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The persistent trends in suicide necessitate action among mental health care providers and payers, researchers, and community leaders. Health care settings provide an important opportunity for suicide intervention and prevention, but they cannot yet fully manage suicide risk because of a lack of training, knowledge gaps, and reimbursement challenges. School, workplace, and community-based interventions can help reduce the incidence of suicidal behavior, as can better access to care and reduced access to lethal means of suicide. To better understand the strategies to improve access to effective interventions to prevent suicide, the Forum on Mental Health and Substance Use Disorders at the National Academies of Sciences, Engineering, and Medicine hosted a two-part virtual public workshop, Strategies and Interventions to Reduce Suicide, on June 22, 2021, and July 28, 2021. The first webinar examined the scope of the public health problem, discussed implementation of effective approaches for suicide prevention care, and addressed known barriers to health care access. The second webinar focused on building 9-8-8, the new nationwide emergency number designated to the National Suicide Prevention Lifeline. Participants discussed current crisis systems, gaps, challenges, and needs for marginalized populations. This Proceedings of a Workshop summarizes the presentations and discussions that occurred during the workshops.

The COVID-19 pandemic has led to dramatic adjustments in cancer care delivery and cancer research. To examine these changes, the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine convened a virtual workshop, Innovation in Cancer Care and Cancer Research in the Context of the COVID-19 Pandemic, in July 2021. Workshop speakers considered the lessons learned from these adaptations in order to improve the delivery of high-quality cancer care and the conduct of cancer clinical trials in the post-pandemic era. This Proceedings of a Workshop highlights presentations and discussions from the workshop.

Overwhelming evidence exists that exposure to outdoor fine particulate matter (PM2.5) is associated with a range of short-term and chronic health impacts, including asthma exacerbation, acute and chronic bronchitis, heart attacks, increased susceptibility to respiratory infections, and premature death, with the burden of these health effects falling more heavily on underserved and marginalized communities. Although less studied to date, indoor exposure to PM2.5 is also gaining attention as a potential source of adverse health effects, particularly given that Americans spend 90 percent of their lives indoors and indoor PM2.5 levels can exceed outdoor levels. To better understand the sources of indoor PM2.5, the possible health effects of exposure to indoor PM2.5, and engineering approaches and interventions to reduce those exposure risks, the National Academies of Sciences, Engineering, and Medicine convened a virtual workshop, Indoor Exposure to Fine Particulate Matter and Practical Mitigation Approaches, on April 14, 21, and 28, 2021. The workshop focused on exposures that occur in residential and school buildings and on existing and practical mitigation technologies and approaches. This publication summarizes the presentation and discussion of the workshop.

A virtual workshop series titled Approaches to Assessing Intake of Food and Dietary Supplements in Pregnant Women and Children 2 to 11 Years of Age was convened in May, 2021 by the Food and Nutrition Board of the National Academies of Sciences, Engineering, and Medicine. The four-day workshop series explored the evidence on methodological approaches to assessing intake of food and dietary supplements in pregnant women and children 2 to 11 years of age. Obtaining reliable and valid dietary intake information for these population groups is particularly difficult - in pregnancy, rapid changes in nutrient needs and dietary intakes occur, and in young children, much of dietary intake is consumed outside the home and is often misreported by the children or their proxy reporters. To advance the quality of the science in these areas, the workshop had four goals: identify the suite of current methods used in dietary assessments, including food and dietary supplements, in pregnant women and children 2 to 11 years of age; identify the methodological challenges and opportunities in improving current methods; explore methodologies in other disciplines and their application in dietary assessments in those populations; and discuss factors to consider when implementing dietary assessment tools in those populations. This publication summarizes the presentations and discussions of the workshop series.

