Bøger udgivet af National Academies Press

People's desire to understand the environments in which they live is a natural one. People spend most of their time in spaces and structures designed, built, and managed by humans, and it is estimated that people in developed countries now spend 90 percent of their lives indoors. As people move from homes to workplaces, traveling in cars and on transit systems, microorganisms are continually with and around them. The human-associated microbes that are shed, along with the human behaviors that affect their transport and removal, make significant contributions to the diversity of the indoor microbiome. The characteristics of "healthy" indoor environments cannot yet be defined, nor do microbial, clinical, and building researchers yet understand how to modify features of indoor environments--such as building ventilation systems and the chemistry of building materials--in ways that would have predictable impacts on microbial communities to promote health and prevent disease. The factors that affect the environments within buildings, the ways in which building characteristics influence the composition and function of indoor microbial communities, and the ways in which these microbial communities relate to human health and well-being are extraordinarily complex and can be explored only as a dynamic, interconnected ecosystem by engaging the fields of microbial biology and ecology, chemistry, building science, and human physiology. This report reviews what is known about the intersection of these disciplines, and how new tools may facilitate advances in understanding the ecosystem of built environments, indoor microbiomes, and effects on human health and well-being. It offers a research agenda to generate the information needed so that stakeholders with an interest in understanding the impacts of built environments will be able to make more informed decisions.

"The obligation to treat animals used in research ethically and humanely extends beyond their lives in the laboratory to include their transportation from place to place. Yet transporting animals is a highly regulated and complex process that raises many difficult issues. To examine these issues, the Roundtable on Science and Welfare in Laboratory Animal Use held a workshop on September 3-4, 2014, in Washington, DC. More than 200 people participated in the workshop in person and online, including representatives of academic research institutions, pharmaceutical and consumer product companies, government agencies, research advocacy groups, professional associations, and the public. The workshop was designed to draw attention to the essential thoughtful journey planning behind each transport of laboratory animals"--

"Since 1938 and 1941, nutrient intake recommendations have been issued to the public in Canada and the United States, respectively. Currently defined as the Dietary Reference Intakes (DRIs), these values are a set of standards established by consensus committees under the National Academies of Sciences, Engineering, and Medicine and used for planning and assessing diets of apparently healthy individuals and groups. In 2015, a multidisciplinary working group sponsored by the Canadian and U.S. government DRI steering committees convened to identify key scientific challenges encountered in the use of chronic disease endpoints to establish DRI values. Their report, Options for Basing Dietary Reference Intakes (DRIs) on Chronic Disease: Report from a Joint US-/Canadian-Sponsored Working Group, outlined and proposed ways to address conceptual and methodological challenges related to the work of future DRI Committees. This report assesses the options presented in the previous report and determines guiding principles for including chronic disease endpoints for food substances that will be used by future National Academies committees in establishing DRIs"--Publishers website.

The academic biomedical research community is a hub of employment, economic productivity, and scientific progress. Academic research institutions are drivers of economic development in their local and state economies and, by extension, the national economy. Beyond the economic input that the academic biomedical research community both receives and provides, it generates knowledge that in turn affects society in myriad ways. The United States has experienced and continues to face the threat of disasters, and, like all entities, the academic biomedical research community can be affected. Recent disasters, from hurricanes to cyber-attacks, and their consequences have shown that the investments of the federal government and of the many other entities that sponsor academic research are not uniformly secure. First and foremost, events that damage biomedical laboratories and the institutions that house them can have impacts on the safety and well-being of humans and research animals. Furthermore, disasters can affect career trajectories, scientific progress, and financial stability at the individual and institutional levels. Strengthening the Disaster Resilience of the Academic Biomedical Research Community offers recommendations and guidance to enhance the disaster resilience of the academic biomedical research community, with a special focus on the potential actions researchers, academic research institutions, and research sponsors can take to mitigate the impact of future disasters.

The 21st century has witnessed a complete revolution in the understanding and description of bacteria in eco- systems and microbial assemblages, and how they are regulated by complex interactions among microbes, hosts, and environments. The human organism is no longer considered a monolithic assembly of tissues, but is instead a true ecosystem composed of human cells, bacteria, fungi, algae, and viruses. As such, humans are not unlike other complex ecosystems containing microbial assemblages observed in the marine and earth environments. They all share a basic functional principle: Chemical communication is the universal language that allows such groups to properly function together. These chemical networks regulate interactions like metabolic exchange, antibiosis and symbiosis, and communication. The National Academies of Sciences, Engineering, and Medicine's Chemical Sciences Roundtable organized a series of four seminars in the autumn of 2016 to explore the current advances, opportunities, and challenges toward unveiling this "chemical dark matter" and its role in the regulation and function of different ecosystems. The first three focused on specific ecosystems--earth, marine, and human--and the last on all microbiome systems. This publication summarizes the presentations and discussions from the seminars.

