Bøger udgivet af National Academies Press

"Substantial empirical evidence of the contribution of social and behavioral factors to functional status and the onset and progression of disease has accumulated over the past few decades. Electronic health records (EHRs) provide crucial information to providers treating individual patients, to health systems, including public health officials, about the health of populations, and to researchers about the determinants of health and the effectiveness of treatment. Inclusion of social and behavioral health domains in EHRs is vital to all three uses. The Health Information Technology for Economic and Clinical Health Act and the Patient Protection and Affordable Care Act place new importance on the widespread adoption and meaningful use of EHRs. "Meaningful use" in a health information technology context refers to the use of EHRs and related technology within a health care organization to achieve specified objectives. Achieving meaningful use also helps determine whether an organization can receive payments from the Medicare EHR Incentive Program or the Medicaid EHR Incentive Program. Capturing Social and Behavioral Domains in Electronic Health Records is the first phase of a two-phase study to identify domains and measures that capture the social determinants of health to inform the development of recommendations for meaningful use of EHRs. This report identifies specific domains to be considered by the Office of the National Coordinator, specifies criteria that should be used in deciding which domains should be included, identifies core social and behavioral domains to be included in all EHRs, and identifies any domains that should be included for specific populations or settings defined by age, socioeconomic status, race/ethnicity, disease, or other characteristics."--

"Since its inception, the U.S. human spaceflight program has grown from launching a single man into orbit to an ongoing space presence involving numerous crewmembers. As the U.S. space program evolves, propelled in part by increasing international and commercial collaborations, long duration or exploration spaceflights - such as extended stays on the International Space Station or missions to Mars - become more realistic. These types of missions will likely expose crews to levels of known risk that are beyond those allowed by current health standards, as well as to a range of risks that are poorly characterized, uncertain, and perhaps unforeseeable. As the National Aeronautics and Space Administration (NASA) and Congress discuss the next generation of NASA's missions and the U.S. role in international space efforts, it is important to understand the ethical factors that drive decision making about health standards and mission design for NASA activities. NASA asked the Institute of Medicine to outline the ethics principles and practices that should guide the agency's decision making for future long duration or exploration missions that fail to meet existing health standards. Health Standards for Long Duration and Exploration Spaceflight identifies an ethics framework, which builds on the work of NASA and others, and presents a set of recommendations for ethically assessing and responding to the challenges associated with health standards for long duration and exploration spaceflight. As technologies improve and longer and more distant spaceflight becomes feasible, NASA and its international and commercial partners will continue to face complex decisions about risk acceptability. This report provides a roadmap for ethically assessing and responding to the challenges associated with NASA's health standards for long duration and exploration missions. Establishing and maintaining a firmly grounded ethics framework for this inherently risky activity is essential to guide NASA's decisions today and to create a strong foundation for decisions about future challenges and opportunities"--

"Although health literacy is commonly defined as an individual trait, it does not depend on the skills of individuals alone. Health literacy is the product of the interaction between individuals' capacities and the health literacy-related demands and complexities of the health care system. Specifically, the ability to understand, evaluate, and use numbers is important to making informed health care choices. Health Literacy and Numeracy is the summary of a workshop convened by The Institute of Medicine Roundtable on Health Literacy in July 2013 to discuss topics related to numeracy, including the effects of ill health on cognitive capacity, issues with communication of health information to the public, and communicating numeric information for decision making. This report includes a paper commissioned by the Roundtable, "Numeracy and the Affordable Care Act: Opportunities and Challenges," that discusses research findings about people's numeracy skill levels; the kinds of numeracy skills that are needed to select a health plan, choose treatments, and understand medication instructions; and how providers should communicate with those with low numeracy skills. The paper was featured in the workshop and served as the basis of discussion."--

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 extremely hazardous substances during accidental releases or intentional releases by terrorists. Pursuant to the Superfund Amendments and Reauthorization Act of 1986, the U.S. Environmental Protection Agency has identified approximately 400 extremely hazardous substances on the basis of acute lethality data in rodents. Acute Exposure Guideline Levels for Selected Airborne Chemicals, Volume 16 identifies, reviews, and interprets relevant toxicologic and other scientific data for selected aliphatic nitriles, benzonitrile, methacrylonitrile, allyl alcohol, hydrogen selenide, ketene, and tear gasin order to develop acute exposure guideline levels (AEGLs) for these high-priority, acutely toxic chemicals. 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.