Rising awareness of and increased attention to sexual harassment has resulted in momentum to implement sexual harassment prevention efforts in higher education institutions. Work on preventing sexual harassment is an area that has recently garnered a lot of attention, especially around education and programs that go beyond the standard anti-sexual harassment trainings often used to comply with legal requirements. On April 20-21, 2021, the National Academies of Sciences, Engineering, and Medicine hosted the workshop Developing Evaluation Metrics for Sexual Harassment Prevention Efforts. The workshop explored approaches and strategies for evaluating and measuring the effectiveness of sexual harassment interventions being implemented at higher education institutions and research and training sites, in order to assist institutions in transforming promising ideas into evidence-based best practices. Workshop participants also addressed methods, metrics, and measures that could be used to evaluate sexual harassment prevention efforts that lead to change in the organizational climate and culture and/or a change in behavior among community members. This publication summarizes the presentations and discussion of the workshop.

In response to a request from the National Oceanic and Atmospheric Administration - and with the support of the National Aeronautics and Space Administration and the National Science Foundation - the National Academies of Sciences, Engineering, and Medicine conducted a two-part virtual workshop, "Space Weather Operations and Research Infrastructure," on June 16-17 and September 9-11, 2020. The overall goals of the workshop were to review present space weather monitoring and forecasting capabilities, to consider future observational infrastructure and research needs, and to consider options toward the further development of an effective, resilient, and achievable national space weather program. This publication summarizes the presentation and discussion of the workshop.

"Federal laboratories play a unique role in the U.S. economy. Research and development conducted at these labs has contributed to the advancement or improvement of such key general-purpose technologies as nuclear energy, computers, the Internet, genomics, satellite navigation, the Global Positioning System, artificial intelligence, and virtual reality. Digital output from federal laboratories includes data, metadata, images, software, code, tools, databases, algorithms, and statistical models. Importantly, these digital products are nonrivalrous, meaning that unlike physical products, they can be copied at little or no cost and used by many without limit or additional cost. Advancing Commercialization of Digital Products from Federal Laboratories explores opportunities to add economic value to U.S. industry through enhanced utilization of intellectual property around digital products created at federal laboratories. This report examines the current state of commercialization of digital products developed at the federal labs and, to a limited extent, by extramural awardees, to help identify barriers to commercialization and technology transfer, taking into account differences between government-owned, contractor-operated (GOCO) and government-owned, government-operated (GOGO) federal labs." --

"The U.S. Social Security Administration (SSA) administers programs that provide disability benefits. Once SSA establishes the presence of a severe impairment, it determines whether the impairment meets the criteria in the Listing of Impairments (Listings) that qualify a candidate for disability benefits. The current Listings that address hearing loss treated with cochlear implantation contain criteria that evaluate hearing ability through a speech recognition test called the Hearing in Noise Test (HINT). Since its development in 1994, the HINT has been widely used to measure cochlear implant candidacy and postoperative outcomes. However, the test characteristics, the state of cochlear implant technology, and the environment that made the HINT a common choice of assessment in 1994 are different in 2021. The HINT has several limitations in its characteristics and deviation from its intended use. At the request of SSA, the National Academies of Sciences, Engineering, and Medicine convened a consensus study committee to identify and recommend generalized testing procedures and criteria for evaluating the level of functional hearing ability needed to make a disability determination in adults and children after cochlear implantation. The committee's report, Evaluating Hearing Loss for Individuals with Cochlear Implants, details and supports its findings, conclusions, and recommendations based on published evidence and professional judgment." --

"Each year, tens of millions of individuals in the U.S. suffer from neurological and psychiatric disorders including neurodegenerative diseases such as Alzheimer's Disease and Parkinson's Disease, and psychiatric disorders such as autism spectrum disorder, depression and schizophrenia. Treatments for these diseases are often completely lacking or only partially effective, due in large part to the difficulty of conducting brain research and the complexity of the brain itself. Researchers in recent years have developed new models to better represent and study the human brain. The three models considered in this report, all of which generate and use pluripotent stem cells from healthy individuals and patients, are human neural organoids, human neural transplants, and human-animal neural chimeras. The Emerging Field of Human Neural Organoids, Transplants, and Chimeras: Science, Ethics, and Governance reviews the status of research, considers its benefits and risks, discusses associated ethical issues, and considers governance mechanisms for this type of research." --

