Bøger udgivet af National Academies Press

Crisis Standards of Care (CSC) inform decisions on medical care during a large-scale crisis such as a pandemic or natural disaster, eliminating the need to make these decisions at the bedside without protections or guidance. Numerous points throughout the COVID-19 pandemic have demonstrated the necessity of this type of crisis planning. The National Academies of Sciences, Engineering, and Medicine Forum on Medical and Public Health Preparedness for Disasters and Emergencies convened a series of public workshops to examine the experiences of healthcare providers during the COVID-19 pandemic and identify lessons that can inform current and future CSC planning and implementation. The workshops examined staffing and workforce needs, planning and implementation of CSC plans, and legal, ethical, and equity considerations of CSC planning. Topics of discussion included improving coordination between the bedside and boardroom, increasing buy-in from elected officials, expanding provider engagement, and addressing health equity issues. This publication summarizes the presentation and discussion of the workshops.

The COVID-19 pandemic has highlighted existing weaknesses in the United States health care system, while creating a new set of challenges related to caring for people with serious illness. The National Academy of Sciences, Engineering, and Medicine's Roundtable on Quality Care for People with Serious Illness hosted a three-part workshop to explore the initial responses to the pandemic by health care teams providing care to people with serious illness, the impact of the pandemic on the health care workforce, the use of telehealth, issues related to clearly communicating with the public about health emergencies, and policy opportunities to improve care for people with serious illness. Issues related to health equity were discussed throughout the three webinars.

"Held on November 16-17, 2017, at the National Academy of Sciences in Washington, D.C."

Fusion energy offers the prospect of addressing the nation's energy needs and contributing to the transition to a low-carbon emission electrical generation infrastructure. Technology and research results from U.S. investments in the major fusion burning plasma experiment known as ITER, coupled with a strong foundation of research funded by the Department of Energy (DOE), position the United States to begin planning for its first fusion pilot plant. Strong interest from the private sector is an additional motivating factor, as the process of decarbonizing and modernizing the nation's electric infrastructure accelerates and companies seek to lead the way. At the request of DOE, Bringing Fusion to the U.S. Grid builds upon the work of the 2019 report Final Report of the Committee on a Strategic Plan for U.S. Burning Plasma Research to identify the key goals and innovations - independent of confinement concept - that are needed to support the development of a U.S. fusion pilot plant that can serve as a model for producing electricity at the lowest possible capital cost.

"Information technology (IT) is widely understood to be the enabling technology of the 21st century. IT has transformed, and continues to transform, all aspects of our lives: commerce and finance, education, energy, health care, manufacturing, government, national security, transportation, communications, entertainment, science, and engineering. IT and its impact on the U.S. economy--both directly (the IT sector itself) and indirectly (other sectors that are powered by advances in IT)--continue to grow in size and importance. IT's impacts on the U.S. economy--both directly (the IT sector itself) and indirectly (other sectors that are powered by advances in IT)--continue to grow. IT enabled innovation and advances in IT products and services draw on a deep tradition of research and rely on sustained investment and a uniquely strong partnership in the United States among government, industry, and universities. Past returns on federal investments in IT research have been extraordinary for both U.S. society and the U.S. economy. This IT innovation ecosystem fuels a virtuous cycle of innovation with growing economic impact. Building on previous National Academies work, this report describes key features of the IT research ecosystem that fuel IT innovation and foster widespread and longstanding impact across the U.S. economy. In addition to presenting established computing research areas and industry sectors, it also considers emerging candidates in both categories."--

"This Proceedings of a Workshop summarizes the presentations and discussions at the Workshop on the Implications of Convergence for How the National Center for Science and Engineering Statistics (NCSES) Measures the Science and Engineering Workforce, which was held virtually and livestreamed on October 22-23, 2020. The workshop was convened by the Committee on National Statistics to help NCSES, a division of the National Science Foundation, set an agenda to inform its methodological research and better measure and assess the implications of convergence for the science and engineering workforce and enterprise. The workshop brought together scientists and researchers from multiple disciplines, along with experts in science policy, university administration, and other stakeholders to review and provide input on defining and measuring convergence and its impact on science and scientists." --