"Scientific advances such as the sequencing of the human genome have created great promise for improving human health by providing a greater understanding of disease biology and enabling the development of new drugs, diagnostics, and preventive services. However, the translation of research advances into clinical applications has so far been slower than anticipated. This is due in part to the complexity of the underlying biology as well as the cost and time it takes to develop a product. Pharmaceutical companies are adapting their business models to this new reality for product development by placing increasing emphasis on leveraging alliances, joint development efforts, early-phase research partnerships, and public-private partnerships. These collaborative efforts make it possible to identify new drug targets, enhance the understanding of the underlying basis of disease, discover novel indications for the use of already approved products, and develop biomarkers for disease outcomes or directed drug use. While the potential benefits of collaboration are significant, the fact that the relationships among development partners are often financial means that it is vital to ensure trust by identifying, disclosing, and managing any potential sources of conflict that could create bias in the research being performed together."Conflict of Interest and Medical Innovation" is the summary of a workshop convened by the Institute of Medicine Roundtable on Translating Genomic-Based Research for Health in June 2013 to explore the appropriate balance between identifying and managing conflicts of interest and advancing medical innovation. A wide range of stakeholders, including government officials, pharmaceutical company representatives, academic administrators and researchers, health care providers, medical ethicists, patient advocates, and consumers, were invited to present their perspectives and participate in discussions during the workshop. This report focuses on current conflict of interest policies and their effect on medical innovation in an effort to identify best practices and potential solutions for facilitating innovation while still ensuring scientific integrity and public trust"--

Combat helmets have evolved considerably over the years from those used in World War I to today's Advanced Combat Helmet. One of the key advances was the development of aramid fibers in the 1960s, which led to today's Kevlar-based helmets. The Department of Defense is continuing to invest in research to improve helmet performance, through better design and materials as well as better manufacturing processes.Review of the Department of Defense Test Protocols for Combat Helmets considers the technical issues relating to test protocols for military combat helmets. At the request of the DOD Director of Operational Test and Evaluation, this report evaluates the adequacy of the Advanced Combat Helmet test protocol for both first article testing and lot acceptance testing, including its use of the metrics of probability of no penetration and the upper tolerance limit (used to evaluate backface deformation). The report evaluates appropriate use of statistical techniques in gathering data; adequacy of current helmet testing procedures; procedures for the conduct of additional analysis of penetration and backface deformation data; and scope of characterization testing relative to the benefit of the information obtained.

Permafrost is a thermal condition -- its formation, persistence and disappearance are highly dependent on climate. General circulation models predict that, for a doubling of atmospheric concentrations of carbon dioxide, mean annual air temperatures may rise up to several degrees over much of the Arctic. In the discontinuous permafrost region, where ground temperatures are within 1-2 degrees of thawing, permafrost will likely ultimately disappear as a result of ground thermal changes associated with global climate warming. Where ground ice contents are high, permafrost degradation will have associated physical impacts. Permafrost thaw stands to have wide-ranging impacts, such as the draining and drying of the tundra, erosion of riverbanks and coastline, and destabilization of infrastructure (roads, airports, buildings, etc.), and including potential implications for ecosystems and the carbon cycle in the high latitudes."Opportunities to Use Remote Sensing in Understanding Permafrost and Related Ecological Characteristics" is the summary of a workshop convened by the National Research Council to explore opportunities for using remote sensing to advance our understanding of permafrost status and trends and the impacts of permafrost change, especially on ecosystems and the carbon cycle in the high latitudes. The workshop brought together experts from the remote sensing community with permafrost and ecosystem scientists. The workshop discussions articulated gaps in current understanding and potential opportunities to harness remote sensing techniques to better understand permafrost, permafrost change, and implications for ecosystems in permafrost areas. This report addresses questions such as how remote sensing might be used in innovative ways, how it might enhance our ability to document long-term trends, and whether it is possible to integrate remote sensing products with the ground-based observations and assimilate them into advanced Arctic system models. Additionally, the report considers the expectations of the quality and spatial and temporal resolution possible through such approaches, and the prototype sensors that are available that could be used for detailed ground calibration of permafrost/high latitude carbon cycle studies.

