sediment, pollution, and habitat destruction have threatened ocean ecosystems globally for decades. In the face of climate change, these ecosystems now face an array of unfamiliar challenges due to destructive rises in ocean temperature, acidity and sea level. These factors lead to an increased frequency of bleaching events, hindered growth, and a decreasing rate of calcification. Research on interventions to combat these relatively new stressors and a reevaluation of longstanding interventions is necessary to understand and protect coral reefs in this changing climate. Previous research on these methods prompts further questions regarding the decision making process for site-specific interventions. A Decision Framework for Interventions to Increase the Persistence and Resilience of Coral Reefs builds upon a previous report that reviews the state of research on methods that have been used, tested, or proposed to increase the resilience of coral reefs. This new report aims to help coral managers evaluate the specific needs of their site and navigate the 23 different interventions described in the previous report. A case study of the Caribbean, a region with low coral population plagued by disease, serves as an example for coral intervention decision making. This report provides complex coral management decision making tools, identifies gaps in coral biology and conservation research, and provides examples to help individuals and communities tailor a decision strategy to a local area."--

"Convergence-based research approaches are critical in solving many scientific challenges, which frequently draw on large teams of collaborators from multiple disciplines. The 2014 report Convergence: Facilitating Transdisciplinary Integration of Life Sciences, Physical Sciences, Engineering, and Beyond describes the term "convergence" as a multidisciplinary approach that melds divergent areas of expertise to form conclusions that are inaccessible otherwise. However, a convergence-based approach involves hybrid systems of people, buildings, and instruments, which pose complex structural and managerial challenges. In October 23-24, 2018, the National Academies of Sciences, Engineering, and Medicine convened a workshop to explore efforts to promote cultures that support convergence-based approaches to research. The 2014 report served as a foundation for this workshop, allowing participants to further explore convergence as a valuable and adaptable approach to organizing research. This publication summarizes the presentations and discussions from the workshop"--Publisher's description

"The National Academies of Sciences, Engineering, and Medicine's Roundtable on Population Health Improvement has been focused on the subject of dependable resources for population health since its inception in 2013. On December 7, 2017, the roundtable convened a workshop to explore tax policy as it relates to advancing population health, health equity, and economic prosperity. This publication summarizes the presentations and discussions from the workshop."--Publisher's description.

"In the 1970s, flame retardants began to be added to synthetic materials to meet strict flammability standards. Over the years, diverse flame retardants have been manufactured and used in various products. Some flame retardants have migrated out of the products, and this has led to widespread human exposure and environmental contamination. There also is mounting evidence that many flame retardants are associated with adverse human health effects. As a result, some flame retardants have been banned, restricted, or voluntarily phased out of production and use. This publication develops a scientifically based scoping plan to assess additive, nonpolymeric organohalogen flame retardants as a class for potential chronic health hazards under the Federal Hazardous Substances Act, including cancer, birth defects, and gene mutations"--

"The Manufacturing USA initiative seeks to reinforce U.S.-based advanced manufacturing through partnerships among industry, academia, and government. Started in 2012 and established with bipartisan support by the Revitalize American Manufacturing and Innovation Act of 2014, the initiative envisages a nationwide network of research centers for manufacturing innovation. Some 14 manufacturing innovation institutes have been established to facilitate the movement of early-stage research into proven capabilities ready for adoption by U.S. manufacturers. To better understand the role and experiences of the Manufacturing USA institutes, a committee of the National Academies of Sciences, Engineering, and Medicine convened a workshop on May 23, 2017 drawing together institute directors and manufacturing policy experts along with leaders from industry, academia, and government. Given the continued prominence of enhancing domestic manufacturing and international competitiveness in public policy discussions, the National Academies convened a second workshop on November 14, 2018, to monitor the progress of the Manufacturing USA institutes. This publication summarizes the presentations and discussions from this second workshop"--Publisher's description

Physical activity has far-reaching benefits for physical, mental, emotional, and social health and well-being for all segments of the population. Despite these documented health benefits and previous efforts to promote physical activity in the U.S. population, most Americans do not meet current public health guidelines for physical activity. Surveillance in public health is the ongoing systematic collection, analysis, and interpretation of outcome-specific data, which can then be used for planning, implementation and evaluation of public health practice. Surveillance of physical activity is a core public health function that is necessary for monitoring population engagement in physical activity, including participation in physical activity initiatives. Surveillance activities are guided by standard protocols and are used to establish baseline data and to track implementation and evaluation of interventions, programs, and policies that aim to increase physical activity. However, physical activity is challenging to assess because it is a complex and multidimensional behavior that varies by type, intensity, setting, motives, and environmental and social influences. The lack of surveillance systems to assess both physical activity behaviors (including walking) and physical activity environments (such as the walkability of communities) is a critical gap. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States develops strategies that support the implementation of recommended actions to improve national physical activity surveillance. This report also examines and builds upon existing recommended actions.

