Bøger af National Academies Of Sciences Engineeri

The environment for women's health has changed over the last 25 years. Increased use of automobiles can lead to health risks from lack of physical activity. There has also been an increase in access to and consumption of unhealthy food. Other changes in the past 2 to 3 decades include the significant increase in the number of women who are heads of households and responsible for all aspects of a household and family. Many women now are also having children later in life, which poses interesting issues for both biology and sociology. The growing stress faced by women and the effect of stress on health and illness are issues that need a more comprehensive examination, as do issues of mental health and mental illness, which have been more common and thus increasingly prominent issues for U.S. women. In September 2015, the National Academies of Sciences, Engineering, and Medicine convened a workshop to shed light on important determinants, consequences, effects, and issues attending the relative disadvantage of women in the United States in comparison with women in other economically advanced nations. This report summarizes the presentations and discussions from the workshop.

In times of rapid change and constrained resources, measures that are important, focused, and reliable are vital. However there is an overabundance of measures available for evaluating various aspects of population health and previous efforts to simplify existing sets to meet the needs of all decision makers have been unsuccessful. The National Academies of Sciences, Engineering, and Medicine convened a workshop to explore the status and uses of measures and measurement in the work of improving population health. Participants explored existing and emerging population health metric sets and characteristics of metrics necessary for stakeholder action across multiple sectors. This report summarizes the presentations and discussions from the workshop.

"The U.S. Social Security Administration (SSA) provides benefits to disabled adults and children, offering vital financial support to more than 19 million disabled Americans. Of that group, approximately 5.5 million have been deemed -- by virtue of youth or mental or physical impairment - incapable of managing or directing the management of their benefits. Hence, a representative payee has been appointed to receive and disburse SSA payments for these beneficiaries to ensure that their basic needs for shelter, food, and clothing are met. Periodically, however, concerns have been expressed about the accuracy of the process by which SSA determines whether beneficiaries are capable of managing their benefits, with some evidence suggesting that underdetection of incapable recipients may be a particular problem. The importance of creating as accurate a process as possible for incapability determinations is underscored by the consequences of incorrectly identifying recipients either as incapable when they can manage their benefits or as capable when they cannot. Failure to identify beneficiaries who are incapable of managing their funds means abandoning a vulnerable population to potential homelessness, hunger, and disease. Informing Social Security's Process for Financial Capability Determination considers capability determination processes used by other similar benefit programs, abilities required to manage, and direct the management of, benefits, and effective methods and measures for assessing capability. This report evaluates SSA's capability determination process for adult beneficiaries and provides recommendations for improving the accuracy and efficiency of the agency's policy and procedures for making these determinations"--

Human spaceflight is inherently risky, with numerous potential hazards posed at each phase of a mission. Potential health risks during spaceflights include short-term health consequences from being in microgravity, as well as long-term health consequences that arise, or continue, months or years after a flight. Additional health considerations are risks posed by exposure to environmental contaminants onboard spacecraft. Because the International Space Station and spacecraft are closed environments that require recirculation of air and water supplies, some contamination of the air and water will occur. Even with onboard air and water purification systems, chemicals will accumulate in the air and water as they recirculate or are recycled onboard. Therefore, it is necessary for the National Aeronautics and Space Administration (NASA) to identify hazardous contaminants and determine exposure levels that are not expected to pose a health risk to astronauts. NASA uses spacecraft maximum allowance concentrations (SMACs) and spacecraft water exposure guidelines (SWEGs) to provide guidance on acceptable exposures to air and water contaminants during normal operations and emergency situations. Refinements to the Methods for Developing Spacecraft Exposure Guidelines updates the methods for establishing SMACs and SWEGs and assists NASA with identifying chemicals that need updated SMACs or SWEGs and new chemicals for which these guidelines should be developed.

