Bøger udgivet af National Academies Press

An adequate, well-trained, and diverse health care workforce is essential for providing access to quality health care services. However, despite more than a decade of concerted global action to address the health workforce crisis, collective efforts are falling short in scaling up the supply of health workers. The resulting health workforce shortage affects people's access to quality health care around the globe. In October 2016, the National Academies of Sciences, Engineering, and Medicine convened a workshop to explore resources for financing health professional education in high-, middle-, and low-income countries and innovative methods for financially supporting investments in health professional education within and across professions. Participants examined opportunities for matching population health needs with the right number, mix, distribution, and skill set of health workers while considering how supply and demand drive decisions within education and health. This publication summarizes the presentations and discussions from the workshop.

The sea ice surrounding Antarctica has increased in extent and concentration from the late 1970s, when satellite-based measurements began, until 2015. Although this increasing trend is modest, it is surprising given the overall warming of the global climate and the region. Indeed, climate models, which incorporate our best understanding of the processes affecting the region, generally simulate a decrease in sea ice. Moreover, sea ice in the Arctic has exhibited pronounced declines over the same period, consistent with global climate model simulations. For these reasons, the behavior of Antarctic sea ice has presented a conundrum for global climate change science. The National Academies of Sciences, Engineering, and Medicine held a workshop in January 2016, to bring together scientists with different sets of expertise and perspectives to further explore potential mechanisms driving the evolution of recent Antarctic sea ice variability and to discuss ways to advance understanding of Antarctic sea ice and its relationship to the broader ocean-climate system. This publication summarizes the presentations and discussions from the workshop.

"Hepatitis B and C cause most cases of hepatitis in the United States and the world. The two diseases account for about a million deaths a year and 78 percent of world's hepatocellular carcinoma and more than half of all fatal cirrhosis. In 2013 viral hepatitis, of which hepatitis B virus (HBV) and hepatitis C virus (HCV) are the most common types, surpassed HIV and AIDS to become the seventh leading cause of death worldwide. The world now has the tools to prevent hepatitis B and cure hepatitis C. Perfect vaccination could eradicate HBV, but it would take two generations at least. In the meantime, there is no cure for the millions of people already infected. Conversely, there is no vaccine for HCV, but new direct-acting antivirals can cure 95 percent of chronic infections, though these drugs are unlikely to reach all chronically-infected people anytime soon. This report, the second of two, builds off the conclusions of the first report and outlines a strategy for hepatitis reduction over time and specific actions to achieve them"--

"Based on the National Research Council Report Developing Assessments for the Next Generation Science Standards Board on Science Education Board on Testing and Assessment Division of Behavioral and Social Sciences and Education."

"The National Academies of Sciences, Engineering and Medicine Workshop on Approaches to the Development of Character, July 26 and 27, 2016, National Academy of Sciences Building, Lecture Room, 2101 Constitution Avenue, NW, Washington, DC"--Page 85.

"Advances in genetics and genomics are transforming medical practice, resulting in a dramatic growth of genetic testing in the health care system. The rapid development of new technologies, however, has also brought challenges, including the need for rigorous evaluation of the validity and utility of genetic tests, questions regarding the best ways to incorporate them into medical practice, and how to weigh their cost against potential short- and long-term benefits. As the availability of genetic tests increases so do concerns about the achievement of meaningful improvements in clinical outcomes, costs of testing, and the potential for accentuating medical care inequality. Given the rapid pace in the development of genetic tests and new testing technologies, An Evidence framework for genetic testing seeks to advance the development of an adequate evidence base for genetic tests to improve patient care and treatment. Additionally, this report recommends a framework for decision-making regarding the use of genetic tests in clinical care"--