Even as malnutrition in the form of hunger and obesity affect the health and well-being of millions of people worldwide, a significant amount of food is lost or wasted every day, in every country, and at every stage in the supply chain from the farm to the household. According to a 2011 estimate by the Food and Agriculture Organization of the United Nations (FAO), about one-third of food produced is lost or wasted globally. Beyond quantity estimates, however, less is known about the impacts on farmers, food prices, food availability, and environment of reducing food loss and waste. On October 17, 2018, the National Academies of Sciences, Engineering, and Medicine organized a workshop to examine key challenges that arise in reducing food loss and waste throughout the supply chain and discussed potential ways to address these challenges. This publication summarizes the presentations and discussions from the workshop.

While the public is generally aware of the use of hydraulic fracturing for unconventional resource development onshore, it is less familiar with the well completion and stimulation technologies used in offshore operations, including hydraulic fracturing, gravel packs, "fracpacks," and acid stimulation. Just as onshore technologies have improved, these well completion and stimulation technologies for offshore hydrocarbon resource development have progressed over many decades. To increase public understanding of these technologies, the National Academies of Sciences, Engineering, and Medicine established a planning committee to organize and convene a workshop on Offshore Well Completion and Stimulation: Using Hydraulic Fracturing and Other Technologies on October 2-3, 2017, in Washington, DC. This workshop examined the unique features about operating in the U.S. offshore environment, including well completion and stimulation technologies, environmental considerations and concerns, and health and safety management. Participants from across government, industry, academia, and nonprofit sectors shared their perspectives on operational and regulatory approaches to mitigating risks to the environment and to humans in the development of offshore resources. This publication summarizes the presentations and discussions from the workshop.

The U.S. Social Security Administration (SSA) provides disability benefits through the Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs. To receive SSDI or SSI disability benefits, an individual must meet the statutory definition of disability, which is "the inability to engage in any substantial gainful activity [SGA] by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." SSA uses a five-step sequential process to determine whether an adult applicant meets this definition. Functional Assessment for Adults with Disabilities examines ways to collect information about an individual's physical and mental (cognitive and noncognitive) functional abilities relevant to work requirements. This report discusses the types of information that support findings of limitations in functional abilities relevant to work requirements, and provides findings and conclusions regarding the collection of information and assessment of functional abilities relevant to work requirements. --

"November 2018, an ad hoc planning committee at the National Academies of Sciences, Engineering, and Medicine planned two sister workshops held in Washington, DC, to examine the lessons from influenza pandemics and other major outbreaks, understand the extent to which the lessons have been learned, and discuss how they could be applied further to ensure that countries are sufficiently ready for future pandemics. This publication summarizes the presentations and discussions from both workshops"--

The United States is facing an opioid use disorder epidemic with opioid overdoses killing 47,000 people in the U.S. in 2017. The past three decades have witnessed a significant increase in the prescribing of opioids for pain, based on the belief that patients were being undertreated for their pain, coupled with a widespread misunderstanding of the addictive properties of opioids. This increase in prescribing of opioids also saw a parallel increase in addiction and overdose. In an effort to address this ongoing epidemic of opioid misuse, policy and regulatory changes have been enacted that have served to limit the availability of prescription opioids for pain management. Overlooked amid the intense focus on efforts to end the opioid use disorder epidemic is the perspective of clinicians who are experiencing a significant amount of daily tension as opioid regulations and restrictions have limited their ability to treat the pain of their patients facing serious illness. Increased public and clinician scrutiny of opioid use has resulted in patients with serious illness facing stigma and other challenges when filling prescriptions for their pain medications or obtaining the prescription in the first place. Thus clinicians, patients, and their families are caught between the responses to the opioid use disorder epidemic and the need to manage pain related to serious illness. The National Academies of Sciences, Engineering, and Medicine sponsored a workshop on November 29, 2018, to examine these unintended consequences of the responses to the opioid use disorder epidemic for patients, families, communities, and clinicians, and to consider potential policy opportunities to address them. This publication summarizes the presentations and discussions from the workshop.