Though cancer was once considered to be a problem primarily in wealthy nations, low- and middle-income countries now bear a majority share of the global cancer burden, and cancer often surpasses the burden of infectious diseases in these countries. Effective low-cost cancer control options are available for some malignancies, with the World Health Organization estimating that these interventions could facilitate the prevention of approximately one-third of cancer deaths worldwide. But these interventions remain inaccessible for many people in the world, especially those residing in low-resource communities that are characterized by a lack of funds - on an individual or societal basis - to cover health infrastructure and care costs. Few guidelines and strategies for cancer control consider the appropriateness and feasibility of interventions in low-resource settings, and may undermine the effectiveness of these efforts. For example, interventions that are designed for high-resource settings may not account for important considerations in low-resource settings, such as resource constraints, infrastructure requirements, or whether a community has the capacity to deliver downstream cancer care. Patients in resource-constrained communities continue to face delayed diagnoses of cancer, potentially resulting in the diagnosis of later stage cancers and worsened patient outcomes. In addition, social stigmas, geopolitical issues, and cultural norms may limit access to cancer care in certain communities. Recognizing the challenges of providing cancer care in these settings, the National Academies of Sciences, Engineering, and Medicine developed a workshop series examining cancer care in low-resource communities. This report summarizes the presentations and discussions from the first workshop, which focused on cancer prevention and early detection.

"As climate has warmed over recent years, a new pattern of more frequent and more intense weather events has unfolded across the globe. Climate models simulate such changes in extreme events, and some of the reasons for the changes are well understood. Warming increases the likelihood of extremely hot days and nights, favors increased atmospheric moisture that may result in more frequent heavy rainfall and snowfall, and leads to evaporation that can exacerbate droughts. Even with evidence of these broad trends, scientists cautioned in the past that individual weather events couldn't be attributed to climate change. Now, with advances in understanding the climate science behind extreme events and the science of extreme event attribution, such blanket statements may not be accurate. The relatively young science of extreme event attribution seeks to tease out the influence of human-cause climate change from other factors, such as natural sources of variability like El Niano, as contributors to individual extreme events. Event attribution can answer questions about how much climate change influenced the probability or intensity of a specific type of weather event. As event attribution capabilities improve, they could help inform choices about assessing and managing risk, and in guiding climate adaptation strategies. This report examines the current state of science of extreme weather attribution, and identifies ways to move the science forward to improve attribution capabilities."--from publisher's description.

The World Health Organization defines the social determinants of health as "the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life." These forces and systems include economic policies, development agendas, cultural and social norms, social policies, and political systems. In an era of pronounced human migration, changing demographics, and growing financial gaps between rich and poor, a fundamental understanding of how the conditions and circumstances in which individuals and populations exist affect mental and physical health is imperative. Educating health professionals about the social determinants of health generates awareness among those professionals about the potential root causes of ill health and the importance of addressing them in and with communities, contributing to more effective strategies for improving health and health care for underserved individuals, communities, and populations. Recently, the National Academies of Sciences, Engineering, and Medicine convened a workshop to develop a high-level framework for such health professional education. A Framework for Educating Health Professionals to Address the Social Determinants of Health also puts forth a conceptual model for the framework's use with the goal of helping stakeholder groups envision ways in which organizations, education, and communities can come together to address health inequalities.

-Living independently and participating in one community are priorities for many people. In many regions across the United States, there are programs that support and enable people with disabilities and older adults to live where they choose and with whom they choose and to participate fully in their communities. Tremendous progress has been made. However, in many cases, the programs themselves - and access to them - vary not only between states but also within states. Many programs are small, and even when they prove to be successful they are still not scaled up to meet the needs of the many people who would benefit from them. The challenges can include insufficient workforce, insufficient funding, and lack of evidence demonstrating effectiveness or value. To get a better understanding of the policies needed to maximize independence and support community living and of the research needed to support implementation of those policies, the National Academies of Sciences, Engineering, and Medicine convened a public workshop in October 2015. Participants explored policies in place that promote independence and community living for older adults and people with physical disabilities, and identified policies and gaps in policies that can be barriers to independence and the research needed to support changing those policies. This report summarizes the presentations and discussions from the workshop---Publisher's description.

"National Summit on Developing a STEM Workforce Strategy, a National Academies of Sciences, Engineering, and Medicine workshop funded by the National Science Foundation, September 21-22, 2015, Room 100, Keck Center, 500 Fifth Street NW, Washington, DC"--Page 103.

