Bøger udgivet af National Academies Press

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.

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.

"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

"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.

"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 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.

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.

"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"--

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.

Although the ocean-and the resources within-seem limitless, there is clear evidence that human impacts such as overfishing, habitat destruction, and pollution disrupt marine ecosystems and threaten the long-term productivity of the seas. Declining yields in many fisheries and decay of treasured marine habitats, such as coral reefs, has heightened interest in establishing a comprehensive system of marine protected areas (MPAs)-areas designated for special protection to enhance the management of marine resources. Therefore, there is an urgent need to evaluate how MPAs can be employed in the United States and internationally as tools to support specific conservation needs of marine and coastal waters. Marine Protected Areas compares conventional management of marine resources with proposals to augment these management strategies with a system of protected areas. The volume argues that implementation of MPAs should be incremental and adaptive, through the design of areas not only to conserve resources, but also to help us learn how to manage marine species more effectively.

"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"--

"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 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.

"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.

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.

"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

"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"--

"Encryption protects information stored on smartphones, laptops, and other devices - in some cases by default. Encrypted communications are provided by widely used computing devices and services - such as smartphones, laptops, and messaging applications - that are used by hundreds of millions of users. Individuals, organizations, and governments rely on encryption to counter threats from a wide range of actors, including unsophisticated and sophisticated criminals, foreign intelligence agencies, and repressive governments. Encryption on its own does not solve the challenge of providing effective security for data and systems, but it is an important tool. At the same time, encryption is relied on by criminals to avoid investigation and prosecution, including criminals who may unknowingly benefit from default settings as well as those who deliberately use encryption. Thus, encryption complicates law enforcement and intelligence investigations. When communications are encrypted "end-to-end," intercepted messages cannot be understood. When a smartphone is locked and encrypted, the contents cannot be read if the phone is seized by investigators. Decrypting the Encryption Debate reviews how encryption is used, including its applications to cybersecurity; its role in protecting privacy and civil liberties; the needs of law enforcement and the intelligence community for information; technical and policy options for accessing plaintext; and the international landscape. This book describes the context in which decisions about providing authorized government agencies access to the plaintext version of encrypted information would be made and identifies and characterizes possible mechanisms and alternative means of obtaining information"--

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

Participants of the July 17-18, 2017, symposium titled Opportunities and Approaches for Supplying Molybdenum-99 and Associated Medical Isotopes to Global Markets examined current trends in molybdenum-99 production, prospects for new global supplies, and technical, economic, regulatory, and other considerations for supplying molybdenum-99 to global markets. This publication summarizes the presentations and discussions from the symposium.

"Millions of Americans use e-cigarettes. Despite their popularity, little is known about their health effects. Some suggest that e-cigarettes likely confer lower risk compared to combustible tobacco cigarettes, because they do not expose users to toxicants produced through combustion. Proponents of e-cigarette use also tout the potential benefits of e-cigarettes as devices that could help combustible tobacco cigarette smokers to quit and thereby reduce tobacco-related health risks. Others are concerned about the exposure to potentially toxic substances contained in e-cigarette emissions, especially in individuals who have never used tobacco products such as youth and young adults. Given their relatively recent introduction, there has been little time for a scientific body of evidence to develop on the health effects of e-cigarettes. Public Health Consequences of E-Cigarettes reviews and critically assesses the state of the emerging evidence about e-cigarettes and health. This report makes recommendations for the improvement of this research and highlights gaps that are a priority for future research." --Publisher's description.

Approximately 4 million U.S. service members took part in the wars in Afghanistan and Iraq. Shortly after troops started returning from their deployments, some active-duty service members and veterans began experiencing mental health problems. Given the stressors associated with war, it is not surprising that some service members developed such mental health conditions as posttraumatic stress disorder, depression, and substance use disorder. Subsequent epidemiologic studies conducted on military and veteran populations that served in the operations in Afghanistan and Iraq provided scientific evidence that those who fought were in fact being diagnosed with mental illnesses and experiencing mental health-related outcomes--in particular, suicide--at a higher rate than the general population. This report provides a comprehensive assessment of the quality, capacity, and access to mental health care services for veterans who served in the Armed Forces in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn. It includes an analysis of not only the quality and capacity of mental health care services within the Department of Veterans Affairs, but also barriers faced by patients in utilizing those services.

