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The Everglades ecosystem is vast, stretching more than 200 miles from Orlando to Florida Bay, and Everglades National Park is but a part located at the southern end. During the 19th and 20th centuries, the historical Everglades has been reduced to half of its original size, and what remains is not the pristine ecosystem many image it to be, but one that has been highly engineered and otherwise heavily influenced, and is intensely managed by humans. Rather than slowly flowing southward in a broad river of grass, water moves through a maze of canals, levees, pump stations, and hydraulic control structures, and a substantial fraction is diverted from the natural system to meet water supply and flood control needs. The water that remains is polluted by phosphorus and other contaminants originating from agriculture and other human activities. Many components of the natural system are highly degraded and continue to degrade. Progress Toward Restoring the Everglades is the sixth biennial review of progress made in meeting the goals of the Comprehensive Everglades Restoration Plan (CERP). This complex, multibillion-dollar project to protect and restore the remaining Everglades has a 30-40 year timeline. This report assesses progress made in the various separate project components and discusses specific scientific and engineering issues that may impact further progress. According to Progress Toward Restoring the Everglades, a dedicated source of funding could provide ongoing long-term system-wide monitoring and assessment that is critical to meeting restoration objectives. This report examines the implications of knowledge gained and changes in widely accepted scientific understanding regarding pre-drainage hydrology, climate change, and the feasibility of water storage since the CERP was developed.

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

"With the amount of data in the world exploding, big data could generate significant value in the field of infectious disease. The increased use of social media provides an opportunity to improve public health surveillance systems and to develop predictive models. Advances in machine learning and crowdsourcing may also offer the possibility to gather information about disease dynamics, such as contact patterns and the impact of the social environment. New, rapid, point-of-care diagnostics may make it possible to capture not only diagnostic information but also other potentially epidemiologically relevant information in real time. With a wide range of data available for analysis, decision-making and policy-making processes could be improved. While there are many opportunities for big data to be used for infectious disease research, operations, and policy, many challenges remain before it is possible to capture the full potential of big data. In order to explore some of the opportunities and issues associated with the scientific, policy, and operational aspects of big data in relation to microbial threats and public health, the National Academies of Sciences, Engineering, and Medicine convened a workshop in May 2016. Participants discussed a range of topics including preventing, detecting, and responding to infectious disease threats using big data and related analytics; varieties of data (including demographic, geospatial, behavioral, syndromic, and laboratory) and their broader applications; means to improve their collection, processing, utility, and validation; and approaches that can be learned from other sectors to inform big data strategies for infectious disease research, operations, and policy. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

"As the demographics of the United States shift toward a population that is made up of an increasing percentage of older adults and people with disabilities, the workforce that supports and enables these individuals is also shifting to meet the demands of this population. For many older adults and people with disabilities, their priorities include maximizing their independence, living in their own homes, and participating in their communities. In order to meet this population's demands, the workforce is adapting by modifying its training, by determining how to coordinate among the range of different professionals who might play a role in supporting any one older adult or individual with disabilities, and by identifying the ways in which technology might be helpful. To better understand how the increasing demand for supports and services will affect the nation's workforce, the National Academies of Sciences, Engineering, and Medicine convened a public workshop in June 2016, in Washington, DC. Participants aimed to identify how the health care workforce can be strengthened to support both community living and community participation for adults with disabilities and older adults. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

Over the past 20 years, public concerns have grown in response to the apparent rising prevalence of food allergy and related atopic conditions, such as eczema. Although evidence on the true prevalence of food allergy is complicated by insufficient or inconsistent data and studies with variable methodologies, many health care experts who care for patients agree that a real increase in food allergy has occurred and that it is unlikely to be due simply to an increase in awareness and better tools for diagnosis. Many stakeholders are concerned about these increases, including the general public, policy makers, regulatory agencies, the food industry, scientists, clinicians, and especially families of children and young people suffering from food allergy. At the present time, however, despite a mounting body of data on the prevalence, health consequences, and associated costs of food allergy, this chronic disease has not garnered the level of societal attention that it warrants. Moreover, for patients and families at risk, recommendations and guidelines have not been clear about preventing exposure or the onset of reactions or for managing this disease. Finding a Path to Safety in Food Allergy examines critical issues related to food allergy, including the prevalence and severity of food allergy and its impact on affected individuals, families, and communities; and current understanding of food allergy as a disease, and in diagnostics, treatments, prevention, and public policy. This report seeks to: clarify the nature of the disease, its causes, and its current management; highlight gaps in knowledge; encourage the implementation of management tools at many levels and among many stakeholders; and delineate a roadmap to safety for those who have, or are at risk of developing, food allergy, as well as for others in society who are responsible for public health.