The National Nuclear Security Administration (NNSA)leads a nuclear security enterprise that includes three national laboratories, several production facilities, and an experimental test site. NNSA's mission is protect the American people by maintaining a safe, secure, and effective nuclear weapons stockpile; by reducing global nuclear threats; and by providing the U.S. Navy with safe, militarily effective naval nuclear propulsion plants. The FY2016 National Defense Authorization Act called for the National Academies, in partnership with the National Academy of Public Administration, to track and assess progress over 2016-2020 to reform governance and management of the enterprise. Governance and Management of the Nuclear Security Enterprise assesses the effectiveness of reform efforts and makes recommendations for further action.--Publisher's website.

"Childhood Cancer and Functional Impacts Across the Care Continuum provides current information and findings and conclusions regarding the diagnosis, treatment, and prognosis of selected childhood cancers, including different types of malignant solid tumors, and the effect of those cancers on children's health and functional capacity, including the relative levels of functional limitation typically associated with the cancers and their treatment. This report also provides a summary of selected treatments currently being studied in clinical trials and identifies any limitations on the availability of these treatments, such as whether treatments are available only in certain geographic areas"--The National Academies of Sciences, Engineering, Medicine website (viewed 5/7/2021)--

The Roundtable on Population Health Improvement, a convening activity of the National Academies of Sciences, Engineering, and Medicine, held a workshop on March 15-16, 2021, to explore issues related to increasing health care spending in the United States. The workshop, U.S. Health Care Expenditures: Costs, Lessons, and Opportunities, was organized to highlight the persisting challenge of health care expenditures that are not commensurate with the health outcomes they produce. This publication summarizes the presentation and discussion of the workshop.

Marine recreational fishing is a popular activity enjoyed by more than 9 million Americans annually and is a driver of the American ocean-or blue-economy. To ensure that fish populations are not overexploited, the NOAA Fisheries' Marine Recreational Information Program (MRIP) monitors recreational catch through a variety of in-person, telephone, mail-in, and other surveys. NOAA Fisheries' management of recreational catch also must take into account annual catch limits (ACLs) established to prevent overfishing for all managed species in federal waters. While MRIP has worked to improve recreational catch surveys over the past decade, the surveys were never designed to meet the demands of in-season management of ACLs. In some cases, estimates of harvest have triggered accountability measures such as early season closures and reductions in future recreational ACLs, which have been a source of contention with the recreational fishing community. This report presents approaches for optimizing MRIP data and complementary data for in-season management and considers alternatives for managing recreational fisheries with ACLs to better serve both social and economic management objectives.

Antimicrobial resistance is a health problem that threatens to undermine almost a century of medical progress. Moreover, it is a global problem that requires action both in the United States and internationally. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine discusses ways to improve detection of resistant infections in the United States and abroad, including monitoring environmental reservoirs of resistance. This report sets out a strategy for improving stewardship and preventing infections in humans and animals. The report also discusses the strength of the pipeline for new antimicrobial medicines and steps that could be taken to bring a range of preventive and therapeutic products for humans and animals to the market.

There is a void in evidence-based information for making informed decisions on how to optimize care for older adults, particularly those 80 years and over. Because older adults are vastly underrepresented in clinical trials, there is a dearth of information about the appropriate use of drugs in this population. Yet older adults have higher rates of comorbidities and simultaneous use of multiple medications than the general population, and are the majority users of many medications. Additionally, age-related physiological and pathological changes, particularly for adults 80 years of age and older, can lead to significant differences in the pharmacokinetics (PK)2 and pharmacodynamics (PD)3 of a given drug compared to the general population. On August 5 and 6, 2020, the National Academies of Sciences, Engineering, and Medicine hosted a workshop titled Drug Research and Development for Adults Across the Older Age Span. The workshop was designed to examine the challenges and opportunities in drug research and development for older adult populations, explore barriers that impede safety and efficacy studies in these populations, and share lessons learned for better understanding clinical pharmacology for populations over age 65. This publication summarizes the presentation and discussion of the workshop.

