Bøger af National Academies Of Sciences Engineeri

The National Academies of Sciences, Engineering, and Medicine held the workshop Applying Big Data to Address the Social Determinants of Health in Oncology on October 28-29, 2019, in Washington, DC. This workshop examined social determinants of health (SDOH) in the context of cancer, and considered opportunities to effectively leverage big data to improve health equity and reduce disparities. The workshop featured presentations and discussion by experts in technology, oncology, and SDOH, as well as representatives from government, industry, academia, and health care systems. This publication summarizes the presentations and discussions from the workshop.

On March 24, 2020, a 1-day public workshop titled The Role of Digital Health Technologies in Drug Development was convened by the National Academies of Sciences, Engineering, and Medicine. This workshop builds on prior efforts to explore how virtual clinical trials facilitated by digital health technologies (DHTs) might change the landscape of drug development. To explore the challenges and opportunities in using DHTs for improving the probability of success in drug R&D, enabling better patient care, and improving precision medicine, the workshop featured presentations and panel discussions on the integration of DHTs across all phases of drug development. Throughout the workshop, participants considered how DHTs could be applied to achieve the greatest impact--and perhaps even change the face of how clinical trials are conducted--in ways that are also ethical, equitable, safe, and effective. This publication summarizes the presentations and discussions from the workshop.

To draw attention to health determinants and health inequities among populations that live in urban environments and to explore challenges faced in establishing urban population health, the Forum on Public-Private Partnerships for Global Health and Safety hosted a 1.5-day workshop on the role of health-focused public-private partnerships (PPPs) in the urban context. The workshop, held June 13-14, 2019, in Washington, DC, aimed to illuminate some of the intervention strategies that have been designed to attenuate these urban health issues and highlighted the importance of PPPs and urban-level governance in remediation efforts. By facilitating discussion among participants in both the public and private sectors, as well as among policy makers, the workshop served as a platform to share best practices on how to address health challenges through interventions that target healthier urban populations. This publication highlights the presentations and discussion of the workshop.

Headlines frequently appear that purport to highlight the differences among workers of different generations and explain how employers can manage the wants and needs of each generation. But is each new generation really that different from previous ones? Are there fundamental differences among generations that impact how they act and interact in the workplace? Or are the perceived differences among generations simply an indicator of age-related differences between older and younger workers or a reflection of all people adapting to a changing workplace? Are Generational Categories Meaningful Distinctions for Workforce Management? reviews the state and rigor of the empirical work related to generations and assesses whether generational categories are meaningful in tackling workforce management problems. This report makes recommendations for directions for future research and improvements to employment practices.

Established in December 2016, the National Academies of Sciences, Engineering, and Medicine's Roundtable on Data Science Postsecondary Education was charged with identifying the challenges of and highlighting best practices in postsecondary data science education. Convening quarterly for 3 years, representatives from academia, industry, and government gathered with other experts from across the nation to discuss various topics under this charge. The meetings centered on four central themes: foundations of data science; data science across the postsecondary curriculum; data science across society; and ethics and data science. This publication highlights the presentations and discussions of each meeting.

Recommendations for feeding infants and young children have changed substantially over time owing to scientific advances, cultural influences, societal trends, and other factors. At the same time, stronger approaches to reviewing and synthesizing scientific evidence have evolved, such that there are now established protocols for developing evidence-based health recommendations. However, not all authoritative bodies have used such approaches for developing infant feeding guidance, and for many feeding questions there is little or no sound evidence available to guide best practices, despite the fact that research on infant and young child feeding has expanded in recent decades. Summarizing the current landscape of feeding recommendations for infants and young children can reveal the level of consistency of existing guidance, shed light on the types of evidence that underpin each recommendation, and provide insight into the feasibility of harmonizing guidelines. Feeding Infants and Children from Birth to 24 Months collects, compares, and summarizes existing recommendations on what and how to feed infants and young children from birth to 24 months of age. This report makes recommendations to stakeholders on strategies for communicating and disseminating feeding recommendations.