"Over the past several decades, fertility rates have fallen substantially in low- and middle-income countries, and efforts to limit fertility, primarily through the implementation of family planning programs, have become increasingly widespread. Although there is a substantial scholarly literature on the determinants of contraceptive use and other measures to limit fertility and on the resulting differentials in fertility, relatively little is known about the role played by women's empowerment as both a determinant and a consequence of fertility decline. In addition, there continues to be little consensus about the link between fertility decline and broader societal impacts, including economic development. The National Academies of Sciences, Engineering, and Medicine convened a workshop, "Family Planning, Women's Empowerment, and Population and Societal Impacts," in September 2020. This event brought together experts and stakeholders to discuss conceptual, methodological, and policy issues regarding the relationships among family planning, women's empowerment, fertility decline, and population and societal impacts. The discussion was intended to inform research and policy focused on the issues of women's roles and empowerment and on longstanding questions surrounding the determinants and consequences of fertility reduction behavior. This publication summarizes the presentations and discussion of the workshop." --

The world is transforming its energy system from one dominated by fossil fuel combustion to one with net-zero emissions of carbon dioxide (CO2), the primary anthropogenic greenhouse gas. This energy transition is critical to mitigating climate change, protecting human health, and revitalizing the U.S. economy. To help policymakers, businesses, communities, and the public better understand what a net-zero transition would mean for the United States, the National Academies of Sciences, Engineering and Medicine convened a committee of experts to investigate how the U.S. could best decarbonize its transportation, electricity, buildings, and industrial sectors. This report, Accelerating Decarbonization of the United States Energy System, identifies key technological and socio-economic goals that must be achieved to put the United States on the path to reach net-zero carbon emissions by 2050. The report presents a policy blueprint outlining critical near-term actions for the first decade (2021-2030) of this 30-year effort, including ways to support communities that will be most impacted by the transition.

Cancer is the second leading cause of death among adults in the United States after heart disease. However, improvements in cancer treatment and earlier detection are leading to growing numbers of cancer survivors. As the number of cancer survivors grows, there is increased interest in how cancer and its treatments may affect a person's ability to work, whether the person has maintained employment throughout the treatment or is returning to work at a previous, current, or new place of employment. Cancer-related impairments and resulting functional limitations may or may not lead to disability as defined by the U.S. Social Security Administration (SSA), however, adults surviving cancer who are unable to work because of cancer-related impairments and functional limitations may apply for disability benefits from SSA. At the request of SSA, Diagnosing and Treating Adult Cancers and Associated Impairments provides background information on breast cancer, lung cancer, and selected other cancers to assist SSA in its review of the listing of impairments for disability assessments. This report addresses several specific topics, including determining the latest standards of care as well as new technologies for understanding disease processes, treatment modalities, and the effect of cancer on a person's health and functioning, in order to inform SSA's evaluation of disability claims for adults with cancer.

"Consumer genomics, encompassing both direct-to-consumer applications (i.e., genetic testing that is accessed by a consumer directly from a commercial company apart from a health care provider) and consumer-driven genetic testing (i.e., genetic testing ordered by a health care provider in response to an informed patient request), has evolved considerably over the past decade, moving from more personal utility-focused applications outside of traditional health care to interfacing with clinical care in nontraditional ways. As consumer genomics has increasingly intersected with clinical applications, discussions have arisen around the need to demonstrate clinical and analytical validity and clinical utility due to the potential for misinterpretation by consumers. Clinical readiness and interest for this information have presented educational and training challenges for providers. At the same time, consumer genomics has emerged as a potentially innovative mechanism for thinking about health literacy and engaging participants in their health and health care. To explore the current landscape of consumer genomics and the implications for how genetic test information is used or may be used in research and clinical care, the Roundtable on Genomics and Precision Health of the National Academies of Sciences, Engineering, and Medicine hosted a public workshop on October 29, 2019, in Washington, DC. Discussions included such topics as the diversity of participant populations, the impact of consumer genomics on health literacy and engagement, knowledge gaps related to the use of consumer genomics in clinical care, and regulatory and health policy issues such as data privacy and security. A broad array of stakeholders took part in the workshop, including genomics and consumer genomics experts, epidemiologists, health disparities researchers, clinicians, users of consumer genomics research applications, representatives from patient advocacy groups, payers, bioethicists, regulators, and policy makers. This publication summarizes the presentations and discussion of the workshop."--