Earthquake-induced soil liquefaction (liquefaction) is a leading cause of earthquake damage worldwide. Liquefaction is often described in the literature as the phenomena of seismic generation of excess porewater pressures and consequent softening of granular soils. Many regions in the United States have been witness to liquefaction and its consequences, not just those in the west that people associate with earthquake hazards. Past damage and destruction caused by liquefaction underline the importance of accurate assessments of where liquefaction is likely and of what the consequences of liquefaction may be. Such assessments are needed to protect life and safety and to mitigate economic, environmental, and societal impacts of liquefaction in a cost-effective manner. Assessment methods exist, but methods to assess the potential for liquefaction triggering are more mature than are those to predict liquefaction consequences, and the earthquake engineering community wrestles with the differences among the various assessment methods for both liquefaction triggering and consequences. State of the Art and Practice in the Assessment of Earthquake-Induced Soil Liquefaction and Its Consequences evaluates these various methods, focusing on those developed within the past 20 years, and recommends strategies to minimize uncertainties in the short term and to develop improved methods to assess liquefaction and its consequences in the long term. This report represents a first attempt within the geotechnical earthquake engineering community to consider, in such a manner, the various methods to assess liquefaction consequences.

Valued for its ecological richness and economic value, the U.S. Gulf of Mexico is under substantial pressure from human activities. The Deepwater Horizon platform explosion and oil spill significantly damaged Gulf ecosystems and led to the largest ecological restoration investment in history. The unprecedented number and diversity of restoration activities provide valuable information for future restoration efforts, but assessment efforts are hampered by many factors, including the need to evaluate the interaction of multiple stressors and consider long-term environmental trends such as sea level rise, increasing hurricane intensity, and rising water temperatures. This report offers a comprehensive approach to assess restoration activities beyond the project scale in the face of a changing environment. A main component of this approach is using different types of scientific evidence to develop "multiple lines of evidence" to evaluate restoration efforts at regional scales and beyond, especially for projects that may be mutually reinforcing (synergistic) or in conflict (antagonistic). Because Gulf of Mexico ecosystems cross political boundaries, increased coordination and collaboration is needed, especially to develop standardized data collection, analysis, synthesis, and reporting. With these improvements, program-level adaptive management approaches can be used more effectively to assess restoration strategies against the backdrop of long-term environmental trends.

The United States faces an alarmingly high rate of maternal morbidity and mortality, distinguishing it from other high-income countries that have achieved decreases in these rates in recent years. U.S. maternal morbidity and mortality rates are disproportionate across racial, ethnic, socioeconomic, and geographic groups. Statistics on maternal health outcomes reveal that there are challenges to protecting both the lives and future health of birthing people and their children. Recognizing the urgency of this growing problem, the National Academies Board on Population Health and Public Health Practice convened a 2-day virtual workshop, Advancing Maternal Health Equity and Reducing Maternal Mortality. The workshop examined the current state of maternal health in the United States and explored the factors needed to help communities and health care systems become more effective in reducing maternal morbidity and mortality and improving health outcomes through the fourth trimester. This publication summarizes the presentations and discussions of the workshop.--Publisher's website.

