Bøger af National Academies Of Sciences Engineeri

"Millions of people in the United States live with serious illnesses such as cancer, heart disease, chronic obstructive pulmonary disorder (COPD), amyotrophic lateral sclerosis, Parkinson's disease, and dementia--often for many years. Those facing serious illness have a range of interconnected medical and non-medical needs, and the way their care is financed has a large impact on the care they receive. Medicare is the predominant payer, but both Medicaid and private payers also play significant roles in financing care for serious illness. In an effort to address the complex needs of people with serious illness, public and private health care payers are testing innovative financing strategies and alternative payment models. These innovative approaches signal a gradual transition from the traditional-fee-for-service system that pays providers based on the quantity of services to a system based on the value of care provided and a heightened focus on improved quality of care at lower cost. To explore this evolving financing and payment landscape for serious illness care within public- and private-sector programs, the Roundtable on Quality Care for People with Serious Illness developed a workshop, Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness. The workshop convened clinicians, researchers, policy analysts, and patient advocates, as well as representatives from academia, government and private health care plans, and insurers to discuss challenges and opportunities in financing high-quality care for people with serious illness. This publication summarizes the presentations and discussions from the workshop"--

The National Academies of Sciences, Engineering, Medicine.

Although the general public in the United States assumes children to be generally healthy and thriving, a substantial and growing number of children have at least one chronic health condition. Many of these conditions are associated with disabilities and interfere regularly with children's usual activities, such as play or leisure activities, attending school, and engaging in family or community activities. In their most severe forms, such disorders are serious lifelong threats to children's social, emotional well-being and quality of life, and anticipated adult outcomes such as for employment or independent living. However, pinpointing the prevalence of disability among children in the U.S. is difficult, as conceptual frameworks and definitions of disability vary among federal programs that provide services to this population and national surveys, the two primary sources for prevalence data. Opportunities for Improving Programs and Services for Children with Disabilities provides a comprehensive analysis of health outcomes for school-aged children with disabilities. This report reviews and assesses programs, services, and supports available to these children and their families. It also describes overarching program, service, and treatment goals; examines outreach efforts and utilization rates; identifies what outcomes are measured and how they are reported; and describes what is known about the effectiveness of these programs and services.

"The increasing diversity of population of the United States presents many challenges to conducting health research that is representative and informative. Dispersion and accessibility issues can increase logistical costs; populations for which it is difficult to obtain adequate sample size are also likely to be expensive to study. Hence, even if it is technically feasible to study a small population, it may not be easy to obtain the funding to do so. In order to address the issues associated with improving health research of small populations, the National Academies of Sciences, Engineering, and Medicine convened a workshop in January 2018. Participants considered ways of addressing the challenges of conducting epidemiological studies or intervention research with small population groups, including alternative study designs, innovative methodologies for data collection, and innovative statistical techniques for analysis"--Publisher's description.

"The U.S. Census Bureau maintains an important portfolio of economic statistics programs, including quinquennial economic censuses, annual economic surveys, and quarterly and monthly indicator surveys. Government, corporate, and academic users rely on the data to understand the complexity and dynamism of the U.S. economy. Historically, the Bureau's economic statistics programs developed sector by sector (e.g., separate surveys of manufacturing, retail trade, and wholesale trade), and they continue to operate largely independently. Consequently, inconsistencies in questionnaire content, sample and survey design, and survey operations make the data not only more difficult to use, but also more costly to collect and process and more burdensome to the business community than they could be. This report reviews the Census Bureau's annual economic surveys. Specifically, it examines the design, operations, and products of 11 surveys and makes recommendations to enable them to better answer questions about the evolving economy"--Publisher's description

In May 2017, the committee convened a workshop in which participants discussed educational models to build relevant foundational, translational, and professional skills for data scientists in various roles; the use of high-impact educational practices in the delivery of data science education; and strategies for broad participation in data science education that rely on formal modes of evaluation and assessment. Participants focused on the ways in which students, institutions, and programs could change in the coming decade, as well as how these changes will affect future plans for data science education.