Every patient is unique, and the evolving field of precision medicine aims to ensure the delivery of the right treatment to the right patient at the right time. In an era of rapid advances in biomedicine and enhanced understanding of the genetic basis of disease, health care providers increasingly have access to advanced technologies that may identify molecular variations specific to an individual patient, which subsequently can be targeted for treatment. Known as biomarker tests for molecularly targeted therapies, these complex tests have the potential to enable the selection of the most beneficial treatment (and also to identify treatments that may be harmful or ineffective) for the molecular underpinnings of an individual patient's disease. Such tests are key to unlocking the promise of precision medicine. Biomarker tests for molecularly targeted therapies represent a crucial area of focus for developing methods that could later be applicable to other areas of precision medicine. The appropriate regulatory oversight of these tests is required to ensure that they are accurate, reliable, properly validated, and appropriately implemented in clinical practice. Moreover, common evidentiary standards for assessing the beneficial impact of biomarker-guided therapy selection on patient outcomes, as well as the effective collection and sharing of information related to those outcomes, are urgently needed to better inform clinical decision making. Biomarker Tests of Molecularly Targeted Therapies examines opportunities for and challenges to the use of biomarker tests to select optimal therapy and offers recommendations to accelerate progress in this field. This report explores regulatory issues, reimbursement issues, and clinical practice issues related to the clinical development and use of biomarker tests for targeting therapies to patients. Properly validated, appropriately implemented biomarker tests hold the potential to enhance patient care and improve outcomes, and therefore addressing the challenges facing such tests is critical.

"To examine the science, policy, and practice surrounding supporting family and community investments in young children globally and children in acute disruptions, the National Academies of Sciences, Engineering, and Medicine held a workshop in partnership with the Ethiopian Academy of Sciences in Addis Ababa, Ethiopia, from July 27-29, 2015. The workshop examined topics related to supporting family and community investments in young children globally. Examples of types of investments included financial and human capital. Participants also discussed how systems can better support children, families, and communities through acute disruptions such as the Ebola outbreak. Over the course of the 3-day workshop, researchers, policy makers, program practitioners, funders, young influencers, and other experts from 19 countries discussed how best to support family and community investments across areas of health, education, nutrition, social protection, and other service domains. This report summarizes the presentations and discussions from the workshop"--Publisher's description.

From 1962 to 1971, the US military sprayed herbicides over Vietnam to strip the thick jungle canopy that could conceal opposition forces, to destroy crops that those forces might depend on, and to clear tall grasses and bushes from the perimeters of US base camps and outlying fire-support bases. Mixtures of 2,4-dichlorophenoxyacetic acid (2,4-D), 2,4,5-trichlorophenoxyacetic acid (2,4,5-T), picloram, and cacodylic acid made up the bulk of the herbicides sprayed. The main chemical mixture sprayed was Agent Orange, a 50:50 mixture of 2,4-D and 2,4,5-T. At the time of the spraying, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), the most toxic form of dioxin, was an unintended contaminant generated during the production of 2,4,5-T and so was present in Agent Orange and some other formulations sprayed in Vietnam. Because of complaints from returning Vietnam veterans about their own health and that of their children combined with emerging toxicologic evidence of adverse effects of phenoxy herbicides and TCDD, the National Academy of Sciences was asked to perform a comprehensive evaluation of scientific and medical information regarding the health effects of exposure to Agent Orange, other herbicides used in Vietnam, and the various components of those herbicides, including TCDD. Updated evaluations were conducted every two years to review newly available literature and draw conclusions from the overall evidence. Veterans and Agent Orange: Update 2014 is a cumulative report of the series thus far.

The Update to the Strategic Plan (USP) is a supplement to the Ten-Year Strategic Plan of the U.S. Global Change Research Program (USGCRP) completed in 2012. The Strategic Plan sets out a research program guiding thirteen federal agencies in accord with the Global Change Research Act of 1990. This report reviews whether USGCRP's efforts to achieve its goals and objectives, as documented in the USP, are adequate and responsive to the Nation's needs, whether the priorities for continued or increased emphasis are appropriate, and if the written document communicates effectively, all within a context of the history and trajectory of the Program.