"The public health burden from lung cancer is substantial: it is the second most commonly diagnosed cancer and the leading cause of cancer-related deaths in the United States. Given the individual and population health burden of lung cancer, especially when it is diagnosed at later stages, there has been a push to develop and implement screening strategies for early detection. However, many factors need to be considered for broad implementation of lung cancer screening in clinical practice. Effective implementation will entail understanding the balance of potential benefits and harms of lung cancer screening, defining and reaching eligible populations, addressing health disparities, and many more considerations. In recognition of the substantial challenges to developing effective lung cancer screening programs in clinical practice, the National Academies of Sciences, Engineering, and Medicine held a workshop in June 2016. At the workshop, experts described the current evidence base for lung cancer screening, the current challenges of implementation, and opportunities to overcome them. Workshop participants also explored capacity and access issues; best practices for screening programs; assessment of patient outcomes, quality, and value in lung cancer screening; and research needs that could improve implementation efforts. This publication summarizes the presentations and discussions from the workshop"--

"Multimodal therapy approaches that combine interventions aimed at different aspects of disease are emerging as potential--and perhaps essential--ways to enhance clinical outcomes for patients with psychiatric and neurological disorders. In order to examine the general principles underlying multimodal therapies and to explore challenges, potential barriers, and opportunities for their development, the National Academies of Sciences, Engineering, and Medicine convened a workshop in June 2016. Participants explored scientific, clinical, regulatory, and reimbursement issues related to multimodal approaches and potential opportunities to enhance clinical outcomes for individuals with nervous system disorders. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

The medical research landscape in the United States is supported by a variety of organizations that spend billions of dollars in government and private funds each year to seek answers to complex medical and public health problems. The largest government funder is the National Institutes of Health (NIH), followed by the Department of Defense (DoD). Almost half of DoD's medical research funding is administered by the Congressionally Directed Medical Research Programs (CDMRP). The mission of CDMRP is to foster innovative approaches to medical research in response to the needs of its stakeholders--the U.S. military, their families, the American public, and Congress. CDMRP funds medical research to be performed by other government and nongovernmental organizations, but it does not conduct research itself. The major focus of CDMRP funded research is the improved prevention, diagnosis, and treatment of diseases, injuries, or conditions that affect service members and their families, and the general public. The hallmarks of CDMRP include reviewing applications for research funding using a two-tiered review process, and involving consumers throughout the process. Evaluation of the Congressionally Directed Medical Research Programs Review Process evaluates the CDMRP two-tiered peer review process, its coordination of research priorities with NIH and the Department of Veterans Affairs, and provides recommendations on how the process for reviewing and selecting studies can be improved.

Evidence from the public health sector demonstrates that health care is only one of the determinants of health, which also include genes, behavior, social factors, and the built environment. These contextual elements are key to understanding why health care organizations are motivated to focus beyond their walls and to consider and respond in unprecedented ways to the social needs of patients, including transportation needs. In June 2016 the National Academies of Sciences, Engineering, and Medicine held a joint workshop to explore partnerships, data, and measurement at the intersection of the health care and transportation sectors. This publication summarizes the presentations and discussions from the workshop.