"A Consensus Study Report of the National Academies of Sciences, Engineering, Medicine."

The National Academies of Sciences, Engineering, and Medicine convened a public workshop in September 2017 to explore the evidence for achieving global harmonization of methodological approaches to establishing nutrient intake recommendations. Participants reviewed current nutrient intake recommendations, discussed the feasibility of harmonizing approaches to setting such recommendations globally, examined the development of principles by which they may be applied in diverse contexts that relate to individuals or populations, or regulatory purposes, and examined perceptions and acceptance of nutrient intake recommendations by different stakeholders. This publication summarizes the presentations and discussions from the workshop.

"Since the 2010 Deepwater Horizon blowout and oil spill, efforts to improve safety in the offshore oil industry have resulted in the adoption of new technological controls, increased promotion of safety culture, and the adoption of new data collection systems to improve both safety and performance. As an essential element of a positive safety culture, operators and regulators are increasingly integrating strategies that empower workers to participate in process safety decisions that reduce hazards and improve safety. While the human factors of personal safety have been widely studied and widely adopted in many high-risk industries, process safety - the application of engineering, design, and operative practices to address major hazard concerns - is less well understood from a human factors perspective, particularly in the offshore oil industry. The National Academies of Sciences, Engineering, and Medicine organized a workshop in January 2018 to explore best practices and lessons learned from other high-risk, high-reliability industries for the benefit of the research community and of citizens, industry practitioners, decision makers, and officials addressing safety in the offshore oil industry. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

"A pressing challenge in the modern health care system is the gap between education and clinical practice. Emerging technologies have the potential to bridge this gap by creating the kind of team-based learning environments and clinical approaches that are increasingly necessary in the modern health care system both in the United States and around the world. To explore these technologies and their potential for improving education and practice, the National Academies of Sciences, Engineering, and Medicine hosted a workshop in November 2017. Participants explored effective use of technologies as tools for bridging identified gaps within and between health professions education and practice in order to optimize learning, performance and access in high-, middle-, and low-income areas while ensuring the well-being of the formal and informal health workforce. This publication summarizes the presentations and discussions from the workshop"--

The surface of the human body and its mucous membranes are heavily colonized by microorganisms. Our understanding of the contributions that complex microbial communities make to health and disease is advancing rapidly. Most microbiome research to date has focused on the mouse as a model organism for delineating the mechanisms that shape the assembly and dynamic operations of microbial communities. However, the mouse is not a perfect surrogate for studying different aspects of the microbiome and how it responds to various environmental and host stimuli, and as a result, researchers have been conducting microbiome studies in other animals. To examine the different animal models researchers employ in microbiome studies and to better understand the strengths and weaknesses of each of these model organisms as they relate to human and nonhuman health and disease, the Roundtable on Science and Welfare in Laboratory Animal Use of the National Academies of Sciences, Engineering, and Medicine convened a workshop in December 2016. The workshop participants explored how to improve the depth and breadth of analysis of microbial communities using various model organisms, the challenges of standardization and biological variability that are inherent in gnotobiotic animal-based research, the predictability and translatability of preclinical studies to humans, and strategies for expanding the infrastructure and tools for conducting studies in these types of models. This publication summarizes the presentations and discussions from the workshop.