"A consensus study report of the National Academies of Sciences, Engineering, Medicine."

"Appendixes B-F are not printed in this publication. They are available online at https://www.nap.edu/catalog/24758" --page 16

Those involved in the drug development process face challenges of efficiency and overall sustainability due in part to high research costs, lengthy development timelines, and late-stage drug failures. Novel clinical trial designs that enroll participants based on their genetics represent a potentially disruptive change that could improve patient outcomes, reduce costs associated with drug development, and further realize the goals of precision medicine. On March 8, 2017, the Forum on Drug Discovery, Development, and Translation and the Roundtable on Genomics and Precision Health of the National Academies of Sciences, Engineering, and Medicine hosted the workshop Enabling Precision Medicine: The Role of Genetics in Clinical Drug Development. Participants examined successes, challenges, and possible best practices for effectively using genetic information in the design and implementation of clinical trials to support the development of precision medicines, including exploring the potential advantages and disadvantages of such trials across a variety of disease areas. This publication summarizes the presentations and discussions from the workshop.

Drug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. The ongoing opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the rising toll of the harms that can arise from the use of opioid medications. Chronic pain and opioid use disorder both represent complex human conditions affecting millions of Americans and causing untold disability and loss of function. In the context of the growing opioid problem, the U.S. Food and Drug Administration (FDA) launched an Opioids Action Plan in early 2016. As part of this plan, the FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to update the state of the science on pain research, care, and education and to identify actions the FDA and others can take to respond to the opioid epidemic, with a particular focus on informing FDA's development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring.

In 2015, the National Academies of Sciences, Engineering, and Medicine convened two workshops with oversight from the Committee on the Science of Changing Behavioral Health Social Norms. The workshops provided input to the committee's deliberations and contributed to the development of the report Ending Discrimination against People with Mental and Substance Use Disorders. That report was issued to help the Substance Abuse and Mental Health Services Administration and the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, utilize the scientific evidence base in improving public attitudes toward and understanding of behavioral health, specifically in the areas of mental health and substance use disorders. This publication summarizes the presentations and discussions at the two workshops.

In September 2015, the Sustainable Development Goals (SDGs) were adopted at the United Nations Development Summit to serve as a 15-year plan of action for all countries and people. The SDGs include 17 specific goals, and 169 associated targets that set out quantitative objectives across the social, economic, and environmental dimensions of sustainable development, all to be achieved by 2030. Health has been recognized as crucial for sustainable human development and an essential contributor to the economic growth of society. Beyond the goal to "ensure healthy lives and promoting well-being for all at all ages," many of the other SDGs include targets that are essential to address the environmental and social determinants of health. Considering this context, the Forum on Public-Private Partnerships for Global Health and Safety convened a workshop series to examine potential opportunities to engage the private sector and develop partnerships to advance health and the SDGs. This publication summarizes the presentations and discussions from the workshop series.

Introduction -- Overview, evaluations, and criticisms of the safety measurement system -- Applications of item response theory models in other contexts and public release and transparency -- Applying item response theory models to highway safety -- Extensions of and implementation of the item response theory model to the safety measurement system -- Data availability and quality.

Building on previous National Academies of Sciences, Engineering, and Medicine workshops that explored how safe and healthy communities are a necessary component of health equity and efforts to improve population health, the Roundtable on Population Health Improvement wanted to explore how a variety of community-based organizations came together to achieve population health. To do so, the roundtable hosted a workshop in Oakland, California, on December 8, 2016, to explore multisector health partnerships that engage residents, reduce health disparities, and improve health and well-being. This publication summarizes the presentations and discussions from the workshop.

"Societies around the world are concerned about dementia and the other forms of cognitive impairment that affect many older adults. We now know that brain changes typically begin years before people show symptoms, which suggests a window of opportunity to prevent or delay the onset of these conditions. Emerging evidence that the prevalence of dementia is declining in high-income countries offers hope that public health interventions will be effective in preventing or delaying cognitive impairments. Until recently, the research and clinical communities have focused primarily on understanding and treating these conditions after they have developed. Thus, the evidence base on how to prevent or delay these conditions has been limited at best, despite the many claims of success made in popular media and advertising. Today, however, a growing body of prevention research is emerging. Preventing Cognitive Decline and Dementia: A Way Forward assesses the current state of knowledge on interventions to prevent cognitive decline and dementia, and informs future research in this area. This report provides recommendations of appropriate content for inclusion in public health messages from the National Institute on Aging"--