With U.S. health care costs projected to grow at an average rate of 5.5 percent per year from 2018 to 2027, or 0.8 percentage points faster than the gross domestic product, and reach nearly $6.0 trillion per year by 2027, policy makers and a wide range of stakeholders are searching for plausible actions the nation can take to slow this rise and keep health expenditures from consuming an ever greater portion of U.S. economic output. While health care services are essential to heath, there is growing recognition that social determinants of health are important influences on population health. Supporting this idea are estimates that while health care accounts for some 10 to 20 percent of the determinants of health, socioeconomic factors and factors related to the physical environment are estimated to account for up to 50 percent of the determinants of health. Challenges related to the social determinants of health at the individual level include housing insecurity and poor housing quality, food insecurity, limitations in access to transportation, and lack of social support. These social needs affect access to care and health care utilization as well as health outcomes. Health care systems have begun exploring ways to address non-medical, health-related social needs as a way to reduce health care costs. To explore the potential effect of addressing non-medical health-related social needs on improving population health and reducing health care spending in a value-driven health care delivery system, the National Academies of Science, Engineering, and Medicine held a full-day public workshop titled Investing in Interventions that Address Non-Medical, Health-Related Social Needs on April 26, 2019, in Washington, DC. The objectives of the workshop were to explore effective practices and the supporting evidence base for addressing the non-medical health-related social needs of individuals, such as housing and food insecurities; review assessments of return on investment (ROI) for payers, healthy systems, and communities; and identify gaps and opportunities for research and steps that could help to further the understanding of the ROI on addressing non-medical health-related social needs. This publication summarizes the presentations and discussions from the workshop.

In September 2015, the National Academies of Sciences, Engineering, and Medicine convened a two-day workshop on evolving paradigms for design and manufacturing. Participants discussed ways to lower costs and shorten production time in defense systems while bringing materials and manufacturing alternatives into the tradespace. This publication summarizes the presentations and discussions from the workshop. --

The challenge of monitoring disparities in educational achievement and opportunities shares some characteristics with other complex regulatory problems. For example, when Congress adopted the Clean Air Act (1970) nearly 50 years ago, it emphasized the importance of public health but provided no clear line for distinguishing clean air from dirty air. Most fundamentally, regulating pollution has required choices about what indicates that air is "polluted" for regulatory purposes, how to measure and monitor those indicators, and when the measured level of an indicator should trigger enforcement or other intervention. The statute provided few answers, or even a definitive list of "pollutants" to be regulated. Nor were there definitive answers in the Constitution, economics, the biological sciences, or epidemiology. Instead, definitions and decisions have been a continuous enterprise involving interpretations of vague statutory language, promulgation of hundreds of federal and state regulations, enforcement experience, research in multiple disciplines, and the turbulence of politics.

"Quantum mechanics, the subfield of physics that describes the behavior of very small (quantum) particles, provides the basis for a new paradigm of computing. First proposed in the 1980s as a way to improve computational modeling of quantum systems, the field of quantum computing has recently garnered significant attention due to progress in building small-scale devices. However, significant technical advances will be required before a large-scale, practical quantum computer can be achieved. Quantum Computing: Progress and Prospects provides an introduction to the field, including the unique characteristics and constraints of the technology, and assesses the feasibility and implications of creating a functional quantum computer capable of addressing real-world problems. This report considers hardware and software requirements, quantum algorithms, drivers of advances in quantum computing and quantum devices, benchmarks associated with relevant use cases, the time and resources required, and how to assess the probability of success"--Publisher's description.