Questions about the reproducibility of scientific research have been raised in numerous settings and have gained visibility through several high-profile journal and popular press articles. Quantitative issues contributing to reproducibility challenges have been considered (including improper data measurement and analysis, inadequate statistical expertise, and incomplete data, among others), but there is no clear consensus on how best to approach or to minimize these problems. A lack of reproducibility of scientific results has created some distrust in scientific findings among the general public, scientists, funding agencies, and industries. While studies fail for a variety of reasons, many factors contribute to the lack of perfect reproducibility, including insufficient training in experimental design, misaligned incentives for publication and the implications for university tenure, intentional manipulation, poor data management and analysis, and inadequate instances of statistical inference. The workshop summarized in this report was designed not to address the social and experimental challenges but instead to focus on the latter issues of improper data management and analysis, inadequate statistical expertise, incomplete data, and difficulties applying sound statistic inference to the available data. Many efforts have emerged over recent years to draw attention to and improve reproducibility of scientific work. This report uniquely focuses on the statistical perspective of three issues: the extent of reproducibility, the causes of reproducibility failures, and the potential remedies for these failures.

Workshop convened by the Computer Science and Telecommunications Board (CSTB) on July 21-22, 2015 in Washington, D.C.--page 1.

"Science and Technology for Sustainability Program"--Page 1 of cover.

"The workshop summarized in this report was organized as part of a study sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of the Assistant Secretary for Planning and Evaluation of the U.S. Department of Health and Human Services, with the goal of assisting SAMHSA in its responsibilities of expanding the collection of behavioral health data in several areas. The workshop brought together experts in mental health, psychiatric epidemiology and survey methods to facilitate discussion of the most suitable measures and mechanisms for producing estimates of specific mental illness diagnoses with functional impairment. The report discusses existing measures and data on mental disorders and functional impairment, challenges associated with collecting these data in large-scale population-based studies, as well as study design and estimation options"--

The National Academies of Sciences, Engineering, and Medicine's Army Research Laboratory Technical Assessment Board (ARLTAB) provides biennial assessments of the scientific and technical quality of the research, development, and analysis programs at the Army Research Laboratory (ARL), focusing on ballistics sciences, human sciences, information sciences, materials sciences, and mechanical sciences. This interim report summarizes the findings of the Board for the first year of this biennial assessment; the current report addresses approximately half the portfolio for each campaign; the remainder will be assessed in 2016. During the first year the Board examined the following elements within the ARL's science and technology campaigns: biological and bioinspired materials, energy and power materials, and engineered photonics materials; battlefield injury mechanisms, directed energy, and armor and adaptive protection; sensing and effecting, and system intelligence and intelligent systems; advanced computing architectures, computing sciences, data-intensive sciences, and predictive simulation sciences; human-machine interaction, intelligence and control, and perception; humans in multiagent systems, real-world behavior, and toward human variability; and mission capability of systems. A second, final report will subsume the findings of this interim report and add the findings from the second year of the review.

For the United States, the 1991 Persian Gulf War was a brief and successful military operation with few injuries and deaths. However, soon after returning from duty, a large number of veterans began reporting health problems they believed were associated with their service in the Gulf. At the request of Congress, the Institute of Medicine (IOM) has been conducting an ongoing review of the evidence to determine veterans' long-term health problems and potential causes. The fourth volume in the series, released in 2006, summarizes the long-term health problems seen in Gulf War veterans. In 2010, the IOM released an update that focuses on existing health problems and identifies possible new ones, considering evidence collected since the initial summary. Gulf War and Health: Volume 10 is an update of the scientific and medical literature on the health effects associated with deployment to the Gulf War that were identified in Volumes 4 and 8. This report reviews and evaluates the associations between illness and exposure to toxic agents, environmental or wartime hazards, or preventive measures and vaccines associated with Gulf War service, and provides recommendations for future research efforts on Gulf War veterans.

In 1982 the Census Bureau requested the Committee on National Statistics to establish a panel to suggest research and experiments, to recommend improved methods, and to guide the Census Bureau on technical problems in appraising contending methods with regard to the conduct of the decennial census. In response, the panel produced an interim report that focused on recommendations for improvements in census methodology that warranted early investigation and testing. This report updates and expands the ideas and conclusions about decennial census methodology.

"The national academies of sciences-engineering-medicine"--Cover.

"This report summarizes an 18-month study by the Committee on Improving Higher Education's Responsiveness to STEM Workforce Needs: Identifying Analytical Tools and Regional Best Practices, organized under the auspices of the Board on Higher Education and Workforce and the National Academy of Sciences, Engineering, and Medicine"--page vii.