Extremely hazardous substances can be released accidentally as a result of chemical spills, industrial explosions, fires, or accidents involving railroad cars and trucks transporting EHSs. Workers and residents in communities surrounding industrial facilities where these substances are manufactured, used, or stored and in communities along the nation's railways and highways are potentially at risk of being exposed to airborne EHSs during accidental releases or intentional releases by terrorists. Pursuant to the Superfund Amendments and Reauthorization Act of 1986, the U.S. Environmental Protection Agency (EPA) has identified approximately 400 EHSs on the basis of acute lethality data in rodents. Acute Exposure Guideline Levels for Selected Airborne Chemicals, Volume 20 reviews and updates the technical support document on acute exposure guideline levels (AEGLs) for selected chloroformates. This update focuses on establishing AEGL-3 values for n-propyl chloroformate and isopropyl chloroformate, but will also consider whether any new data are available that would affect the proposed values for the other 10 chloroformates. AEGLs represent threshold exposure limits (exposure levels below which adverse health effects are not likely to occur) for the general public and are applicable to emergency exposures ranging from 10 minutes (min) to 8 h. Three levels - AEGL-1, AEGL-2, and AEGL-3 - are developed for each of five exposure periods (10 min, 30 min, 1 h, 4 h, and 8 h) and are distinguished by varying degrees of severity of toxic effects. This report will inform planning, response, and prevention in the community, the workplace, transportation, the military, and the remediation of Superfund sites.

The purpose of accreditation is to build a competent health workforce by ensuring the quality of training taking place within those institutions that have met certain criteria. It is the combination of institution or program accreditation with individual licensure--for confirming practitioner competence--that governments and professions use to reassure the public of the capability of its health workforce. Accreditation offers educational quality assurance to students, governments, ministries, and society. Given the rapid changes in society, health, and health care, the National Academies of Sciences, Engineering, and Medicine hosted a workshop in April 2016, aimed to explore global shifts in society, health, health care, and education, and their potential effects on general principles of program accreditation across the continuum of health professional education. Participants explored the effect of societal shifts on new and evolving health professional learning opportunities to best ensure quality education is offered by institutions regardless of the program or delivery platform. This publication summarizes the presentations and discussions from the workshop.

Marine mammals face a large array of stressors, including loss of habitat, chemical and noise pollution, and bycatch in fishing, which alone kills hundreds of thousands of marine mammals per year globally. To discern the factors contributing to population trends, scientists must consider the full complement of threats faced by marine mammals. Once populations or ecosystems are found to be at risk of adverse impacts, it is critical to decide which combination of stressors to reduce to bring the population or ecosystem into a more favorable state. Assessing all stressors facing a marine mammal population also provides the environmental context for evaluating whether an additional activity could threaten it. Approaches to Understanding the Cumulative Effects of Stressors on Marine Mammals builds upon previous reports to assess current methodologies used for evaluating cumulative effects and identify new approaches that could improve these assessments. This review focuses on ways to quantify exposure-related changes in the behavior, health, or body condition of individual marine mammals and makes recommendations for future research initiatives.

Because of the role of innovation as a driver of economic productivity and growth and as a mechanism for improving people's well-being in other ways, understanding the nature, determinants, and impacts of innovation has become increasingly important to policy makers. To be effective, investment in innovation requires this understanding, which, in turn, requires measurement of the underlying inputs and subsequent outcomes of innovation processes. In May 2016, at the request of the National Center for Science and Engineering Statistics of the National Science Foundation, the Committee on National Statistics of the National Academies of Sciences, Engineering, and Medicine convened a workshop - bringing together academic researchers, private and public sector experts, and representatives from public policy agencies - to develop strategies for broadening and modernizing innovation information systems.This publication summarizes the presentation and discussion of the event.

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

Although people in the United States have historically been reasonably supportive of federal censuses and surveys, they are increasingly unavailable for or not willing to respond to interview requests from federal--as well as private--sources. Moreover, even when people agree to respond to a survey, they increasingly decline to complete all questions, and both survey and item nonresponse are growing problems. In March 2016, the National Academies of Sciences, Engineering, and Medicine convened a workshop to consider the respondent burden and its challenges and opportunities of the American Community Survey, which is conducted by the U.S. Census Bureau. This publication summarizes the presentations and discussions from the workshop.