"More than 2 decades have passed since the 1990-1991 conflict in the Persian Gulf. During the intervening years, many Gulf War veterans have experienced various unexplained symptoms that many associate with service in the Gulf region, but no specific exposure has been definitively associated with symptoms. Numerous researchers have described the pattern of signs and symptoms found in deployed Gulf War veterans and noted that they report unexplained symptoms at higher rates than nondeployed veterans or veterans deployed elsewhere during the same period. Gulf War veterans have consistently shown a higher level of morbidity than the nondeployed, in some cases with severe and debilitating consequences. However, efforts to define a unique illness or syndrome in Gulf War veterans have failed, as have attempts to develop a uniformly accepted case definition. Chronic Multisymptom Illness in Gulf War Veterans is a comprehensive review of the available scientific and medical literature regarding symptoms for chronic multisymptom illness (CMI) among the 1991 Gulf War Veterans. This report evaluates and summarizes the literature in an effort to identify appropriate terminology to use in referring to CMI in Gulf War Veterans. While the report does not recommend one specific case definition over another, Chronic Multisymptom Illness in Gulf War Veterans does recommend the consideration of two case definitions on the basis of their concordance with the evidence and their ability to identify specific symptoms commonly reported by Gulf War veterans. This report recommends that the Department of Veterans Affairs use the term Gulf War illness rather than CMI. The report recommends that that the Department of Veterans Affairs, to the extent possible, systematically assess existing data to identify additional features of Gulf War illness, such as onset, duration, severity, frequency of symptoms, and exclusionary criteria to produce a more robust case definition" -- Provided by publisher.

"America's research universities have undergone striking change in recent decades, as have many aspects of the society that surrounds them. This change has important implications for the heart of every university: the faculty. To sustain their high level of intellectual excellence and their success in preparing young people for the various roles they will play in society, universities need to be aware of how evolving conditions affect their ability to attract the most qualified people and to maximize their effectiveness as teachers and researchers. Gender roles, family life, the demographic makeup of the nation and the faculty, and the economic stability of higher education all have shifted dramatically over the past generation. In addition, strong current trends in technology, funding, and demographics suggest that change will continue and perhaps even accelerate in academe in the years to come. One central element of academic life has remained essentially unchanged for generations, however: the formal structure of the professorial career. Developed in the mid-nineteenth and early twentieth centuries to suit circumstances quite different from today's, and based on traditions going back even earlier, this customary career path is now a source of strain for both the individuals pursuing it and the institutions where they work. The Arc of the Academic Research Career is the summary of a workshop convened by The Committee on Science, Engineering, and Public Policy in September 2013 to examine major points of strain in academic research careers from the point of view of both the faculty members and the institutions. National experts from a variety of disciplines and institutions discussed practices and strategies already in use on various campuses and identified issues as yet not effectively addressed. This workshop summary addresses the challenges universities face, from nurturing the talent of future faculty members to managing their progress through all the stages of their careers to finding the best use of their skills as their work winds down."--Publisher's description.