"Communities provide the context in which programs, principles, and policies are implemented. Their needs dictate the kinds of programs that community organizers and advocates, program developers and implementers, and researchers will bring to bear on a problem. Their characteristics help determine whether a program will succeed or fail. The detailed workings of programs cannot be separated from the communities in which they are embedded. Communities also represent the front line in addressing many behavioral health conditions experienced by children, adolescents, young adults, and their families. Given the importance of communities in shaping the health and well being of young people, the National Academies of Sciences, Engineering, and Medicine held a workshop in June 2016, to examine the implementation of evidence- based prevention by communities. Participants examined questions related to scaling up, managing, and sustaining science in communities. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

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

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

Since the passage of the Patient Protection and Affordable Care Act (ACA), health care reform has created major changes in the U.S. health care system. The ACA has brought millions of people into the system who had no previous access, and many of these newly enrolled individuals have had limited experience navigating the complex and complicated U.S. health system. In July 2016 the National Academies of Sciences, Engineering, and Medicine convened a public workshop to examine health insurance through the lens of health literacy, focusing on literacy related barriers to information and coverage as well as on possible solutions. Participants discussed the role of health literacy in accessing health care and remaining in treatment; delivery and financing system reforms that affect organizational health literacy; and quality and equity considerations. This publication summarizes the presentations and discussions from the workshop.

"Between 1973 and 2016, the ways to manipulate DNA to endow new characteristics in an organism (that is, biotechnology) have advanced, enabling the development of products that were not previously possible. What will the likely future products of biotechnology be over the next 5-10 years? What scientific capabilities, tools, and/or expertise may be needed by the regulatory agencies to ensure they make efficient and sound evaluations of the likely future products of biotechnology? Preparing for Future Products of Biotechnology analyzes the future landscape of biotechnology products and seeks to inform forthcoming policy making. This report identifies potential new risks and frameworks for risk assessment and areas in which the risks or lack of risks relating to the products of biotechnology are well understood"--Publisher's description.

"Effectively educating children who are learning English as their second language is a national challenge with consequences both for individuals and for American society. Despite their potential, many young English learners are struggling to meet the requirements for academic success, a difficulty that jeopardizes their prospects for success in post-secondary education and in the workforce. A committee of the National Academies of Sciences, Engineering, and Medicine examined how evidence relevant to the development of English learners can inform policies and practices that can result in better educational outcomes for these young people. The committee's report, Promoting the Educational Success of Children and Youth Learning English: Promising Futures examines what research evidence reveals about learning English from early childhood through high school, identifies effective practices for educators to use, and recommends steps policy makers can take to support high-quality educational outcomes for children and youth who are learning English"--Provided by publisher.

"Countering violent extremism consists of various prevention and intervention approaches to increase the resilience of communities and individuals to radicalization toward violent extremism, to provide nonviolent avenues for expressing grievances, and to educate communities about the threat of recruitment and radicalization to violence. To explore the application of health approaches in community-level strategies to countering violent extremism and radicalization, the National Academies of Sciences, Engineering, and Medicine held a public workshop in September 2016. Participants explored the evolving threat of violent extremism and radicalization within communities across America, traditional versus health-centered approaches to countering violent extremism and radicalization, and opportunities for cross-sector and interdisciplinary collaboration and learning among domestic and international stakeholders and organizations. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

Military operations produce a great deal of trash in an environment where standard waste management practices may be subordinated to more pressing concerns. As a result, ground forces have long relied on incineration in open-air pits as a means of getting rid of refuse. Concerns over possible adverse effects of exposure to smoke from trash burning in the theater were first expressed in the wake of the 1990-1991 Gulf War and stimulated a series of studies that indicated that exposures to smoke from oil-well fires and from other combustion sources, including waste burning, were stressors for troops. In January 2013, Congress directed the Department of Veterans Affairs (VA) to establish and maintain a registry for service members who may have been exposed to toxic airborne chemicals and fumes generated by open burn pits. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry analyzes the initial months of data collected by the registry and offers recommendations on ways to improve the instrument and best use the information it collects. This report assesses the effectiveness of the VA's information gathering efforts and provides recommendations for addressing the future medical needs of the affected groups, and provides recommendations on collecting, maintaining, and monitoring information collected by the VA's Airborne Hazards and Open Burn Pit Registry.