Over the past several decades, the public and private sectors made significant investments in global health, leading to meaningful changes for many of the world's poor. These investments and the resulting progress are often concentrated in vertical health programs, such as child and maternal health, malaria, and HIV, where donors may have a strategic interest. Frequently, partnerships between donors and other stakeholders can coalesce on a specific topical area of expertise and interest. However, to sustain these successes and continue progress, there is a growing recognition of the need to strengthen health systems more broadly and build functional administrative and technical infrastructure that can support health services for all, improve the health of populations, increase the purchasing and earning power of consumers and workers, and advance global security. In June 2015, the National Academies of Sciences, Engineering, and Medicine held a workshop on the role of public-private partnerships (PPPs) in health systems strengthening. Participants examined a range of incentives, innovations, and opportunities for relevant sectors and stakeholders in strengthening health systems through partnerships; to explore lessons learned from pervious and ongoing efforts with the goal of illuminating how to improve performance and outcomes going forward; and to discuss measuring the value and outcomes of investments and documenting success in partnerships focused on health systems strengthening. This report summarizes the presentations and discussions from the workshop.

"The social cost of carbon (SCC) for a given year is an estimate, in dollars, of the present discounted value of the damage caused by a 1-metric ton increase in CO2 emissions into the atmosphere in that year; or equivalently, the benefits of reducing CO2 emissions by the same amount in that given year. The SCC is intended to provide a comprehensive measure of the monetized value of the net damages from global climate change from an additional unit of CO2, including, but not limited to, changes in net agricultural productivity, energy use, human health effects, and property damages from increased flood risk. Federal agencies use the SCC to value the CO2 emissions impacts of various policies including emission and fuel economy standards for vehicles, regulations of industrial air pollutants from industrial manufacturing, emission standards for power plants and solid waste incineration, and appliance energy efficiency standards. There are significant challenges to estimating a dollar value that reflects all the physical, human, ecological, and economic impacts of climate change. Recognizing that the models and scientific data underlying the SCC estimates evolve and improve over time, the federal government made a commitment to provide regular updates to the estimates. To assist with future revisions of the SCC, the Interagency Working Group on the Social Cost of Carbon (IWG) requested the National Academies of Sciences, Engineering, and Medicine complete a study that assessed the merits and challenges of a limited near-term update to the SCC and of a comprehensive update of the SCC to ensure that the estimates reflect the best available science. This interim report focuses on near-term updates to the SCC estimates"--

"Since the 2014 Ebola outbreak many public- and private-sector leaders have seen a need for improved management of global public health emergencies. The effects of the Ebola epidemic go well beyond the three hardest-hit countries and beyond the health sector. Education, child protection, commerce, transportation, and human rights have all suffered. The consequences and lethality of Ebola have increased interest in coordinated global response to infectious threats, many of which could disrupt global health and commerce far more than the recent outbreak. In order to explore the potential for improving international management and response to outbreaks the National Academy of Medicine agreed to manage an international, independent, evidence-based, authoritative, multistakeholder expert commission. As part of this effort, the Institute of Medicine convened four workshops in summer of 2015 to inform the commission report. The presentations and discussions from the Governance for Global Health Workshop are summarized in this report"--

"The Global Health Risk Framework Project Workshop on Pandemic Financing, National Academy of Sciences Building, 2101 Constitution Avenue NW, Washington, DC, Thursday, August 27, 2015"--Page 79.

"The Board on Health Sciences Policy within the Institute of Medicine of the National Academies of Science, Engineering, and Medicine convened Global Health Risk Framework: a Workshop on Resilient and Sustainable Health Systems to Respond to Global Infectious Disease Outbreaks, held August 5-7, 2015 in Accra, Ghana"--Page 6.

Summary of Meeting on "Updating and Optimizing a List of Civilian Research and Test Reactors that Operate Using HEU Fuel," held July 27-29, 2015 in Vienna Austria.

"The Workshop on Research and Development of Medical Products is one of the four workstream activities of the Global Health Risk Framework Initiative ... The workshop was co-hosted by the Institute of Medicine (IOM) and the University of Hong Kong, in Hong Kong, on August 19-21, 2015"--Page 2-3.