"Being deployed to a war zone can result in numerous adverse psychological health conditions. It is well documented in the literature that there are high rates of psychological disorders among military personnel serving in Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom in Iraq as well as among the service members' families. For service members' families, the degree of hardship and negative consequences rises with the amount of the service members' exposure to traumatic or life-altering experiences. Adult and child members of the families of service members who experience wartime deployments have been found to be at increased risk for symptoms of psychological disorders and to be more likely to use mental health services. In an effort to provide early recognition and early intervention that meet the psychological health needs of service members and their families, DOD currently screens for many of these conditions at numerous points during the military life cycle, and it is implementing structural interventions that support the improved integration of military line personnel, non-medical caregivers, and clinicians, such as RESPECT-Mil (Re-engineering Systems of Primary Care Treatment in the Military), embedded mental health providers, and the Patient-Centered Medical Home. Preventing Psychological Disorders in Service Members and Their Families evaluates risk and protective factors in military and family populations and suggests that prevention strategies are needed at multiple levels - individual, interpersonal, institutional, community, and societal - in order to address the influence that these factors have on psychological health. This report reviews and critiques reintegration programs and prevention strategies for PTSD, depression, recovery support, and prevention of substance abuse, suicide, and interpersonal violence"--Publisher's description.

Since the United States began combat operations in Afghanistan in October 2001 and then in Iraq in March 2003, the numbers of US soldiers killed exceed 6,700 and of US soldiers wounded 50,500. Although all wars since World War I have involved the use of explosives by the enemy, the wars in Afghanistan and Iraq differ from previous wars in which the United States has been involved because of the enemy's use of improvised explosive devices (IEDs). The use of IEDs has led to an injury landscape different from that in prior US wars. The signature injury of the Afghanistan and Iraq wars is blast injury. Numerous US soldiers have returned home with devastating blast injuries and they continue to experience many challenges in readjusting to civilian life. Gulf War and Health, Volume 9 is an assessment of the relevant scientific information and draws conclusions regarding the strength of the evidence of an association between exposure to blast and health effects. The report also includes recommendations for research most likely to provide VA with knowledge that can be used to inform decisions on how to prevent blast injuries, how to diagnose them effectively, and how to manage, treat, and rehabilitate victims of battlefield traumas in the immediate aftermath of a blast and in the long term.

"Advancing Land Change Modeling: Opportunities and Research Requirements describes various LCM approaches, suggests guidance for their appropriate application, and makes recommendations to improve the integration of observation strategies into the models. This report provides a summary and evaluation of several modeling approaches, and their theoretical and empirical underpinnings, relative to complex land-change dynamics and processes, and identifies several opportunities for further advancing the science, data, and cyberinfrastructure involved in the LCM enterprise. Because of the numerous models available, the report focuses on describing the categories of approaches used along with selected examples, rather than providing a review of specific models. Additionally, because all modeling approaches have relative strengths and weaknesses, the report compares these relative to different purposes."--Publisher's description.

Introduction -- Documenting the U.S. Health disadvantage -- Shorter lives -- Poorer health throughout life -- Explaining the U.S. Health disadvantage -- Framing the question -- Public health and medical care systems -- Individual behaviors -- Social factors -- Physical and social environmental factors -- Policies and social values -- Future directions for understanding the U.S. Health disadvantage -- Research agenda -- Next steps.

Climate change can reasonably be expected to increase the frequency and intensity of a variety of potentially disruptive environmental events--slowly at first, but then more quickly. It is prudent to expect to be surprised by the way in which these events may cascade, or have far-reaching effects. During the coming decade, certain climate-related events will produce consequences that exceed the capacity of the affected societies or global systems to manage; these may have global security implications. Although focused on events outside the United States, Climate and Social Stress: Implications for Security Analysis recommends a range of research and policy actions to create a whole-of-government approach to increasing understanding of complex and contingent connections between climate and security, and to inform choices about adapting to and reducing vulnerability to climate change.

Healthcare decision makers in search of reliable information that compares health interventions increasingly turn to systematic reviews for the best summary of the evidence. Systematic reviews identify, select, assess, and synthesize the findings of similar but separate studies, and can help clarify what is known and not known about the potential benefits and harms of drugs, devices, and other healthcare services. Systematic reviews can be helpful for clinicians who want to integrate research findings into their daily practices, for patients to make well-informed choices about their own care, for professional medical societies and other organizations that develop clinical practice guidelines. Too often systematic reviews are of uncertain or poor quality. There are no universally accepted standards for developing systematic reviews leading to variability in how conflicts of interest and biases are handled, how evidence is appraised, and the overall scientific rigor of the process. In Finding What Works in Health Care the Institute of Medicine (IOM) recommends 21 standards for developing high-quality systematic reviews of comparative effectiveness research. The standards address the entire systematic review process from the initial steps of formulating the topic and building the review team to producing a detailed final report that synthesizes what the evidence shows and where knowledge gaps remain. Finding What Works in Health Care also proposes a framework for improving the quality of the science underpinning systematic reviews. This book will serve as a vital resource for both sponsors and producers of systematic reviews of comparative effectiveness research.