At the request of the Advisory Committee for Geosciences of the National Science Foundation (NSF), a review of the Geospace Section of the NSF Division of Atmospheric and Geospace Sciences was undertaken in 2015. The Portfolio Review Committee was charged with reviewing the portfolio of facilities, research programs, and activities funded by Geospace Section and to recommend critical capabilities and the balance of investments needed to enable the science program articulated in the 2013 NRC decadal survey Solar and Space Physics: A Science for a Technological Society. The Portfolio Review Committee's report Investments in Critical Capabilities for Geospace Science 2016 to 2025 (ICCGS) was accepted by the Advisory Committee for Geosciences in April 2016. Assessment of the National Science Foundation's 2015 Geospace Portfolio Review provides an independent assessment of the ICCGS report. This publication assesses how well the ICCGS provides a clear set of findings, conclusions, and recommendations for Geospace Section that align with the science priorities of the NRC decadal survey, and adequately take into account issues such as the current budget outlook and the science needs of the community. Additionally, this study makes recommendations focused on options and considerations for NSF's implementation of the ICCGS recommendations.

Federal guidance on nutrition and diet is intended to reflect the state of the science and deliver the most reliable recommendations possible according to the best available evidence. This guidance, updated and presented every 5 years in the Dietary Guidelines for Americans (DGA), serves as the basis for all federal nutrition policies and nutrition assistance programs, as well as nutrition education programs. Despite the use of the guidelines over the past 30 years, recent challenges prompted Congress to question the process by which food and nutrition guidance is developed. This report assesses the process used to develop the guidelines; it does not evaluate the substance or use of the guidelines. As part of an overall, comprehensive review of the process to update the DGA, this first report seeks to discover how the advisory committee selection process can be improved to provide more transparency, eliminate bias, and include committee members with a range of viewpoints for the purpose of informing the 2020 cycle.

The United States has long recognized that the nation's prosperity and security depend on how we address challenges of disasters, poverty, famine, and disease around the world. The U.S. Agency for International Development (USAID) has played a vital role in promoting U.S. national and international interests by advancing strategies for employing science, technology, and innovation to respond to global challenges. The focus by USAID on science, technology, and innovation is critical to improve development outcomes. At the core of this progress is the engagement of science institutions and other innovative enterprises and their commitment to work in partnership with USAID to research, test, and scale solutions. The Role of Science, Technology, Innovation, and Partnerships in the Future of USAID provides an assessment and advice on the current and future role for science, technology, and innovation in assistance programs at USAID and on the role of partnerships in the public and private sectors to expand impact. This report examines challenges and opportunities for USAID in expanding the utilization of science, technology, and innovation in development assistance; assesses how USAID has deployed science, technology, and innovation; and recommends priority areas for improvement going forward in partnership with others.

This volume presents papers on the topics covered at the National Academy of Engineering's 2016 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 2016 symposium was held September 19-21 at the Arnold and Mabel Beckman Center in Irvine, California. 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.

"On June 16, 2016, the Roundtable on Population Health Improvement held a workshop at the Lutheran Church of the Good Shepherd in Brooklyn, New York, to explore the influence of trauma and violence on communities. The workshop highlighted examples of community-based organizations using trauma-informed approaches to treat violence and build safe and healthy communities. Presentations showcased examples that can serve as models in different sectors and communities and shared lessons learned. This publication summarizes the presentation and discussion of the event"--Publisher's description.

Federal government statistics provide critical information to the country and serve a key role in a democracy. For decades, sample surveys with instruments carefully designed for particular data needs have been one of the primary methods for collecting data for federal statistics. However, the costs of conducting such surveys have been increasing while response rates have been declining, and many surveys are not able to fulfill growing demands for more timely information and for more detailed information at state and local levels. Innovations in Federal Statistics examines the opportunities and risks of using government administrative and private sector data sources to foster a paradigm shift in federal statistical programs that would combine diverse data sources in a secure manner to enhance federal statistics. This first publication of a two-part series discusses the challenges faced by the federal statistical system and the foundational elements needed for a new paradigm.