Electric power is a critical infrastructure that is vital to the U.S. economy and national security. Today, the nation's electric power infrastructure is threatened by malicious attacks, accidents, and failures, as well as disruptive natural events. As the electric grid evolves and becomes increasingly interdependent with other critical infrastructures, the nation is challenged to defend against these threats and to advance grid capabilities with reliable defenses. On November 1, 2019, the National Academies of Sciences, Engineering, and Medicine convened a workshop to gather diverse perspectives on current and future threats to the electric power system, activities that the subsector is pursuing to defend itself, and how this work may evolve over the coming decades. This publications summarizes the presentations and discussions from the workshop.

"On December 4-5, 2019, the National Academies of Sciences, Engineering, and Medicine held a 1.5-day public workshop titled Exploring the Frontiers of Innovation to Tackle Microbial Threats. The workshop participants examined major advances in scientific, technological, and social innovations against microbial threats. Such innovations include diagnostics, vaccines (both development and production), and antimicrobials, as well as nonpharmaceutical interventions and changes in surveillance. This publication summarizes the presentations and discussions from the workshop."--

This report evaluates the In-House Laboratory Independent Research (ILIR) conducted at the Research, Development, and Engineering Centers (RDECs) of the U.S. Army's Research, Development, and Engineering Command (RDECOM) during 2018. It reviews and offers recommendations for each of the eight areas of ILIR research: chemistry, computational sciences, electronics, life sciences, materials science, mechanical sciences, network sciences, and physics.

Because of the individualized nature of drug and therapeutic treatments, clinical trials require participants who represent the diversity of the patient base. If early trials do not have a broad patient base, it can be difficult to know who may or may not benefit from or respond to a treatment later. In addition to diversity in recruitment, informed consent during participation is also crucial. If participants do not fully understand what they are signing up for, they may become confused, mistrustful, or drop out of a trial altogether, confusing investigators and possibly affecting the generalizability of a study. To explore the incorporation of health literacy practices into clinical trials, the Roundtable on Health Literacy convened a workshop titled Clinical Trials: Practice and Impact on April 11, 2019, in Washington, DC. The workshop presentations and discussion centered around issues related to the challenges or barriers for diverse populations' participation in clinical trials, best practices for clinical trial sites and researchers incorporating health literacy practices, and effective health literacy strategies for clear communication with participants. This publication summarizes the presentation and discussion of the workshop.

"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."--

"Opioid use and infectious diseases are intertwined epidemics. Despite the fact that the United States is more than two decades into the opioid crisis - the cause of tens of thousands of deaths every year on its own - the health system has not sufficiently addressed the morbidity and mortality of drug use coupled with infectious diseases. This is at least in part due to traditional models of substance use disorder care wherein substance use disorder treatment is delivered independently of other medical care, thereby inhibiting the delivery of comprehensive care. As a result, the United States is experiencing a drastic increase in infectious diseases that spread with drug use. Opportunities to Improve Opioid Use Disorder and Infectious Disease Services examines current efforts to integrate care and describes barriers, such as inadequate workforce and training; lack of data integration and sharing; and stigma among people who use drugs and have also been diagnosed with an infectious disease. The conclusions and recommendations of this report will help to promote patient-centered, integrated programs to address this dual epidemic."--

Research and innovation in the life sciences is driving rapid growth in agriculture, biomedical science, information science and computing, energy, and other sectors of the U.S. economy. This economic activity, conceptually referred to as the bioeconomy, presents many opportunities to create jobs, improve the quality of life, and continue to drive economic growth. While the United States has been a leader in advancements in the biological sciences, other countries are also actively investing in and expanding their capabilities in this area. Maintaining competitiveness in the bioeconomy is key to maintaining the economic health and security of the United States and other nations. Safeguarding the Bioeconomy evaluates preexisting and potential approaches for assessing the value of the bioeconomy and identifies intangible assets not sufficiently captured or that are missing from U.S. assessments. This study considers strategies for safeguarding and sustaining the economic activity driven by research and innovation in the life sciences. It also presents ideas for horizon scanning mechanisms to identify new technologies, markets, and data sources that have the potential to drive future development of the bioeconomy.