Environmental research has driven landmark improvements that led to the protection of human and ecosystem health. Recognizing the value of knowledge generated by environmental research and the ingenuity within academic and nonprofit institutions, the US Environmental Protection Agency (EPA) created a program known as Science to Achieve Results, or STAR, in 1995. STAR is EPA's primary competitive extramural grants program. A Review of the Environmental Protection Agency's Science to Achieve Results Research Program assesses the program's scientific merit, public benefits, and overall contributions in the context of other relevant research and recommends ways to enhance those aspects of the program. This report also considers the conclusions and recommendations of a prior National Research Council review of the STAR program (2003), the STAR program's research priorities in light of the nation's environmental challenges, and the effects of recent STAR funding trends on obtaining scientific information needed to protect public health and the environment.

"Building communication capacity is a critical piece of preparing for, detecting, and responding to infectious disease threats. The International Health Regulations (IHR) establish risk communication--the real-time exchange of information, advice, and opinions between experts or officials and people who face a threat to their survival, health, and economic or social well-being--as a core capacity that World Health Organization member states must fulfill to strengthen the fight against these threats. Despite global recognition of the importance of complying with IHR, 67 percent of signatory countries report themselves as not compliant. By investing in communication capacity, public health and government officials and civil society organizations facing health crises would be prepared to provide advice, information, and reassurance to the public as well as to rapidly develop messages and community engagement activities that are coordinated and take into account social and behavioral dynamics among all sectors. To learn about current national and international efforts to develop the capacity to communicate effectively during times of infectious disease outbreaks, and to explore gaps in the research agenda that may help address communication needs to advance the field, the Forum on Microbial Threats of the National Academies of Sciences, Engineering, and Medicine convened a 1.5 day workshop on December 13 and 14, 2016, in Washington, DC. Participants reviewed progress and needs in strengthening communication capacity for dealing with infectious disease threats for both outbreaks and routine challenges in the United States and abroad. This publication summarizes the presentations and discussions from the workshop"--

"Brucellosis is a nationally and internationally regulated disease of livestock with significant consequences for animal health, public health, and international trade. In cattle, the primary cause of brucellosis is Brucella abortus, a zoonotic bacterial pathogen that also affects wildlife, including bison and elk. As a result of the Brucellosis Eradication Program that began in 1934, most of the country is now free of bovine brucellosis. The Greater Yellowstone Area (GYA), where brucellosis is endemic in bison and elk, is the last known B. abortus reservoir in the United States. The GYA is home to more than 5,500 bison that are the genetic descendants of the original free-ranging bison herds that survived in the early 1900s, and home to more than 125,000 elk whose habitats are managed through interagency efforts, including the National Elk Refuge and 22 supplemental winter feedgrounds maintained in Wyoming." --

After decades of increases in the obesity rate among U.S. adults and children, the rate recently has dropped among some populations, particularly young children. What are the factors responsible for these changes? How can promising trends be accelerated? What else needs to be known to end the epidemic of obesity in the United States? To examine these and other pressing questions, the Roundtable on Obesity Solutions, of the National Academies of Sciences, Engineering, and Medicine, held a workshop in September 2016. The workshop brought together leaders from business, early care and education, government, health care, and philanthropy to discuss the most promising approaches for the future of obesity prevention and treatment. This publication summarizes the presentations and discussions from the workshop.

"A consensus study report of The National Academies of Sciences, Engineering, Medicine."

"While much progress has been made on achieving the Millennium Development Goals over the last decade, the number and complexity of global health challenges has persisted. Growing forces for globalization have increased the interconnectedness of the world and our interdependency on other countries, economies, and cultures. Monumental growth in international travel and trade have brought improved access to goods and services for many, but also carry ongoing and ever-present threats of zoonotic spillover and infectious disease outbreaks that threaten all. Global Health and the Future Role of the United States identifies global health priorities in light of current and emerging world threats. This report assesses the current global health landscape and how challenges, actions, and players have evolved over the last decade across a wide range of issues, and provides recommendations on how to increase responsiveness, coordination, and efficiency - both within the U.S. government and across the global health field."--

"In the coming years, complex domestic and international environments and challenges to national security will continue. Intelligence analysts and the intelligence community will need access to the appropriate tools and developing knowledge about threats to national security in order to provide the best information to policy makers. Research and knowledge from the social and behavioral sciences (SBS) can help inform the work of intelligence analysis; however, in the past, bringing important findings from research to bear on the day-to-day work of intelligence analysis has been difficult. In order to understand how knowledge from science can be directed and applied to help the intelligence community fulfill its critical responsibilities, the National Academies of Sciences, Engineering, and Medicine will undertake a 2-year survey of the social and behavioral sciences. To launch this discussion, a summit designed to highlight cutting-edge research and identify future directions for research in a few areas of the social and behavioral sciences was held in October 2016. This publication summarizes the presentations and discussions from the summit"--Publisher's description.