"BioWatch is the Department of Homeland Security's (DHS's) system for detecting an aerosolized biological attack using collectors that are positioned strategically across the country to continuously monitor the air for biological threats. As currently deployed, BioWatch collectors draw air through filters that field technicians collect daily and transport to laboratories, where professional technicians analyze the material collected on the filter for evidence of biological threats. As part of the BioWatch program's efforts to enhance its effectiveness and capabilities, particularly with regard to detecting biological threats in challenging indoor environments, DHS requested the National Academies of Sciences, Engineering, and Medicine hold a workshop to explore alternative and effective biodetection systems for aerosolized biological agents that would meet BioWatch's technical and operational requirements, integrate into the existing system architecture and public health infrastructure, and be deployable by 2027. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

The 2006 Institute of Medicine (IOM) consensus study report From Cancer Patient to Cancer Survivor: Lost in Transition made recommendations to improve the quality of care that cancer survivors receive, in recognition that cancer survivors are at risk for significant physical, psychosocial, and financial repercussions from cancer and its treatment. Since then, efforts to recognize and address the unique needs of cancer survivors have increased, including an emphasis on improving the evidence base for cancer survivorship care and identifying best practices in the delivery of high-quality cancer survivorship care. To examine progress in cancer survivorship care since the Lost in Transition report, the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine held a workshop in July 2017, in Washington, DC. Workshop participants highlighted potential opportunities to improve the planning, management, and delivery of cancer survivorship care. This publication summarizes the presentations and discussions from the workshop.

Solving the world's health challenges requires multidisciplinary collaborations that bring together the talents, experiences, resources, and ideas from multiple sectors. These collaborations in global health frequently occur through public-private partnerships (PPPs) in which public and private parties share risks, responsibilities, and decision-making processes with the objective of collectively and more effectively addressing a common goal. However, these numerous stakeholders bring varying strengths and resources to global health partnerships, but they also bring their own organizational cultures, regulations, and expectations. Managing partnerships among them is complex and requires intentional and thoughtful governance. Over the last several decades, as the number of interested stakeholders, resources invested, and initiatives launched within the global health field has grown, effective governance of global health PPPs has become increasingly critical. To explore the role of governance in PPPs for global health, the Forum on Public-Private Partnerships for Global Health and Safety convened a workshop. Participants explored best practices, common challenges, and lessons learned in the varying approaches to partnership governance. They also highlighted key issues in the governance of PPPs for global health with the goal of increasing their effectiveness in improving health outcomes. This publication summarizes the presentations and discussions from the workshop.

"Chronic pain is one of the most prevalent, costly, and disabling health conditions in the United States. Estimates show that more than 11 percent of the American population suffer from chronic pain, yet the federal pain research investment has been minimal. In parallel with a gradual increased recognition of the problems of treating chronic pain, the opioid epidemic has emerged as a growing public health emergency. The intersection of these two crises lies in the fact that an unintended consequence of treating pain has been an increasing number of opioid prescriptions and diversion of drugs for illicit purposes. In May 2017, the National Institutes of Health (NIH), and the National Institute on Drug Abuse announced a public-private partnership to develop solutions to the opioid crisis and cut in half the time it takes to develop non-addictive analgesics. To advance the planning of NIH's anticipated public-private partnerships, the National Academies' Forum on Neuroscience and Nervous Systems Disorders hosted a public workshop that brought together a diverse group of stakeholders from academia, federal agencies, advocacy organizations and companies developing therapeutics for pain and opioid use disorders. Participants discussed potential strategies to accelerate development of non-addictive pain medications and treatments for opioid use disorders. This publication summarizes the presentations and discussions from the workshop"--

Oil and gas well completion and stimulation technologies to develop unconventional hydrocarbon resources in the United States have evolved over the past several decades, particularly in relation to the development of shale oil and shale gas. Shale oil and shale gas resources and the technology associated with their production are often termed "unconventional" because the oil and gas trapped inside the shale or other low-permeability rock formation cannot be extracted using conventional technologies. Since about 2005, the application of these technologies to fields in the U.S. have helped produce natural gas and oil in volumes that allowed the country to reduce its crude oil imports by more than 50% and to become a net natural gas exporter. The regional and national economic and energy advances gained through production and use of these resources have been accompanied, however, by rapid expansion of the infrastructure associated with the development of these fields and public concern over the impacts to surface- and groundwater, air, land, and communities where the resources are extracted. The intent of the first day of the workshop of the National Academies of Sciences, Engineering, and Medicine's Roundtable on Unconventional Hydrocarbon Development was to discuss onshore unconventional hydrocarbon development in the context of potential environmental impacts and the ways in which the risks of these kinds of impacts can be managed. Specifically, the workshop sought to examine the lifecycle development of these fields, including decommissioning and reclamation of wells and related surface and pipeline infrastructure, and the approaches from industry practice, scientific research, and regulation that could help to ensure management of the operations in ways that minimize impacts to the environment throughout their active lifetimes and after operations have ceased. This publication summarizes the presentations and discussions from the workshop.