"Retail trade has experienced dramatic changes over the past several decades in the United States, with changes in the types of outlets where goods are sold, the nature of the transactions that provide goods to consumers, and the structure of retail operations behind the scenes. The recent changes include the rise of warehouse stores and e-commerce and the further growth of imports and large retail chains. These changes highlight and typify many aspects of the broader evolution of the economy as a whole in recent years - with the growing role of large firms and information technology - while taking place in a sector that directly serves the vast majority of the American population and provides substantial employment. Despite the everyday experience of these dramatic changes in retail, there is concern that the most transformational aspects of those changes may not be captured well by the economic indicators about the sector. In order to develop appropriate economic policies, we need to be able to capture more detailed data, including data about changes to productivity. At the request of the U.S. Bureau of Labor Statistics, this report evaluates changes in the retail trade sector, assesses measures of employment and labor productivity for the sector, and recommends a new satellite account that could measure retail-related employment and labor productivity in ways that would better capture the transformation."--

The USAir Force human capital management (HCM) system is not easily defined or mapped. It affects virtually every part of the Air Force because workforce policies, procedures, and processes impact all offices and organizations that include Airmen and responsibilities and relationships change regularly. To ensure the readiness of Airmen to fulfill the mission of the Air Force, strategic approaches are developed and issued through guidance and actions of the Office of the Deputy Chief of Staff for Manpower, Personnel and Services and the Office of the Assistant Secretary of the Air Force for Manpower and Reserve Affairs. Strengthening US Air Force Human Capital Management assesses and strengthens the various U.S. Air Force initiatives and programs working to improve person-job match and human capital management in coordinated support of optimal mission capability. This report considers the opportunities and challenges associated with related interests and needs across the USAF HCM system as a whole, and makes recommendations to inform improvements to USAF personnel selection and classification and other critical system components across career trajectories. Strengthening US Air Force Human Capital Management offers the Air Force a strategic approach, across a connected HCM system, to develop 21st century human capital capabilities essential for the success of 21st century Airmen.

"National Academies of Science, Engineering, Medicine."

"One of the holy grails in biology is the ability to predict functional characteristics from an organism's genetic sequence. Despite decades of research since the first sequencing of an organism in 1995, scientists still do not understand exactly how the information in genes is converted into an organism's phenotype, its physical characteristics. Functional genomics attempts to make use of the vast wealth of data from "-omics" screens and projects to describe gene and protein functions and interactions. A February 2020 workshop was held to determine research needs to advance the field of functional genomics over the next 10-20 years. Speakers and participants discussed goals, strategies, and technical needs to allow functional genomics to contribute to the advancement of basic knowledge and its applications that would benefit society. This publication summarizes the presentations and discussions from the workshop."--

"For many years, laboratory dogs have served as important animal models for biomedical research that has advanced human health. Conducted at the request of the U.S. Department of Veterans Affairs (VA), this report assesses whether laboratory dogs are or will continue to be necessary for biomedical research related to the VA's mission. The report concludes that using laboratory dogs in research at the VA is scientifically necessary for only a few areas of current biomedical research. The report recommends that the VA adopt an expanded set of criteria for determining when it is scientifically necessary to use laboratory dogs in VA biomedical research; that the VA promote the development and use of alternatives to laboratory dogs; and highlights opportunities for the VA to enhance the welfare of laboratory dogs that are being used in biomedical research areas for which they have been deemed necessary."--

"With unprecedented global aging, societies must undertake all-of-society efforts to maximize the benefits and minimize the burdens of aging populations. The Global Roadmap for Healthy Longevity (Global Roadmap) describes a realistic vision of healthy longevity that could be achieved by 2050. The vision includes full inclusion of people of all ages, regardless of health or functional status, in all aspects of society and societies characterized by social cohesion and equity. To achieve the vision, Global Roadmap recommends changes that need to be made to health systems, social infrastructure, physical environments, education, work, and retirement. In some cases, the recommended changes benefit older people most directly, but when older people thrive, people of all ages benefit. If taken up, the recommendations of this report can support individuals of all ages in all corners of the globe to live long, meaningful, and purpose-driven lives by 2050."--