The process of discovering and developing a new drug or therapy is extremely costly and time consuming, and recently, it has been estimated that the creation of a new medicine costs on average more than $2 billion and takes 10 years to reach patients. The challenges associated with bringing new medicines to market have led many pharmaceutical companies to seek out innovative methods for streamlining their drug discovery research. One way to increase the odds of success for compounds in the drug development pipeline is to adopt genetically guided strategies for drug discovery, and recognizing the potential benefits of collecting genetic and phenotypic information across specific populations, pharmaceutical companies have started collaborating with healthcare systems and private companies that have curated genetic bioresources, or large databases of genomic information. Large-scale cohort studies offer an effective way to collect and store information that can be used to assess gene-environment interactions, identify new potential drug targets, understand the role of certain genetic variants in the drug response, and further elucidate the underlying mechanisms of disease onset and progression. To examine how genetic bioresources could be used to improve drug discovery and target validation, the National Academies of Sciences, Engineering, and Medicine hosted a workshop in March 2016. Participants at the workshop explored the current landscape of genomics-enabled drug discovery activities in industry, academia, and government; examined enabling partnerships and business models; and considered gaps and best practices for collecting population data for the purpose of improving the drug discovery process. This publication summarizes the presentations and discussions from the workshop.

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

The decay product of the medical isotope molybdenum-99 (Mo-99), technetium-99m (Tc-99m), and associated medical isotopes iodine-131 (I-131) and xenon-133 (Xe-133) are used worldwide for medical diagnostic imaging or therapy. The United States consumes about half of the world's supply of Mo-99, but there has been no domestic (i.e., U.S.-based) production of this isotope since the late 1980s. The United States imports Mo-99 for domestic use from Australia, Canada, Europe, and South Africa. Mo-99 and Tc-99m cannot be stockpiled for use because of their short half-lives. Consequently, they must be routinely produced and delivered to medical imaging centers. Almost all Mo-99 for medical use is produced by irradiating highly enriched uranium (HEU) targets in research reactors, several of which are over 50 years old and are approaching the end of their operating lives. Unanticipated and extended shutdowns of some of these old reactors have resulted in severe Mo-99 supply shortages in the United States and other countries. Some of these shortages have disrupted the delivery of medical care. Molybdenum-99 for Medical Imaging examines the production and utilization of Mo-99 and associated medical isotopes, and provides recommendations for medical use.

This is the 20th Volume in the series Memorial Tributes compiled by the National Academy of Engineering as a personal remembrance of the lives and outstanding achievements of its members and foreign associates. These volumes are intended to stand as an enduring record of the many contributions of engineers and engineering to the benefit of humankind. In most cases, the authors of the tributes are contemporaries or colleagues who had personal knowledge of the interests and the engineering accomplishments of the deceased. Through its members and foreign associates, the Academy carries out the responsibilities for which it was established in 1964. Under the charter of the National Academy of Sciences, the National Academy of Engineering was formed as a parallel organization of outstanding engineers. Members are elected on the basis of significant contributions to engineering theory and practice and to the literature of engineering or on the basis of demonstrated unusual accomplishments in the pioneering of new and developing fields of technology. The National Academies share a responsibility to advise the federal government on matters of science and technology. The expertise and credibility that the National Academy of Engineering brings to that task stem directly from the abilities, interests, and achievements of our members and foreign associates, our colleagues and friends, whose special gifts we remember in this book.

NASA operates a large number of space science missions, approximately three-quarters of which are currently in their extended operations phase. They represent not only a majority of operational space science missions, but a substantial national investment and vital national assets. They are tremendously scientifically productive, making many of the major discoveries that are reported in the media and that rewrite textbooks. Extending Science - NASA's Space Science Mission Extensions and the Senior Review Process evaluates the scientific benefits of missions extensions, the current process for extending missions, the current biennial requirement for senior reviews of mission extensions, the balance between starting new missions and extending operating missions, and potential innovative cost-reduction proposals for extended missions, and makes recommendations based on this review.

"Nanoscale science, engineering, and technology, often referred to simply as "nanotechnology," is the understanding, characterization, and control of matter at the scale of nanometers, the dimension of atoms and molecules. Advances in nanotechnology promise new materials and structures that are the basis of solutions, for example, for improving human health, optimizing available energy and water resources, supporting a vibrant economy, raising the standard of living, and increasing national security. Established in 2001, the National Nanotechnology Initiative (NNI) is a coordinated, multiagency effort with the mission to expedite the discovery, development, and deployment of nanoscale science and technology to serve the public good. This report is the latest triennial review of the NNI called for by the 21st Century Nanotechnology Research and Development Act of 2003. It examines and comments on the mechanisms in use by the NNI to advance focused areas of nanotechnology towards advanced development and commercialization and on the physical and human infrastructure needs for successful realization in the United States of the benefits of nanotechnology development"--Publisher's description.