To effectively mature and transition DoD manufacturing science and technology advances into production, DoD must have access to a robust and responsive U.S. industrial base which is often driven by advanced manufacturing technologies. The Manufacturing USA institutes are considered crucial and game-changing catalysts that are bringing together innovative ecosystems in various technology and market sectors critical to DoD and the nation. Since 2012 DoD has invested $600 million directly in its Manufacturing USA institutes with the understanding that the initial federal investment included (1) core funding and (2) one-time, start-up funding to establish the institutes within a period of 5 to 7 years. As the institutes now begin to reach year five, DoD is evaluating the effectiveness of the institutes in fulfilling their goals and the best on going roles for the federal government, including on-going funding options, to ensure optimal benefit to U.S. competitiveness. This report reviews the role of DoDs investment to date in establishing its eight institutes as public private partnerships and its engagement with each institute after it has matured beyond the start-up period. --

On November 13 and 14, 2018, members of the National Academies of Sciences, Engineering, and Medicine's Global Forum on Innovation in Health Professional Education participated in a joint workshop with affiliates of the National Center for Interprofessional Practice and Education. The workshop participants explored the intersection of health professions education and practice. Both sectors are working toward the same goal of improving the health of patients and populations, without compromising the mental stability and wellbeing of the workforce or its learners. However, while education and practice have the same goal, there is a need for greater alignment between the sectors to more fully realize these desired outcomes. For example, educators, practitioners, and administrators must learn to adapt and respond to the growing role of technology within a wider context, in order to most effectively apply higher education within health systems. This publication summarizes the presentations and discussions from the workshop. --

"Since its origin 23 years ago as a pilot test conducted in four U.S. counties, the U.S. Census Bureau's American Community Survey (ACS) has been the focus of continuous research, development, and refinement. The survey cleared critical milestones 14 years ago when it began full-scale operations, including comprehensive nationwide coverage, and 5 years later when the ACS replaced a long-form sample questionnaire in the 2010 census as a source of detailed demographic and socioeconomic information. Throughout that existence and continuing today, ACS research and testing has worked to improve the survey's conduct in the face of challenges ranging from detailed and procedural to the broad and existential. This publication summarizes the presentations and discussion at the September 26-27, 2018, Workshop on Improving the American Community Survey (ACS), sponsored by the U.S. Census Bureau. Workshop participants explored uses of administrative records and third-party data to improve ACS operations and potential for boosting respondent participation through improved communication"--Publisher's description.

"Pain is a leading cause of disability globally. The dramatic increase in opioid prescriptions within the past decade in the United States has contributed to the opioid epidemic the country currently faces, magnifying the need for longer term solutions to treat pain. The substantial burden of pain and the ongoing opioid crisis have attracted increased attention in medical and public policy communities, resulting in a revolution in thinking about how pain is managed. This new thinking acknowledges the complexity and biopsychosocial nature of the pain experience and the need for multifaceted pain management approaches with both pharmacological and nonpharmacological therapies. The magnitude and urgency of the twin problems of chronic pain and opioid addiction, combined with the changing landscape of pain management, prompted the National Academies of Sciences, Engineering, and Medicine to convene a workshop on December 4-5, 2018, in Washington, DC. The workshop brought together a diverse group of stakeholders to discuss the current status of nonpharmacological approaches to pain management, gaps, and future directions. This publication summarizes the presentations and discussions from the workshop."--

"This study was supported by contract 36C10X18C0019 between the National Academy of Sciences and the Department of Veterans Affairs"--Title page verso.

On August 1 and 2, 2018, the National Academies of Sciences, Engineering, and Medicine hosted a public workshop in Washington, DC, on sustainable diets, food, and nutrition. Workshop participants reviewed current and emerging knowledge on the concept of sustainable diets within the field of food and nutrition; explored sustainable diets and relevant impacts for cross-sector partnerships, policy, and research; and discussed how sustainable diets influence dietary patterns, the food system, and population and public health. This publication briefly summarizes the presentations and discussions from the workshop.