Graduate medical education (GME) is critical to the career development of individual physicians, to the functioning of many teaching institutions, and to the production of our physician workforce. However, recent reports have called for substantial reform of GME. The current lack of established GME outcome measures limits our ability to assess the impact of individual graduates, the performance of residency programs and teaching institutions, and the collective contribution of GME graduates to the physician workforce. To examine the opportunities and challenges in measuring and assessing GME outcomes, the National Academies of Sciences, Engineering, and Medicine held a workshop on October 10-11, 2017, in Washington, DC. Workshop participants discussed: meaningful and measurable outcomes of GME; possible metrics that could be used to track these GME outcomes; possible mechanisms for collecting, collating, analyzing, and reporting these data; and further work to accomplish this ambitious goal. This publication summarizes the presentations and discussions from the workshop.

Prior to 2012, unmanned aircraft systems (UAS) technology had been primarily used by the military and hobbyists, but it has more recently transitioned to broader application, including commercial and scientific applications, as well as to expanded military use. These new uses encroach on existing structures for managing the nation's airspace and present significant challenges to ensure that UASs are coordinated safely and suitably with existing manned aircraft and air traffic management systems, particularly with the National Airspace System (NAS). Of particular concern is the interaction between human pilots, operators, or controllers and increasingly automated systems. Enhanced understanding of these interactions is essential to avoid unintended consequences, especially as new technologies emerge. In order to explore these issues, the National Academies of Sciences, Engineering, and Medicine organized a 2-day workshop in January 2018. This publication summarizes the presentations and discussions from the workshop.

Genomic applications are being integrated into a broad range of clinical and research activities at health care systems across the United States. This trend can be attributed to a variety of factors, including the declining cost of genome sequencing and the potential for improving health outcomes and cutting the costs of care. The goals of these genomics-based programs may be to identify individuals with clinically actionable variants as a way of preventing disease, providing diagnoses for patients with rare diseases, and advancing research on genetic contributions to health and disease. Of particular interest are genomics- based screening programs, which will, in this publication, be clinical screening programs that examine genes or variants in unselected populations in order to identify individuals who are at an increased risk for a particular health concern (e.g., diseases, adverse drug outcomes) and who might benefit from clinical interventions. On November 1, 2017, the National Academies of Sciences, Engineering, and Medicine hosted a public workshop to explore the challenges and opportunities associated with integrating genomics-based screening programs into health care systems. This workshop was developed as a way to explore the challenges and opportunities associated with integrating genomics-based programs in health care systems in the areas of evidence collection, sustainability, data sharing, infrastructure, and equity of access. This publication summarizes the presentations and discussions from the workshop.