This volume presents papers on the topics covered at the National Academy of Engineering's 2017 US Frontiers of Engineering Symposium. Every year the symposium brings together 100 outstanding young leaders in engineering to share their cutting-edge research and innovations in selected areas. The 2017 symposium was held September 25-27 at the United Technologies Research Center in East Hartford, Connecticut. The intent of this book is to convey the excitement of this unique meeting and to highlight innovative developments in engineering research and technical work.

"Decades of continuous efforts to address known hazards in the national airspace system (NAS) and to respond to issues illuminated by analysis of incidents and accidents have made commercial airlines the safest mode of transportation. The task of maintaining a high level of safety for commercial airlines is complicated by the dynamic nature of the NAS. The number of flights by commercial transports is increasing; air traffic control systems and procedures are being modernized to increase the capacity and efficiency of the NAS; increasingly autonomous systems are being developed for aircraft and ground systems, and small aircraft--most notably unmanned aircraft systems--are becoming much more prevalent. As the NAS evolves to accommodate these changes, aviation safety programs will also need to evolve to ensure that changes to the NAS do not inadvertently introduce new risks. Real-time system-wide safety assurance (RSSA) is one of six focus areas for the National Aeronautics and Space Administration (NASA) aeronautics program. NASA envisions that an RSSA system would provide a continuum of information, analysis, and assessment that supports awareness and action to mitigate risks to safety. Maintaining the safety of the NAS as it evolves will require a wide range of safety systems and practices, some of which are already in place and many of which need to be developed. This report identifies challenges to establishing an RSSA system and the high-priority research that should be implemented by NASA and other interested parties in government, industry, and academia to expedite development of such a system"--Publisher's description.

Alcohol-impaired driving is an important health and social issue as it remains a major risk to Americans' health today, surpassing deaths per year of certain cancers, HIV/AIDS, and drownings, among others, and contributing to long-term disabilities from head and spinal injuries. Progress has been made over the past decades towards reducing these trends, but that progress has been incremental and has stagnated more recently. Getting to Zero Alcohol-Impaired Driving Fatalities examines which interventions (programs, systems, and policies) are most promising to prevent injuries and death from alcohol-impaired driving, the barriers to action and approaches to overcome them, and which interventions need to be changed or adopted. This report makes broad-reaching recommendations that will serve as a blueprint for the nation to accelerate the progress in reducing alcohol-impaired driving fatalities.

The National Science Foundation's National Center for Science and Engineering Statistics (NCSES), one of the nation's principal statistical agencies, is charged to collect, acquire, analyze, report, and disseminate statistical data related to the science and engineering enterprise in the United States and other nations that is relevant and useful to practitioners, researchers, policymakers, and to the public. NCSES data, based primarily on several flagship surveys, have become the major evidence base for American science and technology policy, and the agency is well respected globally for these data. This report assesses and provides guidance on NCSES's approach to measuring the science and engineering workforce population in the United States. It also proposes a framework for measuring the science and engineering workforce in the next decade and beyond, with flexibility to examine emerging issues related to this unique population while at the same time allowing for stability in the estimation of key trends

The workplace is where 156 million working adults in the United States spend many waking hours, and it has a profound influence on health and well-being. Although some occupations and work-related activities are more hazardous than others and face higher rates of injuries, illness, disease, and fatalities, workers in all occupations face some form of work-related safety and health concerns. Understanding those risks to prevent injury, illness, or even fatal incidents is an important function of society. Occupational safety and health (OSH) surveillance provides the data and analyses needed to understand the relationships between work and injuries and illnesses in order to improve worker safety and health and prevent work-related injuries and illnesses. Information about the circumstances in which workers are injured or made ill on the job and how these patterns change over time is essential to develop effective prevention programs and target future research. The nation needs a robust OSH surveillance system to provide this critical information for informing policy development, guiding educational and regulatory activities, developing safer technologies, and enabling research and prevention strategies that serves and protects all workers. A Smarter National Surveillance System for Occupational Safety and Health in the 21st Century provides a comprehensive assessment of the state of OSH surveillance. This report is intended to be useful to federal and state agencies that have an interest in occupational safety and health, but may also be of interest broadly to employers, labor unions and other worker advocacy organizations, the workers' compensation insurance industry, as well as state epidemiologists, academic researchers, and the broader public health community. The recommendations address the strengths and weaknesses of the envisioned system relative to the status quo and both short- and long-term actions and strategies needed to bring about a progressive evolution of the current system.