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The world is transforming its energy system from one dominated by fossil fuel combustion to one with net-zero emissions of carbon dioxide (CO2), the primary anthropogenic greenhouse gas. This energy transition is critical to mitigating climate change, protecting human health, and revitalizing the U.S. economy. To help policymakers, businesses, communities, and the public better understand what a net-zero transition would mean for the United States, the National Academies of Sciences, Engineering and Medicine convened a committee of experts to investigate how the U.S. could best decarbonize its transportation, electricity, buildings, and industrial sectors. This report, Accelerating Decarbonization of the United States Energy System, identifies key technological and socio-economic goals that must be achieved to put the United States on the path to reach net-zero carbon emissions by 2050. The report presents a policy blueprint outlining critical near-term actions for the first decade (2021-2030) of this 30-year effort, including ways to support communities that will be most impacted by the transition.

Cancer is the second leading cause of death among adults in the United States after heart disease. However, improvements in cancer treatment and earlier detection are leading to growing numbers of cancer survivors. As the number of cancer survivors grows, there is increased interest in how cancer and its treatments may affect a person's ability to work, whether the person has maintained employment throughout the treatment or is returning to work at a previous, current, or new place of employment. Cancer-related impairments and resulting functional limitations may or may not lead to disability as defined by the U.S. Social Security Administration (SSA), however, adults surviving cancer who are unable to work because of cancer-related impairments and functional limitations may apply for disability benefits from SSA. At the request of SSA, Diagnosing and Treating Adult Cancers and Associated Impairments provides background information on breast cancer, lung cancer, and selected other cancers to assist SSA in its review of the listing of impairments for disability assessments. This report addresses several specific topics, including determining the latest standards of care as well as new technologies for understanding disease processes, treatment modalities, and the effect of cancer on a person's health and functioning, in order to inform SSA's evaluation of disability claims for adults with cancer.

"Consumer genomics, encompassing both direct-to-consumer applications (i.e., genetic testing that is accessed by a consumer directly from a commercial company apart from a health care provider) and consumer-driven genetic testing (i.e., genetic testing ordered by a health care provider in response to an informed patient request), has evolved considerably over the past decade, moving from more personal utility-focused applications outside of traditional health care to interfacing with clinical care in nontraditional ways. As consumer genomics has increasingly intersected with clinical applications, discussions have arisen around the need to demonstrate clinical and analytical validity and clinical utility due to the potential for misinterpretation by consumers. Clinical readiness and interest for this information have presented educational and training challenges for providers. At the same time, consumer genomics has emerged as a potentially innovative mechanism for thinking about health literacy and engaging participants in their health and health care. To explore the current landscape of consumer genomics and the implications for how genetic test information is used or may be used in research and clinical care, the Roundtable on Genomics and Precision Health of the National Academies of Sciences, Engineering, and Medicine hosted a public workshop on October 29, 2019, in Washington, DC. Discussions included such topics as the diversity of participant populations, the impact of consumer genomics on health literacy and engagement, knowledge gaps related to the use of consumer genomics in clinical care, and regulatory and health policy issues such as data privacy and security. A broad array of stakeholders took part in the workshop, including genomics and consumer genomics experts, epidemiologists, health disparities researchers, clinicians, users of consumer genomics research applications, representatives from patient advocacy groups, payers, bioethicists, regulators, and policy makers. This publication summarizes the presentations and discussion of the workshop."--

With U.S. health care costs projected to grow at an average rate of 5.5 percent per year from 2018 to 2027, or 0.8 percentage points faster than the gross domestic product, and reach nearly $6.0 trillion per year by 2027, policy makers and a wide range of stakeholders are searching for plausible actions the nation can take to slow this rise and keep health expenditures from consuming an ever greater portion of U.S. economic output. While health care services are essential to heath, there is growing recognition that social determinants of health are important influences on population health. Supporting this idea are estimates that while health care accounts for some 10 to 20 percent of the determinants of health, socioeconomic factors and factors related to the physical environment are estimated to account for up to 50 percent of the determinants of health. Challenges related to the social determinants of health at the individual level include housing insecurity and poor housing quality, food insecurity, limitations in access to transportation, and lack of social support. These social needs affect access to care and health care utilization as well as health outcomes. Health care systems have begun exploring ways to address non-medical, health-related social needs as a way to reduce health care costs. To explore the potential effect of addressing non-medical health-related social needs on improving population health and reducing health care spending in a value-driven health care delivery system, the National Academies of Science, Engineering, and Medicine held a full-day public workshop titled Investing in Interventions that Address Non-Medical, Health-Related Social Needs on April 26, 2019, in Washington, DC. The objectives of the workshop were to explore effective practices and the supporting evidence base for addressing the non-medical health-related social needs of individuals, such as housing and food insecurities; review assessments of return on investment (ROI) for payers, healthy systems, and communities; and identify gaps and opportunities for research and steps that could help to further the understanding of the ROI on addressing non-medical health-related social needs. This publication summarizes the presentations and discussions from the workshop.