The electric power delivery system that carries electricity from large central generators to customers could be severely damaged by a small number of well-informed attackers. The system is inherently vulnerable because transmission lines may span hundreds of miles, and many key facilities are unguarded. This vulnerability is exacerbated by the fact that the power grid, most of which was originally designed to meet the needs of individual vertically integrated utilities, is being used to move power between regions to support the needs of competitive markets for power generation. Primarily because of ambiguities introduced as a result of recent restricting the of the industry and cost pressures from consumers and regulators, investment to strengthen and upgrade the grid has lagged, with the result that many parts of the bulk high-voltage system are heavily stressed.Electric systems are not designed to withstand or quickly recover from damage inflicted simultaneously on multiple components. Such an attack could be carried out by knowledgeable attackers with little risk of detection or interdiction. Further well-planned and coordinated attacks by terrorists could leave the electric power system in a large region of the country at least partially disabled for a very long time. Although there are many examples of terrorist and military attacks on power systems elsewhere in the world, at the time of this study international terrorists have shown limited interest in attacking the U.S. power grid. However, that should not be a basis for complacency. Because all parts of the economy, as well as human health and welfare, depend on electricity, the results could be devastating.Terrorism and the Electric Power Delivery System focuses on measures that could make the power delivery system less vulnerable to attacks, restore power faster after an attack, and make critical services less vulnerable while the delivery of conventional electric power has been disrupted.

"The Food Forum convened a public workshop on February 22-23, 2012, to explore current and emerging knowledge of the human microbiome, its role in human health, its interaction with the diet, and the translation of new research findings into tools and products that improve the nutritional quality of the food supply. The Human Microbiome, Diet, and Health: Workshop Summary summarizes the presentations and discussions that took place during the workshop. Over the two day workshop, several themes covered included: 1) The microbiome is integral to human physiology, health, and disease; 2) The microbiome is arguably the most intimate connection that humans have with their external environment, mostly through diet; 3) Given the emerging nature of research on the microbiome, some important methodology issues might still have to be resolved with respect to undersampling and a lack of causal and mechanistic studies; 4) Dietary interventions intended to have an impact on host biology via their impact on the microbiome are being developed, and the market for these products is seeing tremendous success. However, the current regulatory framework poses challenges to industry interest and investment"--Publisher's description.

At the request of the Chief of Naval Operations, the National Research Council (NRC) conducted a study to determine the technological requirements, operational changes, and combat service support structure necessary to land and support forces ashore under the newly evolving Navy and Marine Corps doctrine. The Committee on Naval Expeditionary Logistics, operating under the auspices of the NRC's Naval Studies Board, was appointed to (1) evaluate the packaging, sealift, and distribution network and identify critical nodes and operations that affect timely insertion of fuels, ammunition, water, medical supplies, food, vehicles, and maintenance parts and tool blocks; (2) determine specific changes required to relieve these critical nodes and support forces ashore, from assault through follow-on echelonment; and (3) present implementable changes to existing support systems, and suggest the development of innovative new systems and technologies to land and sustain dispersed units from the shoreline to 200 miles inland. In the course of its study, the committee soon learned that development of OMFTS is not yet at a stage to allow, directly, detailed answers to many of these questions. As a result, the committee addressed the questions in terms of the major logistics functions of force deployment, force sustainment, and force medical support, and the fundamental logistics issues related to each of these functions.