Satellite remote sensing is the primary tool for measuring global changes in the land, ocean, biosphere, and atmosphere. Over the past three decades, active remote sensing technologies have enabled increasingly precise measurements of Earth processes, allowing new science questions to be asked and answered. As this measurement precision increases, so does the need for a precise geodetic infrastructure. Evolving the Geodetic Infrastructure to Meet New Scientific Needs summarizes progress in maintaining and improving the geodetic infrastructure and identifies improvements to meet new science needs that were laid out in the 2018 report Thriving on Our Changing Planet: A Decadal Strategy for Earth Observation from Space. Focusing on sea-level change, the terrestrial water cycle, geological hazards, weather and climate, and ecosystems, this study examines the specific aspects of the geodetic infrastructure that need to be maintained or improved to help answer the science questions being considered.--Publisher's website.

On September 16, 2019, the Roundtable on Obesity Solutions of the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine, held a public workshop, Advancing Effective Obesity Communications, in Washington, DC. The workshop explored effective communication of obesity-related issues by providing an overview of the current communications environment and addressing the complexity of identifying key audiences and developing targeted messages. Speakers discussed communications strategies to reach specific intermediary audiences, such as the public, decision makers, and policy makers. The workshop also explored challenges in communicating about obesity issues, which include aligning the intended meaning of messages with an individual's perception of and response to those messages, addressing obesity bias and stigma through communications, and addressing misinformation. This publication summarizes the presentations and discussions that occurred at the workshop.

In November 2018, National Academy of Sciences (NAS) President Marcia McNutt visited China for the first time in her official role. As part of this visit, the National Academies of Sciences, Engineering, and Medicine's Science and Technology for Sustainability (STS) program and the Chinese Academy of Sciences organized a one-day workshop relating to urban sustainability in Beijing. The goal of the visit was to begin to explore some areas where the U.S. National Academies and the Chinese Academy might develop collaboration. At the same time, the trip provided an opportunity to develop links to other parts of the science and technology community in China. To further elucidate some of these issues and build upon current partnerships, an expert committee under the STS program, in collaboration with the Chinese Academy of Sciences, organized a one-day public workshop on urban sustainability in China and the United States, held on December 16, 2019. The workshop focused on the intersection of urban climate change mitigation and adaptation, urban health, and sustainable transportation, including green infrastructure and urban flooding in both countries. This publication summarizes the presentations and discussions from the workshop.

Temporomandibular disorders (TMDs), are a set of more than 30 health disorders associated with both the temporomandibular joints and the muscles and tissues of the jaw. TMDs have a range of causes and often co-occur with a number of overlapping medical conditions, including headaches, fibromyalgia, back pain and irritable bowel syndrome. TMDs can be transient or long-lasting and may be associated with problems that range from an occasional click of the jaw to severe chronic pain involving the entire orofacial region. Everyday activities, including eating and talking, are often difficult for people with TMDs, and many of them suffer with severe chronic pain due to this condition. Common social activities that most people take for granted, such as smiling, laughing, and kissing, can become unbearable. This dysfunction and pain, and its associated suffering, take a terrible toll on affected individuals, their families, and their friends. Individuals with TMDs often feel stigmatized and invalidated in their experiences by their family, friends, and, often, the health care community. Misjudgments and a failure to understand the nature and depths of TMDs can have severe consequences -- more pain and more suffering -- for individuals, their families and our society. Temporomandibular Disorders: Priorities for Research and Care calls on a number of stakeholders -- across medicine, dentistry, and other fields -- to improve the health and well-being of individuals with a TMD. This report addresses the current state of knowledge regarding TMD research, education and training, safety and efficacy of clinical treatments of TMDs, and burden and costs associated with TMDs. The recommendations of Temporomandibular Disorders focus on the actions that many organizations and agencies should take to improve TMD research and care and improve the overall health and well-being of individuals with a TMD.--