On February 26-27, 2014, the National Academies of Sciences, Engineering, and Medicine's Forum on Global Violence Prevention convened a workshop titled Mental Health and Violence: Opportunities for Prevention and Early Intervention. The workshop brought together advocates and experts in public health and mental health, anthropology, biomedical science, criminal justice, global health and development, and neuroscience to examine experience, evidence, and practice at the intersection of mental health and violence. Participants explored how violence impacts mental health and how mental health influences violence and discussed approaches to improve research and practice in both domains. This publication summarizes the presentations and discussions from the workshop"--

"To derive statistics about crime - to estimate its levels and trends, assess its costs to and impacts on society, and inform law enforcement approaches to prevent it - a conceptual framework for defining and thinking about crime is virtually a prerequisite. Developing and maintaining such a framework is no easy task, because the mechanics of crime are ever evolving and shifting: tied to shifts and development in technology, society, and legislation. Interest in understanding crime surged in the 1920s, which proved to be a pivotal decade for the collection of nationwide crime statistics. Now established as a permanent agency, the Census Bureau commissioned the drafting of a manual for preparing crime statistics--intended for use by the police, corrections departments, and courts alike. The new manual sought to solve a perennial problem by suggesting a standard taxonomy of crime. Shortly after the Census Bureau issued its manual, the International Association of Chiefs of Police in convention adopted a resolution to create a Committee on Uniform Crime Records --to begin the process of describing what a national system of data on crimes known to the police might look like. Report 1 performed a comprehensive reassessment of what is meant by crime in U.S. crime statistics and recommends a new classification of crime to organize measurement efforts. This second report examines methodological and implementation issues and presents a conceptual blueprint for modernizing crime statistics"--Publisher's description.

"The second State of the Climate Cycle Report (SOCCR2) aims to elucidate the fundamental physical, chemical, and biological aspects of the carbon cycle and to discuss the challenges of accounting for all major carbon stocks and flows for the North American continent. This assessment report has broad value, as understanding the carbon cycle is not just an academic exercise. Rather, this understanding can provide an important foundation for making a wide variety of societal decisions about land use and natural resource management, climate change mitigation strategies, urban planning, and energy production and consumption ... To ensure that SOCCR2 is scientifically credible and effectively communicates, the USGCRP asked the National Academies of Sciences, Engineering, and Medicine to review the draft document (during the same time period in which the draft SOCCR2 report was available for public comment). The Academies appointed an ad hoc expert Committee to conduct this review, and offered here are the Committee's findings and recommendations"--

"Rural counties make up about 80 percent of the land area of the United States, but they contain less than 20 percent of the U.S. population. The relative sparseness of the population in rural areas is one of many factors that influence the health and well-being of rural Americans. Rural areas have histories, economies, and cultures that differ from those of cities and from one rural area to another. Understanding these differences is critical to taking steps to improve health and well-being in rural areas and to reduce health disparities among rural populations. To explore the impacts of economic, demographic, and social issues in rural communities and to learn about asset-based approaches to addressing the associated challenges, the National Academies of Sciences, Engineering, and Medicine held a workshop on June 13, 2017. This publication summarizes the presentations and discussions from the workshop"--

The National Climate Assessment, coordinated by the U.S. Global Change Research Program, is a mandated report intended to inform response decisions. These reports are developed every four years.

"Many different groups of people are subject to stereotypes. Positive stereotypes (e.g., "older and wiser") may provide a benefit to the relevant groups. However, negative stereotypes of aging and of disability continue to persist and, in some cases, remain socially acceptable. Research has shown that when exposed to negative images of aging, older persons demonstrate poor physical and cognitive performance and function, while those who are exposed to positive images of aging (or who have positive self-perceptions of aging) demonstrate better performance and function. Furthermore, an individual's expectations about and perceptions of aging can predict future health outcomes. To better understand how stereotypes affect older adults and individuals with disabilities, the National Academies of Sciences, Engineering, and Medicine, with support from AARP, convened a public workshop on October 10, 2017. This publication summarizes the presentations and discussions from the workshop"--

"Abortion is a legal medical procedure that has been provided to millions of American women. Since the Institute of Medicine first reviewed the health implications of national legalized abortion in 1975, there has been a plethora of related scientific research, including well-designed randomized clinical trials, systematic reviews, and epidemiological studies examining abortion care. This research has focused on examining the relative safety of abortion methods and the appropriateness of methods for different clinical circumstances. With this growing body of research, earlier abortion methods have been refined, discontinued, and new approaches have been developed. The Safety and Quality of Abortion Care in the United States offers a comprehensive review of the current state of the science related to the provision of safe, high-quality abortion services in the United States. This report considers 8 research questions and presents conclusions, including gaps in research"--Publisher's description.