Many studies during the past few decades have sought to determine whether the death penalty has any deterrent effect on homicide rates. Researchers have reached widely varying, even contradictory, conclusions. Some studies have concluded that the threat of capital punishment deters murders, saving large numbers of lives; other studies have concluded that executions actually increase homicides; still others, that executions have no effect on murder rates. Commentary among researchers, advocates, and policymakers on the scientific validity of the findings has sometimes been acrimonious.Against this backdrop, the National Research Council report Deterrence and the Death Penalty assesses whether the available evidence provides a scientific basis for answering questions of if and how the death penalty affects homicide rates. This new report from the Committee on Law and Justice concludes that research to date on the effect of capital punishment on homicide rates is not useful in determining whether the death penalty increases, decreases, or has no effect on these rates. The key question is whether capital punishment is less or more effective as a deterrent than alternative punishments, such as a life sentence without the possibility of parole. Yet none of the research that has been done accounted for the possible effect of noncapital punishments on homicide rates. The report recommends new avenues of research that may provide broader insight into any deterrent effects from both capital and noncapital punishments.

"This study was supported by the University of Alaska Fairbanks under contract number UAF-08-0050, the National Oceanic and Atmospheric Administration under contract number DG133W08SE4972, and the National Academy of Sciences."--T.p. verso.

"On February 26, 2020, the Board on Health Sciences Policy of the National Academies of Sciences, Engineering, and Medicine hosted a 1-day public workshop in Washington, DC, to examine current and emerging bioethical issues that might arise in the context of biomedical research and to consider research topics in bioethics that could benefit from further attention. The scope of bioethical issues in research is broad, but this workshop focused on issues related to the development and use of digital technologies, artificial intelligence, and machine learning in research and clinical practice; issues emerging as nontraditional approaches to health research become more widespread; the role of bioethics in addressing racial and structural inequalities in health; and enhancing the capacity and diversity of the bioethics workforce. This publication summarizes the presentations and discussions from the workshop."--

Business structures, employment relationships, job characteristics, and worker outcomes have changed in the United States over the last few decades--in some ways unpredictably. A high level of interest exists among policy makers and researchers in addressing concerns about the future of work in the United States. These concerns are heightened by the perceived fracturing of relationships between workers and employers, the loss of safety net protections and benefits to workers, the growing importance of access to skills and education as the impacts of new technologies and automation are felt, and the market-based pressure that companies face to produce short-term profits, sometimes at the expense of long-term value. These issues, as well as related ones such as wage stagnation and job quality, are often associated with alternative work arrangements (AWAs)--which include independent-contractor and other nonemployee jobs, work through intermediaries such as temporary help agencies and other contract companies, and work with unpredictable schedules--although they also pertain to many standard jobs. A better understanding of the magnitude of and trends in AWAs, along with the implications for job quality, is needed to develop appropriate policies in response to the changing nature of work. Measuring Alternative Work Arrangements for Research and Policy reviews the Contigent Worker Supplement (CWS) of the Current Population Survey (CPS) for the Bureau of Labor Statistics (BLS) in the U.S. Department of Labor. The CWS provides key measures of temporary (contingent) work, alternative work arrangements, and the "gig" economy. Disagreements, however, exist among researchers, policy makers, and other stakeholders about the definitions and measures of these concepts and priorities for future data collection. The report also reviews measures of employment, earnings, and worker well-being in temporary and alternative work arrangements that can be estimated using household survey data, such as those generated by the CWS, as well as measures that can be produced using administrative, commercial, and combined data sources. The comparative advantages and complementarities of different data sources will be assessed, as well as methodological issues underpinning BLS's measurement objectives.

The Intelligence Community (IC) is no stranger to the valuable contributions made by research in the social and behavioral sciences (SBS) to the work of intelligence analysis. Likewise, researchers in many SBS disciplines have benefited from opportunities to work with the IC and conduct research on countless topics related to intelligence. But in an age when both technologies and national security concerns are evolving at lightening speed, the IC has recognized the critical need to more systematically take advantage of cutting-edge research from diverse SBS fields. In this context, the Office of the Director of National Intelligence (ODNI) turned to the National Academies of Science, Engineering, and Medicine (the National Academies) to explore opportunities for research from the SBS disciplines to support the work of intelligence analysts and enhance national security. ODNI requested that The National Academies conduct a decadal survey that would support the IC in developing a 10-year agenda for SBS research with applications to intelligence analysis. --