The Earth system functions and connects in unexpected ways - from the microscopic interactions of bacteria and rocks to the macro-scale processes that build and erode mountains and regulate Earth's climate. Efforts to study Earth's intertwined processes are made even more pertinent and urgent by the need to understand how the Earth can continue to sustain both civilization and the planet's biodiversity. A Vision for NSF Earth Sciences 2020-2030: Earth in Time provides recommendations to help the National Science Foundation plan and support the next decade of Earth science research, focusing on research priorities, infrastructure and facilities, and partnerships. This report presents a compelling and vibrant vision of the future of Earth science research.

Pain is both a symptom and a disease. It manifests in multiple forms and its treatment is complex. Physical, social, economic, and emotional consequences of pain can impair an individual's overall health, well-being, productivity, and relationships in myriad ways. The impact of pain at a population level is vast and, while estimates differ, the Centers for Disease Control and Prevention reported that 50 million U.S. adults are living in pain. In terms of pain's global impact, estimates suggest the problem affects approximately 1 in 5 adults across the world, with nearly 1 in 10 adults newly diagnosed with chronic pain each year. In recent years, the issues surrounding the complexity of pain management have contributed to increased demand for alternative strategies for treating pain. One such strategy is to expand use of topical pain medications--medications applied to intact skin. This nonoral route of administration for pain medication has the potential benefit, in theory, of local activity and fewer systemic side effects. Compounding is an age-old pharmaceutical practice of combining, mixing, or adjusting ingredients to create a tailored medication to meet the needs of a patient. The aim of compounding, historically, has been to provide patients with access to therapeutic alternatives that are safe and effective, especially for people with clinical needs that cannot otherwise be met by commercially available FDA-approved drugs. Compounded Topical Pain Creams explores issues regarding the safety and effectiveness of the ingredients in these pain creams. This report analyzes the available scientific data relating to the ingredients used in compounded topical pain creams and offers recommendations regarding the treatment of patients.

The United States faces a significantly aging population as well as a growing share of the population that is living longer with multiple chronic conditions. To provide high-quality care to people of all ages living with serious illness, it is critical that the nation develop an adequately trained and prepared workforce consisting of a range of professionals, including physicians, nurses, social workers, direct care workers, and chaplains. To explore some of the key workforce-related challenges to meeting the needs of people with serious illness, the National Academies of Sciences, Engineering, and Medicine hosted a workshop on November 7, 2019. This publication summarizes the presentations and discussions from the workshop.

On August 7-8, 2019, the National Academies of Sciences, Engineering, and Medicine hosted a public workshop in Washington, DC, to review the status of current and emerging knowledge about innovations for modern food systems and strategies for meeting future needs. The workshop addressed different perspectives on the topic of food systems and would build on a workshop on the topic of sustainable diets hosted by the Food Forum in August 2018. This publication summarizes the presentations and discussions from the workshop.

The goal of planetary protection is to control, to the degree possible, the biological cross-contamination of planetary bodies. Guidelines developed by the Committee on Space Research (COSPAR) are used by all spacefaring nations to guide their preparations for encounters with solar system bodies. NASA's Science Mission Directorate has convened the Planetary Protection Independent Review Board (PPIRB) to consider updating the COSPAR guidelines given the growing interest from commercial and private groups in exploration and utilization of Mars and other bodies in space. At the request of NASA, this publication reviews the findings of the PPIRB and comments on their consistency with the recommendations of the recent National Academies report Review and Assessment of the Planetary Protection Policy Development Processes.