The social cost of carbon (SC-CO2) is an economic metric intended to provide a comprehensive estimate of the net damages - that is, the monetized value of the net impacts, both negative and positive - from the global climate change that results from a small (1-metric ton) increase in carbon-dioxide (CO2) emissions. Under Executive Orders regarding regulatory impact analysis and as required by a court ruling, the U.S. government has since 2008 used estimates of the SC-CO2 in federal rulemakings to value the costs and benefits associated with changes in CO2 emissions. In 2010, the Interagency Working Group on the Social Cost of Greenhouse Gases (IWG) developed a methodology for estimating the SC-CO2 across a range of assumptions about future socioeconomic and physical earth systems. Valuing Climate Changes examines potential approaches, along with their relative merits and challenges, for a comprehensive update to the current methodology. This publication also recommends near- and longer-term research priorities to ensure that the SC- CO2 estimates reflect the best available science.

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

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) began 40 years ago as a pilot program and has since grown to serve over 8 million pregnant women, and mothers of and their infants and young children. Today the program serves more than a quarter of the pregnant women and half of the infants in the United States, at an annual cost of about $6.2 billion. Through its contribution to the nutritional needs of pregnant, breastfeeding, and post-partum women; infants; and children under 5 years of age; this federally supported nutrition assistance program is integral to meeting national nutrition policy goals for a significant portion of the U.S. population. To assure the continued success of the WIC, Congress mandated that the Food and Nutrition Service of the U.S. Department of Agriculture (USDA) reevaluate the program's food packages every 10 years. In 2014, the USDA asked the Institute of Medicine to undertake this reevaluation to ensure continued alignment with the goals of the Dietary Guidelines for Americans. In this third report, the committee provides its final analyses, recommendations, and the supporting rationale.

Over the last decade, several large-scale United States and international programs have been initiated to incorporate advances in molecular and cellular biology, -omics technologies, analytical methods, bioinformatics, and computational tools and methods into the field of toxicology. Similar efforts are being pursued in the field of exposure science with the goals of obtaining more accurate and complete exposure data on individuals and populations for thousands of chemicals over the lifespan; predicting exposures from use data and chemical-property information; and translating exposures between test systems and humans. Using 21st Century Science to Improve Risk-Related Evaluations makes recommendations for integrating new scientific approaches into risk-based evaluations. This study considers the scientific advances that have occurred following the publication of the NRC reports Toxicity Testing in the 21st Century: A Vision and a Strategy and Exposure Science in the 21st Century: A Vision and a Strategy. Given the various ongoing lines of investigation and new data streams that have emerged, this publication proposes how best to integrate and use the emerging results in evaluating chemical risk. Using 21st Century Science to Improve Risk-Related Evaluations considers whether a new paradigm is needed for data validation, how to integrate the divergent data streams, how uncertainty might need to be characterized, and how best to communicate the new approaches so that they are understandable to various stakeholders.

Produced water--water from underground formations that is brought to the surface during oil and gas production--is the greatest volume byproduct associated with oil and gas production. It is managed by some combination of underground injection, treatment and subsequent use, treatment and discharge, or evaporation, subject to compliance with state and federal regulations. Management of these waters is challenging not only for industry and regulators, but also for landowners and the public because of differences in the quality and quantity of produced water, varying infrastructure needs, costs, and environmental considerations associated with produced water disposal, storage, and transport. Unconventional oil and gas development involves technologies that combine horizontal drilling with the practice of hydraulic fracturing. Hydraulic fracturing is a controlled, high-pressure injection of fluid and proppant into a well to generate fractures in the rock formation containing the oil or gas. After the hydraulic fracture procedure is completed, the injected fluid is allowed to flow back into the well, leaving the proppant in the newly created fractures. As a result, a portion of the injected water returns to the surface and this water is called "flowback water" which initially may mix with the naturally occurring produced water from the formation. The chemistry and volume of water returning to the surface from unconventional oil and gas operations thus changes during the lifetime of the well due to the amount of fluid used in the initial stage of well development, the amount of water naturally occurring in the geologic formation, the original water and rock chemistry, the type of hydrocarbon being produced, and the way in which production is conducted. The volume and composition of flowback and produced waters vary with geography, time, and site-specific factors. A workshop was conducted by the National Academies of Sciences, Engineering, and Medicine to highlight the challenges and opportunities associated in managing produced water from unconventional hydrocarbon development, and particularly in the area of potential beneficial uses for these waters. This publication summarizes the presentations and discussions from the workshop.