The next decade of planetary science and astrobiology holds tremendous promise. New research will expand our understanding of our solar system's origins, how planets form and evolve, under what conditions life can survive, and where to find potentially habitable environments in our solar system and beyond. Origins, Worlds, and Life: A Decadal Strategy for Planetary Science and Astrobiology 2023-2032 highlights key science questions, identifies priority missions, and presents a comprehensive research strategy that includes both planetary defense and human exploration. This report also recommends ways to support the profession as well as the technologies and infrastructure needed to carry out the science.

"The early to mid-1990s saw a large surge in U.S. cigar consumption, including premium cigars. Based on recent import data, premium cigar use may be increasing, though they currently make up a small percent of the total U.S. cigar market. Premium cigars have also been the subject of legal and regulatory efforts for the past decade. In 1998, the National Cancer Institute undertook a comprehensive review of available knowledge about cigars - the only one to date. The resulting research recommendations have largely not been addressed, and many of the identified information gaps persist. Furthermore, there is no single, consistent definition of premium cigars, making research challenging. In response, the Food and Drug Administration (FDA) and the National Institutes of Health commissioned the National Academies of Sciences, Engineering, and Medicine to convene a committee of experts to address this issue. The resulting report, Premium Cigars: Patterns of Use, Marketing, and Health Effects, includes 13 findings, 24 conclusions, and nine priority research recommendations and assesses the state of evidence on premium cigar characteristics, current patterns of use, marketing and perceptions of the product, and short- long-term health effects" --

In response to the coronavirus disease 2019 (COVID-19) pandemic and the societal disruption it has brought, national governments and the international community have invested billions of dollars and immense amounts of human resources to develop a safe and effective vaccine in an unprecedented time frame. Vaccination against this novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), offers the possibility of significantly reducing severe morbidity and mortality and transmission when deployed alongside other public health strategies and improved therapies. Health equity is intertwined with the impact of COVID-19 and there are certain populations that are at increased risk of severe illness or death from COVID-19. In the United States and worldwide, the pandemic is having a disproportionate impact on people who are already disadvantaged by virtue of their race and ethnicity, age, health status, residence, occupation, socioeconomic condition, or other contributing factors. Framework for Equitable Allocation of COVID-19 Vaccine offers an overarching framework for vaccine allocation to assist policy makers in the domestic and global health communities. Built on widely accepted foundational principles and recognizing the distinctive characteristics of COVID-19, this report's recommendations address the commitments needed to implement equitable allocation policies for COVID-19 vaccine.

Participants in this workshop, which took place on January 17, 2020, considered whether embryo model systems - especially those that use nonhuman primate cells - can be used to predict the function of systems made with human cells. Presentations provided an overview of the current state of the science of in vitro development of human trophoblast--The National Academies of Sciences, Engineering, Medicine website (viewed September 18, 2020)

The U.S. Centers for Disease Control and Prevention (CDC) is responsible for preventing the introduction, transmission, and spread of communicable diseases into the United States. It does this primarily through the Division of Global Migration and Quarantine (DGMQ), which oversees the federal quarantine station network. Over the past two decades, the frequency and volume of microbial threats worldwide have continued to intensify. The COVID-19 pandemic, in particular, has prompted a reevaluation of many of our current disease control mechanisms, including the use and role of quarantine as a public health tool. The emergence of COVID-19 prompted CDC to request that the National Academies of Sciences, Engineering, and Medicine convene a committee to assess the role of DGMQ and the federal quarantine station network in mitigating the risk of onward communicable disease transmission in light of changes in the global environment, including large increases in international travel, threats posed by emerging infections, and the movement of animals and cargo. The committee was also tasked with identifying how lessons learned during COVID-19 and other public health emergencies can be leveraged to strengthen pandemic response. The report's findings and recommendations span five domains: organizational capacity, disease control and response efforts, new technologies and data systems, coordination and collaboration, and legal and regulatory authority.