"A report of the National Academies of Sciences, Engineering, Medicine."

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

"A report of the National Academies of Sciences, Engineering, Medicine."

"A consensus study report of The National Academies of Sciences, Engineering, Medicine."

"The 2014-2015 Ebola epidemic in western Africa was the longest and most deadly Ebola epidemic in history, resulting in 28,616 cases and 11,310 deaths in Guinea, Liberia, and Sierra Leone. The Ebola virus has been known since 1976, when two separate outbreaks were identified in the Democratic Republic of Congo (then Zaire) and South Sudan (then Sudan). However, because all Ebola outbreaks prior to that in West Africa in 2014-2015 were relatively isolated and of short duration, little was known about how to best manage patients to improve survival, and there were no approved therapeutics or vaccines. When the World Heath Organization declared the 2014-2015 epidemic a public health emergency of international concern in August 2014, several teams began conducting formal clinical trials in the Ebola affected countries during the outbreak. Integrating Clinical Research into Epidemic Response: The Ebola Experience assesses the value of the clinical trials held during the 2014-2015 epidemic and makes recommendations about how the conduct of trials could be improved in the context of a future international emerging or re-emerging infectious disease events"--

"The Department of Energy's Office of Environmental Management (DOE) is responsible for the safe cleanup of sites used for nuclear weapons development and government-sponsored nuclear energy research. Low-level radioactive waste (LLW) is the most volumetrically significant waste stream generated by the DOE cleanup program. LLW is also generated through commercial activities such as nuclear power plant operations and medical treatments. The laws and regulations related to the disposal of LLW in the United States have evolved over time and across agencies and states, resulting in a complex regulatory structure. DOE asked the National Academies of Sciences, Engineering, and Medicine to organize a workshop to discuss approaches for the management and disposition of LLW. Participants explored the key physical, chemical, and radiological characteristics of low-level waste that govern its safe and secure management and disposal in aggregate and in individual waste streams, and how key characteristics of low level waste are incorporated into standards, orders, and regulations that govern the management and disposal of LLW in the United States and in other major waste-producing countries. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

"The U.S. Environmental Protection Agency (EPA) has a mission and regulatory responsibility to protect human health and the environment. EPA's pursuit of that goal includes a variety of research activities involving human subjects, such as epidemiologic studies and surveys. Those research activities also involve studies of individuals who volunteer to be exposed to air pollutants intentionally in controlled laboratory settings so that measurements can be made of transient and reversible biomarker or physiologic responses to those exposures that can indicate pathways of toxicity and mechanisms of air-pollution responses. The results of those controlled human inhalation exposure (CHIE) studies, also referred to as human clinical studies or human challenge studies, are used to inform policy decisions and help establish or revise standards to protect public health and improve air quality. Controlled Human Inhalation-Exposure Studies at EPA addresses scientific issues and provides guidance on the conduct of CHIE studies. This report assesses the utility of CHIE studies to inform and reduce uncertainties in setting air-pollution standards to protect public health and assess whether continuation of such studies is warranted. It also evaluates the potential health risks to test subjects who participated in recent studies of air pollutants at EPA's clinical research facility"--

Biodiversity--the genetic variety of life--is an exuberant product of the evolutionary past, a vast human-supportive resource (aesthetic, intellectual, and material) of the present, and a rich legacy to cherish and preserve for the future. Two urgent challenges, and opportunities, for 21st-century science are to gain deeper insights into the evolutionary processes that foster biotic diversity, and to translate that understanding into workable solutions for the regional and global crises that biodiversity currently faces. A grasp of evolutionary principles and processes is important in other societal arenas as well, such as education, medicine, sociology, and other applied fields including agriculture, pharmacology, and biotechnology. The ramifications of evolutionary thought also extend into learned realms traditionally reserved for philosophy and religion. The central goal of the In the Light of Evolution (ILE) series is to promote the evolutionary sciences through state-of-the-art colloquia--in the series of Arthur M. Sackler colloquia sponsored by the National Academy of Sciences--and their published proceedings. Each installment explores evolutionary perspectives on a particular biological topic that is scientifically intriguing but also has special relevance to contemporary societal issues or challenges. This tenth and final edition of the In the Light of Evolution series focuses on recent developments in phylogeographic research and their relevance to past accomplishments and future research directions.