"Commercially significant amounts of crude oil and natural gas lie under the continental shelf of the United States. Advances in locating deposits, and improvements in drilling and recovery technology, have made it technically and economically feasible to extract these resources under harsh conditions. But extracting these offshore petroleum resources involves the possibility, however remote, of oil spills, with resulting damage to the ocean and the coastline ecosystems and risks to life and limb of those performing the extraction. The environmental consequences of an oil spill can be more severe underwater than on land because sea currents can quickly disperse the oil over a large area and, thus, cleanup can be problematic. Bolted connections are an integral feature of deep-water well operations. High-Performance Bolting Technology for Offshore Oil and Natural Gas Operations summarizes strategies for improving the reliability of fasteners used in offshore oil exploration equipment, as well as best practices from other industrial sectors. It focuses on critical bolting--bolts, studs, nuts, and fasteners used on critical connections"--Publisher's description

Despite substantial advances in developing treatments for the serious illnesses that affect people worldwide, there remains a tremendous unmet need in the treatment of complex neurologic diseases, including neuropsychiatric and neurodegenerative disorders. Chief among the challenges that have hindered the development of therapeutics for central nervous system (CNS) disorders is the blood-brain barrier (BBB). The Forum on Neuroscience and Nervous System Disorders of the National Academies of Sciences, Engineering, and Medicine convened a workshop to explore the challenges associated with the BBB that have thus far stymied development of CNS drugs, examine new technologies that could address these challenges, and highlight potential opportunities for moving the field forward. This publication summarizes the presentations and discussions from the workshop.

"In its landmark report, Health Literacy: A Prescription to End Confusion, the Institute of Medicine noted that there are 90 million adults in the United States with limited health literacy who cannot fully benefit from what the health and health care systems have to offer. Since the release of that report, health literacy has become a vibrant research field that has developed and disseminated a wide range of tools and practices that have helped organizations, ranging in size from large health care systems to individual health care providers and pharmacists, to engage in health literate discussions with and provide health literate materials for patients and family members. Improving the health literacy of organizations can be an important component of addressing the social determinants of health and achieving the triple aim of improving the patient experience, improving the health of populations, and reducing the cost of care. However, the focus on organizations does not address the larger issue of how to improve health literacy across the U.S. population. To get a better understanding of the state of community-based health literacy interventions, the Roundtable on Health Literacy hosted a workshop on July 19, 2017 on community-based health literacy interventions. It featured examples of community-based health literacy programs, discussions on how to evaluate such programs, and the actions the field can take to embrace this larger view of health literacy. This publication summarizes the presentations and discussions from the workshop." --

"Health literacy, cultural competence, and language access services are distinct but inextricably linked concepts for delivering equitable care to all members of the increasingly diverse population of the United States. These concepts are linked, but they developed via different paths, and each has its own unique focus with regard to enabling every individual to obtain the ability to process and understand basic health information and services needed to make appropriate health care decisions. Fragmentation of these disciplines has impeded implementation of relevant measures for quality improvement and accountability. To foster an integrated approach to health literacy, cultural competency, and language access services, the Roundtable on Health Literacy initiated a project with three components: a commissioned paper to propose a framework for integrating measurements of health literacy, cultural competency, and language access; a workshop to review and discuss the framework; and a second commissioned paper that will provide a roadmap for integrating health literacy, cultural competency, and language access services as well as a revised measurement framework. Held on May 4, 2017, the workshop explored the quality performance measures for integration of health literacy, cultural competence, and language access services. This publication summarizes the presentations and discussions from the workshop"--