"On June 27-28, 2018, the U.S. National Academies of Sciences, Engineering, and Medicine (the National Academies) convened an international workshop in Amsterdam, the Netherlands, on developing norms for the provision of laboratories in low-resource contexts. The U.S. Department of State's Biosecurity Engagement Program requested that the National Academies organize this workshop to engage an international group of organizations that provide funding for construction, upgrades, and maintenance of biological laboratories in countries without the means to build such labs themselves. Twenty-one people from 19 organizations participated. The intent was to advance the conversation about the identification and application of guiding principles and common norms for use by these organizations in their grants, partnerships, and aid. This publication summarizes the presentations and discussions from the workshop"--

"Flooding is the natural hazard with the greatest economic and social impact in the United States, and these impacts are becoming more severe over time. Catastrophic flooding from recent hurricanes, including Superstorm Sandy in New York (2012) and Hurricane Harvey in Houston (2017), caused billions of dollars in property damage, adversely affected millions of people, and damaged the economic well-being of major metropolitan areas. Flooding takes a heavy toll even in years without a named storm or event. Major freshwater flood events from 2004 to 2014 cost an average of $9 billion in direct damage and 71 lives annually. These figures do not include the cumulative costs of frequent, small floods, which can be similar to those of infrequent extreme floods. Framing the Challenge of Urban Flooding in the United States contributes to existing knowledge by examining real-world examples in specific metropolitan areas. This report identifies commonalities and variances among the case study metropolitan areas in terms of causes, adverse impacts, unexpected problems in recovery, or effective mitigation strategies, as well as key themes of urban flooding. It also relates, as appropriate, causes and actions of urban flooding to existing federal resources or policies"--Publisher's description.

Whether the result of an oil well blowout, vessel collision or grounding, leaking pipeline, or other incident at sea, each marine oil spill will present unique circumstances and challenges. The oil type and properties, location, time of year, duration of spill, water depth, environmental conditions, affected biomes, potential human community impact, and available resources may vary significantly. Also, each spill may be governed by policy guidelines, such as those set forth in the National Response Plan, Regional Response Plans, or Area Contingency Plans. To respond effectively to the specific conditions presented during an oil spill, spill responders have used a variety of response options--including mechanical recovery of oil using skimmers and booms, in situ burning of oil, monitored natural attenuation of oil, and dispersion of oil by chemical dispersants. Because each response method has advantages and disadvantages, it is important to understand specific scenarios where a net benefit may be achieved by using a particular tool or combination of tools. This report builds on two previous National Research Council reports on dispersant use to provide a current understanding of the state of science and to inform future marine oil spill response operations. The response to the 2010 Deepwater Horizon spill included an unprecedented use of dispersants via both surface application and subsea injection. The magnitude of the spill stimulated interest and funding for research on oil spill response, and dispersant use in particular. This study assesses the effects and efficacy of dispersants as an oil spill response tool and evaluates trade-offs associated with dispersant use.

The marmoset, a type of small monkey native to South America, is a research model of increasing importance for biomedical research in the United States and globally. Marmosets offer a range of advantages as animal models in neuroscience, aging, infectious diseases, and other fields of study. They may be particularly useful for the development of new disease models using genetic engineering and assisted reproductive technologies. However, concerns have been voiced with respect to the development of new marmoset-based models of disease, ethical considerations for their use, the supply of marmosets available for research, and gaps in guidance for their care and management. To explore and address these concerns, the Roundtable on Science and Welfare in Laboratory Animal Use hosted a public workshop on October 22-23, 2018, in Washington, DC. The workshop focused on the availability of marmosets in the United States and abroad; animal welfare and ethical considerations stemming from the use of wildtype and genetically modified marmosets; and standards of housing and care, dietary needs, and feeding requirements for marmosets in captivity. This publication summarizes the presentations and discussions from the workshop.

"The field of health literacy has evolved from early efforts that focused on individuals to its current recognition that health literacy is a multidimensional team and system function. Health literacy includes system demands and complexities as well as individual skills and abilities. While communicating in a health-literate manner is truly important for everyone, it can be especially important for those with mental or behavioral health issues and for the systems and teams that interact with them and treat these individuals. The purpose of the workshop, which was held on July 11, 2018, in Washington, DC, was to explore issues associated with effective communication with individuals with mental or behavioral health issues and to identify ways in which health literacy approaches can facilitate communication. In particular, the workshop aimed to gain a better understanding of how behavioral health and mental health concerns can adversely affect communications between providers and patients and their families. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

"Scientists strive to develop clear rules for naming and grouping living organisms. But taxonomy, the scientific study of biological classification and evolution, is often highly debated. Members of a species, the fundamental unit of taxonomy and evolution, share a common evolutionary history and a common evolutionary path to the future. Yet, it can be difficult to determine whether the evolutionary history or future of a population is sufficiently distinct to designate it as a unique species. A species is not a fixed entity - the relationship among the members of the same species is only a snapshot of a moment in time. Different populations of the same species can be in different stages in the process of species formation or dissolution. In some cases hybridization and introgression can create enormous challenges in interpreting data on genetic distinctions between groups. Hybridization is far more common in the evolutionary history of many species than previously recognized. As a result, the precise taxonomic status of an organism may be highly debated. This is the current case with the Mexican gray wolf (Canis lupus baileyi) and the red wolf (Canis rufus), and this report assesses the taxonomic status for each"--