"It is not yet 60 years since the first artificial satellite was placed into Earth orbit. In just over a half century, mankind has gone from no presence in outer space to a condition of high dependence on orbiting satellites. These sensors, receivers, transmitters, and other such devices, as well as the satellites that carry them, are components of complex space systems that include terrestrial elements, electronic links between and among components, organizations to provide the management, care and feeding, and launch systems that put satellites into orbit. In many instances, these space systems connect with and otherwise interact with terrestrial systems; for example, a very long list of Earth-based systems cannot function properly without information from the Global Positioning System (GPS). Space systems are fundamental to the information business, and the modern world is an information-driven one. In addition to navigation (and associated timing), space systems provide communications and imagery and other Earth-sensing functions. Among these systems are many that support military, intelligence, and other national security functions of the United States and many other nations. Some of these are unique government, national security systems; however, functions to support national security are also provided by commercial and civil-government space systems."--

"Our world is changing at an accelerating rate. The global human population has grown from 6.1 billion to 7.1 billion in the last 15 years and is projected to reach 11.2 billion by the end of the century. The distribution of humans across the globe has also shifted, with more than 50 percent of the global population now living in urban areas, compared to 29 percent in 1950. Along with these trends, increasing energy demands, expanding industrial activities, and intensification of agricultural activities worldwide have in turn led to changes in emissions that have altered the composition of the atmosphere. The Future of Atmospheric Chemistry Research: Remembering Yesterday, Understanding Today, Anticipating Tomorrow summarizes the rationale and need for supporting a comprehensive U.S. research program in atmospheric chemistry; comments on the broad trends in laboratory, field, satellite, and modeling studies of atmospheric chemistry; determines the priority areas of research for advancing the basic science of atmospheric chemistry; and identifies the highest priority needs for improvements in the research infrastructure to address those priority research topics. This report describes the scientific advances over the past decade in six core areas of atmospheric chemistry: emissions, chemical transformation, oxidants, atmospheric dynamics and circulation, aerosol particles and clouds, and biogeochemical cycles and deposition. This material was developed for the NSF's Atmospheric Chemistry Program; however, the findings will be of interest to other agencies and programs that support atmospheric chemistry research"--

An estimated 90 percent of oncology patients in the United States receive treatment in outpatient cancer centers and clinics. This change from the older model of inpatient care has important implications for overall quality of care for oncology patients and nutritional care in particular. Amidst growing concern about access to oncology nutrition services, combined with growing recognition of the importance of providing nutritional care to optimize oncology treatment outcomes and maximize quality of life among both patients and survivors of cancer, the National Academies of Sciences, Engineering, and Medicine convened a public workshop in March 2016 to explore evolving interactions between nutritional care, cancer, and health outcomes. Participants explored how health outcomes and survival of cancer patients in outpatient cancer centers are affected by current standards for nutritional services, nutritional interventions, and benefits associated with oncology patient access to medical nutrition therapy. They also studied the cost of outpatient nutritional care and assessed cost-benefit relationships between oncology nutrition services and health outcomes and survival. This publication summarizes the presentations and discussions from the workshop.

Even as the U.S. population becomes steadily more diverse, minorities and women remain underrepresented in clinical trials to develop new drugs and medical devices. Although progress in increasing minority participation in clinical trials has occurred, participation rates do not fully represent the overall population of minorities in the United States. This underrepresentation threatens the health of both these populations and the general population, since greater minority representation could reveal factors that affect health in all populations. Federal legislation has sought to increase the representation of minorities and women in clinical trials, but legislation by itself has not been sufficient to overcome the many barriers to greater participation. Only much broader changes will bring about the meaningful participation of all population groups in the clinical research needed to improve health. To examine the barriers to participation in clinical trials and ways of overcoming those barriers, the National Academies of Sciences, Engineering, and Medicine held a workshop in April 2015. This publication summarizes the presentations and discussions from the workshop.