Radiation exposure at low doses (below 100 milligray) or low-dose rates (less than 5 milligray per hour) occurs in a wide range of medical, industrial, military, and commercial settings. The effects of exposure at these levels are not fully understood, but there are long-standing concerns that such exposure could negatively affect human health. Although cancer has been linked to low-dose radiation exposure for decades, there is increasing evidence that low-dose radiation exposure may also be associated with cardiovascular disease, neurological disorders, immune dysfunction, and cataracts. Recent advances in research, new tools, and a coordinated multidisciplinary research program could help fill knowledge gaps about the health impacts of low-dose radiation exposures. This report calls for the development of a U.S. research program to study how low doses of radiation affect cancer, cardiovascular disease, neurological disorders, and other disease risks. Research should also better define the impacts of radiation doses, dose rates, types of radiation, and exposure duration. The report estimates $100 million annually for the next 15 years would be required to conduct epidemiological and biological research, and to establish an infrastructure for research.

"The US Global Change Research Program (USGCRP) is a collection of 13 Federal entities charged by law to assist the United States and the world to understand, assess, predict, and respond to human-induced and natural processes of global change. Global Change Research Needs and Opportunities for 2022-2031 advises the USGCRP on how best to meet its mandate in light of climate change impacts happening today and projected into the future. This report identifies critical climate change risks, research needed to support decision-making relevant to managing these risks, and opportunities for the USGCRP's participating agencies and other partners to advance these research priorities over the next decade." --

"Transplantation of a solid organ, such as a kidney, heart, or liver, is a lifesaving procedure and is sometimes the only viable treatment for patients experiencing end-stage organ failure as a result of illness or injury. A growing prevalence of solid organ diseases in the United States is contributing to more people needing a transplant and longer wait times on the national transplant waiting list. While transplantation can lengthen a person's life, the road to recovery is difficult and complex. Transplant recipients commonly experience considerable impairments related to health factors, medication side effects, organ rejection, or other setbacks that can cause functional limitations. A spectrum of services and supports can be beneficial to patient functioning and quality of life, but patient access is variable due to individual, system, and social factors. To gain an understanding of current scientific findings in the field of solid organ transplantation, the U.S. Social Security Administration asked the National Academies of Sciences, Engineering, and Medicine's Board on Health Care Services to organize a virtual public workshop to examine disability associated with organ transplantation. The workshop, held March 22-23, 2021, focused on kidney, heart, liver, and lung transplantation, and to a lesser extent intestine transplantation. Subject-matter experts presented on clinical aspects of post-transplantation recovery and described the implications for physical, cognitive, and psychosocial functioning in adults and children. This publication summarizes the presentations and panel discussions from the workshop." --

"Every year, significant amounts of expensive drugs are discarded. This is due in part to the growing number of prescription drugs that are administered in variable doses (rather than fixed or flat doses) based on a patient's weight or body size. Strict regulations and guidance generally prohibit or severely restrict the acceptable time frame for sharing medication from single-dose vials among patients, and so the unused amount will typically be discarded. Due to the current system for producing, administering, and paying for drugs in the United States, significant - but indeterminate - amounts of expensive prescription drugs are discarded each year. At the request of the Centers for Medicare & Medicaid Services, Medications in Single Dose Vials: Implications of Discarded Drugs explores the federal health care costs, safety, and quality concerns associated with discarded drugs that result from the weight-based dosing of medicines contained in single-dose vials."--

"A Research Strategy to Examine the Taxonomy of the Red Wolf provides independent guidance about taxonomic research on the red wolf, Canis rufus. Building from the 2019 report Evaluating the Taxonomic Status of the Mexican Gray Wolf and the Red Wolf, this report reviews and ranks research applications to determine the taxonomy of wild canid populations in southern Louisiana and other relevant locations. The report then develops a research strategy to examine the evolutionary relationships between ancient red wolves, the extant managed red wolf populations, and the unidentified canid populations." --