"The National Academies of Sciences, Engineering, and Medicine held a workshop on August 22-23, 2018, in Washington, DC, to explore medical and public health preparedness for a nuclear incident. The event brought together experts from government, nongovernmental organizations, academia, and the private sector to explore current assumptions behind the status of medical and public health preparedness for a nuclear incident, examine potential changes in these assumptions in light of increasing concerns about the use of nuclear warfare, and discuss challenges and opportunities for capacity building in the current threat environment. This publication summarizes the presentations and discussions from the workshop."--Publisher's description.

The emerging multidisciplinary field of regenerative engineering is devoted to the repair, regeneration, and replacement of damaged tissues or organs in the body. To accomplish this it uses a combination of principles and technologies from disciplines such as advanced materials science, developmental and stem cell biology, immunology, physics, and clinical translation. The term "regenerative engineering" reflects a new understanding of the use of tissue engineering for regeneration and also the growing number of research and product development efforts that incorporate elements from a variety of fields. Because regenerative engineered therapies rely on live cells and scaffolds, there are inherent challenges in quality control arising from variability in source and final products. Furthermore, each patient recipient, tissue donor, and product application is unique, meaning that the field faces complexities in the development of safe and effective new products and therapies which are not faced by developers of more conventional therapies. Understanding the many sources of variability can help reduce this variability and ensure consistent results. The Forum on Regenerative Medicine hosted a public workshop on October 18, 2018, in Washington, DC, to explore the various factors that must be taken into account in order to develop successful regenerative engineering products. Invited speakers and participants discussed factors and sources of variability in the development and clinical application of regenerative engineering products, characteristics of high-quality products, and how different clinical needs, models, and contexts can inform the development of a product to improve patient outcomes. This publication summarizes the presentation and discussion of the workshop.

"The frequency and severity of disasters over the last few decades have presented unprecedented challenges for communities across the United States. In 2005, Hurricane Katrina exposed the complexity and breadth of a deadly combination of existing community stressors, aging infrastructure, and a powerful natural hazard. In many ways, the devastation of Hurricane Katrina was a turning point for understanding and managing disasters, as well as related plan making and policy formulation. It brought the phrase "community resilience" into the lexicon of disaster management. Building and Measuring Community Resilience: Actions for Communities and the Gulf Research Program summarizes the existing portfolio of relevant or related resilience measurement efforts and notes gaps and challenges associated with them. It describes how some communities build and measure resilience and offers four key actions that communities could take to build and measure their resilience in order to address gaps identified in current community resilience measurement efforts. This report also provides recommendations to the Gulf Research Program to build and measure resilience in the Gulf of Mexico region"--Publisher's description.

"The opioid crisis in the United States has come about because of excessive use of these drugs for both legal and illicit purposes and unprecedented levels of consequent opioid use disorder (OUD). More than 2 million people in the United States are estimated to have OUD, which is caused by prolonged use of prescription opioids, heroin, or other illicit opioids. OUD is a life-threatening condition associated with a 20-fold greater risk of early death due to overdose, infectious diseases, trauma, and suicide. Mortality related to OUD continues to escalate as this public health crisis gathers momentum across the country, with opioid overdoses killing more than 47,000 people in 2017 in the United States. Efforts to date have made no real headway in stemming this crisis, in large part because tools that already exist--like evidence-based medications--are not being deployed to maximum impact"--

Industrial stormwater is derived from precipitation and/or runoff that comes in contact with industrial manufacturing, processing, storage, or material overburden and then runs offsite and enters drainage systems or receiving waters. In 1987, Congress significantly expanded the National Pollutant Discharge Elimination System (NPDES) program through amendments to the Clean Water Act to include industrial stormwater runoff conveyed through outfalls directly to receiving waters or indirectly through municipal separate storm sewer systems. The added regulation of stormwater in the NPDES program has been challenging. Stormwater is produced throughout a developed landscape, and its production and delivery are episodic. In 2009, the National Research Council released a comprehensive report on the Environmental Protection Agency's Stormwater Program that covered all sectors of the program. This study builds on that report, with a focus on industrial stormwater monitoring and management.