"Workshop on Improving Collection of Indicators of Criminal Justice System Involvement in Population Health Data Programs, March 29-30, 2016 ... Washington, DC"--Page 75.

The term "service-learning" generally refers to projects planned as components of academic coursework in which students use knowledge and skills taught in the course to address real needs in their communities. This kind of learning experience, which allows students to focus on critical, reflective thinking and civic responsibility, has become an increasingly popular component of undergraduate science education. In April 2016, the National Academies of Sciences, Engineering, and Medicine planned a workshop to explore the current and potential role of service-learning in undergraduate geosciences education. Participants explored how service learning is being used in geoscience education, its potential benefits, and the strength of the evidence base regarding the nature and benefits of these experiences. This publication summarizes the presentations and discussions from the workshop.

Cardiac arrest often strikes seemingly healthy individuals without warning and without regard to age, gender, race, or health status. Representing the third leading cause of death in the United States, cardiac arrest is defined as "a severe malfunction or cessation of the electrical and mechanical activity of the heart ... [which] results in almost instantaneous loss of consciousness and collapse". Although the exact number of cardiac arrests is unknown, conservative estimates suggest that approximately 600,000 individuals experience a cardiac arrest in the United States each year. In June 2015, the Institute of Medicine (IOM) released its consensus report Strategies to Improve Cardiac Arrest Survival: A Time to Act, which evaluated the factors affecting resuscitation research and outcomes in the United States. Following the release of this report, the National Academies of Sciences, Engineering, and Medicine was asked to hold a workshop to explore the barriers and opportunities for advancing the IOM recommendations. This publication summarizes the presentations and discussions from the workshop.

"The Small Business Innovation Research (SBIR) program is one of the largest examples of U.S. public-private partnerships, and was established in 1982 to encourage small businesses to develop new processes and products and to provide quality research in support of the U.S. government's many missions. The Small Business Technology Transfer (STTR) Program was created in 1992 by the Small Business Research and Development Enhancement Act to expand joint venture opportunities for small businesses and nonprofit research institutions by requiring small business recipients to collaborate formally with a research institution. The U.S. Congress tasked the National Research Council with undertaking a comprehensive study of how the SBIR and STTR programs have stimulated technological innovation and used small businesses to meet federal research and development needs, and with recommending further improvements to the programs. In the first round of this study, an ad hoc committee prepared a series of reports from 2004 to 2009 on the SBIR and STTR programs at the five agencies responsible for 96 percent of the programs' operations -- including the Department of Energy (DoE). Building on the outcomes from the first round, this second round presents the committee's second review of the DoE SBIR program's operations. Public-private partnerships like SBIR and STTR are particularly important since today's knowledge economy is driven in large part by the nation's capacity to innovate. One of the defining features of the U.S. economy is a high level of entrepreneurial activity. Entrepreneurs in the United States see opportunities and are willing and able to assume risk to bring new welfare-enhancing, wealth-generating technologies to the market. Yet, although discoveries in areas such as genomics, bioinformatics, and nanotechnology present new opportunities, converting these discoveries into innovations for the market involves substantial challenges. The American capacity for innovation can be strengthened by addressing the challenges faced by entrepreneurs"--Publisher's description.