The Social Security Administration (SSA) administers two programs that provide disability benefits: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. SSDI provides disability benefits to people (under the full retirement age) who are no longer able to work because of a disabling medical condition. SSI provides income assistance for disabled, blind, and aged people who have limited income and resources regardless of their prior participation in the labor force. Both programs share a common disability determination process administered by SSA and state agencies as well as a common definition of disability for adults: "the inability to engage in any substantial gainful activity 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." Disabled workers might receive either SSDI benefits or SSI payments, or both, depending on their recent work history and current income and assets. Disabled workers might also receive benefits from other public programs such as workers' compensation, which insures against work-related illness or injuries occurring on the job, but those other programs have their own definitions and eligibility criteria. Selected Health Conditions and Likelihood of Improvement with Treatment identifies and defines the professionally accepted, standard measurements of outcomes improvement for medical conditions. This report also identifies specific, long-lasting medical conditions for adults in the categories of mental health disorders, cancers, and musculoskeletal disorders. Specifically, these conditions are disabling for a length of time, but typically don't result in permanently disabling limitations; are responsive to treatment; and after a specific length of time of treatment, improve to the point at which the conditions are no longer disabling.

In 2009 the Institute of Medicine (IOM) began to assess the need for better-defined medical and public health crisis standards of care (CSC) for catastrophic disasters and public health emergencies. Over the next 10 years, the IOM defined templates for those stakeholders responsible for integrated CSC planning and implementation; created a tool kit with guidance on indicators and triggers; provided a discussion kit for stakeholders to use with their own communities to establish appropriate indicators and triggers to guide their planning; disseminated the messages and key concepts of CSC; and built on the initial efforts to refine certain elements and address remaining gaps. This current Proceedings of a Workshop captures the discussions from a 2019 workshop reviewing the successes and gaps over the last 10 years of CSC work, in order to inform the next phases of planning and implementation.

"Speakers at the workshop discussed patient recruitment and selection for gene-based clinical trials, explored how the safety of new therapies is assessed, reviewed the challenges involving dose escalation, and spoke about ethical issues such as informed consent and the role of clinicians in recommending trials as options to their patients"--The National Academies of Sciences, Engineering, Medicine website (viewed September 17, 2020)

Brain health affects Americans across all ages, genders, races, and ethnicities. Enriching the body of scientific knowledge around brain health and cognitive ability has the potential to improve quality of life and longevity for many millions of Americans and their families. The Centers for Disease Control and Prevention estimate that as many as 5 million Americans were living with Alzheimer's disease in 2014. That same year, more than 800,000 children were treated for concussion or traumatic brain injuries in U.S. emergency departments. Each year, more than 795,000 people in the United States have a stroke. Developing more effective treatment strategies for brain injuries and illnesses is essential, but brain health is not focused exclusively on disease, disorders, and vulnerability. It is equally important to better understand the ways our brains grow, learn, adapt, and heal. Addressing all of these domains to optimize brain health will require consideration about how to define brain health and resilience and about how to identify key elements to measure those concepts. Understanding the interactions between the brain, the body, and socioenvironmental forces is also fundamental to improving brain health. To explore issues related to brain health throughout the life span, from birth through old age, a public workshop titled Brain Health Across the Life Span was convened on September 24 and 25, 2019, by the Board on Population Health and Public Health Practice in the Health and Medicine Division of the National Academies. This publication summarizes the presentation and discussion of the workshop.

The social determinants of mental health involve the economic, social, and political conditions into which one is born that influence a person's mental health - and, in particular, that affect the likelihood a person raised in deficient or dangerous conditions often associated with poverty will develop persistent mental health challenges throughout his or her life. To explore how health professions education and practice organizations and programs are currently addressing social determinants that contribute to mental health disparities across the lifespan, the Global Forum on Innovation in Health Professional Education of the National Academies of Sciences, Engineering, and Medicine hosted a workshop in Washington, DC on November 14-15, 2019. This publication summarizes the presentation and discussion of the workshop. Publisher's website.