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. --

"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.

An international consensus policy to prevent the biological cross-contamination of planetary bodies exists and is maintained by the Committee on Space Research (COSPAR) of the International Council for Science, which is consultative to the United Nations Committee on the Peaceful Uses of Outer Space. Currently, COSPAR's planetary protection policy does not specify the status of sample-return missions from Phobos or Deimos, the moons of Mars. Although the moons themselves are not considered potential habitats for life or of intrinsic relevance to prebiotic chemical evolution, recent studies indicate that a significant amount of material recently ejected from Mars could be present on the surface of Phobos and, to a lesser extent, Deimos. This report reviews recent theoretical, experimental, and modeling research on the environments and physical conditions encountered by Mars ejecta during certain processes. It recommends whether missions returning samples from Phobos and/or Deimos should be classified as "restricted" or "unrestricted" Earth return in the framework of the planetary protection policy maintained by COSPAR. This report also considers the specific ways the classification of sample return from Deimos is a different case than sample return from Phobos. --

"A growing body of research indicates that social determinants of health have a significant impact on health care utilization and outcomes. Researchers and policymakers in the United States have spent decades exploring and discussing approaches to integrating health care and social services. While no nation has a truly integrated system, many other industrialized nations invest more heavily in social services than the United States, and are more effective in integrating these services with health care. Integrating health care and social services, such as accessible housing, meals and nutrition services, transportation, and caregiver training, is particularly important for those facing serious illness who typically encounter multiple chronic conditions, pain and other symptoms, functional dependency, frailty, and significant family caregiver needs. In an effort to better understand and facilitate discussions about the challenges and opportunities related to integrating health care and social services for people with serious illness, the National Academies of Sciences, Engineering, and Medicine held a full-day public workshop on July 19, 2018 in Washington, DC. The workshop featured a broad range of experts and stakeholders including researchers, policy analysts, patient and family caregiving advocates, and representatives of federal agencies. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

"Suicide prevention initiatives are part of much broader systems connected to activities such as the diagnosis of mental illness, the recognition of clinical risk, improving access to care, and coordinating with a broad range of outside agencies and entities around both prevention and public health efforts. Yet suicide is also an intensely personal issue that continues to be surrounded by stigma. On September 11-12, 2018, the National Academies of Sciences, Engineering, and Medicine held a workshop in Washington, DC, to discuss preventing suicide among people with serious mental illness. The workshop was designed to illustrate and discuss what is known, what is currently being done, and what needs to be done to identify and reduce suicide risk. Improving Care to Prevent Suicide Among People with Serious Mental Illness summarizes presentations and discussions of the workshop"--Publisher's description

"Continuing rapid developments in the life sciences offer the promise of providing tools to meet global challenges in health, agriculture, the environment, and economic development; some of the benefits are already being realized. However, such advances also bring with them new social, ethical, legal, and security challenges. Governance questions form an increasingly important part of the discussions about these advances--whether the particular issue under debate is the development of ethical principles for human genome editing, how to establish regulatory systems for the safe conduct of field trials of gene drive-modified organisms, or many others. However there are continuing concerns that the knowledge, tools, and techniques resulting from life sciences research could also enable the development of bioweapons or facilitate bioterrorism. Between June 10 and 13, 2018, more than 70 participants from 30 different countries and 5 international organizations took part in an international workshop, The Governance of Dual Use Research in the Life Sciences: Advancing Global Consensus on Research Oversight, in Zagreb, Croatia. Hosted by the Croatian Academy of Sciences and Arts, the workshop was a collaboration among the InterAcademy Partnership, the Croatian Academy, the Croatian Society for Biosafety and Biosecurity, and the U.S. National Academies of Sciences, Engineering, and Medicine. This publication summarizes the presentations and discussions from the workshop."--Publisher's description.