"A critical component of the nation's economic vitality is ensuring that all Americans can contribute and prosper. Such contributions presuppose an intentional focus on achieving the highest levels of health possible, which requires that conditions in communities, schools, workplaces, and other settings promote health and address the social determinants of health for all community members. Many organizations, in both the private and public sectors, have been establishing partnerships to further healthy workplaces and health equity in general. Many are taking the lead in producing economic growth that is inclusive and responsive to the nation's diverse needs and populations. Increasingly, private-public partnerships are emerging as ways of doing business. Additionally, a variety of new developments in health, health care, and community benefits obligations that are part of the Affordable Care Act have contributed to this interest in economic growth and health and in the creation of new partnerships. To examine past successes and future opportunities, the National Academies of Sciences, Engineering, and Medicine held a workshop in November 2015. The workshop focused on the potential of the private sector to produce a triple bottom line: economic opportunity (including workforce development) and growth, healthy work and community environments, and improved employee health. At the same time, participants looked beyond the private sector to public-private partnerships and to public-sector actions that combine opportunities for economic growth and good health for all. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

Science and art were not always two separate entities. Historically, times of great scientific progress occurred during profound movements in art, the two disciplines working together to enrich and expand humanity's understanding of its place in this cosmos. Only recently has a dividing line been drawn, and this seeming dichotomy misses some of the fundamental similarities between the two endeavors. At the National Academies Keck Futures Initiative Conference on Art, Design and Science, Engineering and Medicine Frontier Collaborations: Ideation, Translation, and Realization, participants spent 3 days exploring diverse challenges at the interface of science, engineering, and medicine. They were arranged into Seed Groups that were intentionally diverse, to encourage the generation of new approaches by combining a range of different types of contributions. The teams included creative practitioners from the fields of art, design, communications, science, engineering, and medicine, as well as representatives from private and public funding agencies, universities, businesses, journals, and the science media.

Children with disabilities and complex medical and educational needs present a special challenge for policy makers and practitioners. These children exhibit tremendous heterogeneity in their conditions and needs, requiring a varied array of services to meet those needs. Uneven public and professional awareness of their conditions and a research base marked by significant gaps have led to programs, practices, and policies that are inconsistent in quality and coverage. Parents often have to navigate and coordinate, largely on their own, a variety of social, medical, and educational support services, adding to the already daunting financial, logistical, and emotional challenges of raising children with special needs. The unmet needs of children with disabilities and complex medical and educational needs can cause great suffering for these children and for those who love and care for them. To examine how systems can be configured to meet the needs of children and families as they struggle with disabilities and complex health and educational needs, the National Academies of Sciences, Engineering, and Medicine held a workshop in December 2015. The goal of the workshop was to highlight the main barriers and promising solutions for improving care and outcome of children with complex medical and educational needs. Workshop participants examined prevention, care, service coordination, and other topics relevant to children with disabilities and complex health and educational needs, along with their families and caregivers. More broadly, the workshop seeks actionable understanding on key research questions for enhancing the evidence base; promoting and sustaining the quality, accessibility, and use of relevant programs and services; and informing relevant policy development and implementation. By engaging in dialogue to connect the prevention, treatment, and implementation sciences with settings where children are seen and cared for, the forum seeks to improve the lives of children by improving the systems that affect those children and their families. This publications summarizes the presentations and discussions from the workshop.

Science is a way of knowing about the world. At once a process, a product, and an institution, science enables people to both engage in the construction of new knowledge as well as use information to achieve desired ends. Access to science--whether using knowledge or creating it--necessitates some level of familiarity with the enterprise and practice of science: we refer to this as science literacy. Science literacy is desirable not only for individuals, but also for the health and well- being of communities and society. More than just basic knowledge of science facts, contemporary definitions of science literacy have expanded to include understandings of scientific processes and practices, familiarity with how science and scientists work, a capacity to weigh and evaluate the products of science, and an ability to engage in civic decisions about the value of science. Although science literacy has traditionally been seen as the responsibility of individuals, individuals are nested within communities that are nested within societies--and, as a result, individual science literacy is limited or enhanced by the circumstances of that nesting. Science Literacy studies the role of science literacy in public support of science. This report synthesizes the available research literature on science literacy, makes recommendations on the need to improve the understanding of science and scientific research in the United States, and considers the relationship between scientific literacy and support for and use of science and research.

"Workshop on Encryption and Mechanisms for Authorized Government Access to Plaintext, Keck Center, Washington, D.C., June 23, 2016 -- Page 50.