Successful drug development relies on accurate and efficient clinical trials to deliver the best and most effective pharmaceuticals and clinical care to patients. However, the current model for clinical trials is outdated, inefficient and costly. Clinical trials are limited by small sample sizes that do not reflect variations among patients in the real world, financial burdens on participants, and slow processes, and these factors contribute to the disconnect between clinical research and clinical practice. On November 28-29, the National Academies of Sciences, Engineering, and Medicine convened a workshop to investigate the current clinical trials system and explore the potential benefits and challenges of implementing virtual clinical trials as an enhanced alternative for the future. This publication summarizes the presentations and discussions from the workshop.--Publishers website

In September 2015, the National Academies of Sciences, Engineering, and Medicine convened a two-day workshop on evolving paradigms for design and manufacturing. Participants discussed ways to lower costs and shorten production time in defense systems while bringing materials and manufacturing alternatives into the tradespace. This publication summarizes the presentations and discussions from the workshop. --

The challenge of monitoring disparities in educational achievement and opportunities shares some characteristics with other complex regulatory problems. For example, when Congress adopted the Clean Air Act (1970) nearly 50 years ago, it emphasized the importance of public health but provided no clear line for distinguishing clean air from dirty air. Most fundamentally, regulating pollution has required choices about what indicates that air is "polluted" for regulatory purposes, how to measure and monitor those indicators, and when the measured level of an indicator should trigger enforcement or other intervention. The statute provided few answers, or even a definitive list of "pollutants" to be regulated. Nor were there definitive answers in the Constitution, economics, the biological sciences, or epidemiology. Instead, definitions and decisions have been a continuous enterprise involving interpretations of vague statutory language, promulgation of hundreds of federal and state regulations, enforcement experience, research in multiple disciplines, and the turbulence of politics.

"Quantum mechanics, the subfield of physics that describes the behavior of very small (quantum) particles, provides the basis for a new paradigm of computing. First proposed in the 1980s as a way to improve computational modeling of quantum systems, the field of quantum computing has recently garnered significant attention due to progress in building small-scale devices. However, significant technical advances will be required before a large-scale, practical quantum computer can be achieved. Quantum Computing: Progress and Prospects provides an introduction to the field, including the unique characteristics and constraints of the technology, and assesses the feasibility and implications of creating a functional quantum computer capable of addressing real-world problems. This report considers hardware and software requirements, quantum algorithms, drivers of advances in quantum computing and quantum devices, benchmarks associated with relevant use cases, the time and resources required, and how to assess the probability of success"--Publisher's description.

The United States is facing an opioid use disorder epidemic with opioid overdoses killing 47,000 people in the U.S. in 2017. The past three decades have witnessed a significant increase in the prescribing of opioids for pain, based on the belief that patients were being undertreated for their pain, coupled with a widespread misunderstanding of the addictive properties of opioids. This increase in prescribing of opioids also saw a parallel increase in addiction and overdose. In an effort to address this ongoing epidemic of opioid misuse, policy and regulatory changes have been enacted that have served to limit the availability of prescription opioids for pain management. Overlooked amid the intense focus on efforts to end the opioid use disorder epidemic is the perspective of clinicians who are experiencing a significant amount of daily tension as opioid regulations and restrictions have limited their ability to treat the pain of their patients facing serious illness. Increased public and clinician scrutiny of opioid use has resulted in patients with serious illness facing stigma and other challenges when filling prescriptions for their pain medications or obtaining the prescription in the first place. Thus clinicians, patients, and their families are caught between the responses to the opioid use disorder epidemic and the need to manage pain related to serious illness. The National Academies of Sciences, Engineering, and Medicine sponsored a workshop on November 29, 2018, to examine these unintended consequences of the responses to the opioid use disorder epidemic for patients, families, communities, and clinicians, and to consider potential policy opportunities to address them. This publication summarizes the presentations and discussions from the workshop.

To effectively mature and transition DoD manufacturing science and technology advances into production, DoD must have access to a robust and responsive U.S. industrial base which is often driven by advanced manufacturing technologies. The Manufacturing USA institutes are considered crucial and game-changing catalysts that are bringing together innovative ecosystems in various technology and market sectors critical to DoD and the nation. Since 2012 DoD has invested $600 million directly in its Manufacturing USA institutes with the understanding that the initial federal investment included (1) core funding and (2) one-time, start-up funding to establish the institutes within a period of 5 to 7 years. As the institutes now begin to reach year five, DoD is evaluating the effectiveness of the institutes in fulfilling their goals and the best on going roles for the federal government, including on-going funding options, to ensure optimal benefit to U.S. competitiveness. This report reviews the role of DoDs investment to date in establishing its eight institutes as public private partnerships and its engagement with each institute after it has matured beyond the start-up period. --

On November 13 and 14, 2018, members of the National Academies of Sciences, Engineering, and Medicine's Global Forum on Innovation in Health Professional Education participated in a joint workshop with affiliates of the National Center for Interprofessional Practice and Education. The workshop participants explored the intersection of health professions education and practice. Both sectors are working toward the same goal of improving the health of patients and populations, without compromising the mental stability and wellbeing of the workforce or its learners. However, while education and practice have the same goal, there is a need for greater alignment between the sectors to more fully realize these desired outcomes. For example, educators, practitioners, and administrators must learn to adapt and respond to the growing role of technology within a wider context, in order to most effectively apply higher education within health systems. This publication summarizes the presentations and discussions from the workshop. --

"Pain is a leading cause of disability globally. The dramatic increase in opioid prescriptions within the past decade in the United States has contributed to the opioid epidemic the country currently faces, magnifying the need for longer term solutions to treat pain. The substantial burden of pain and the ongoing opioid crisis have attracted increased attention in medical and public policy communities, resulting in a revolution in thinking about how pain is managed. This new thinking acknowledges the complexity and biopsychosocial nature of the pain experience and the need for multifaceted pain management approaches with both pharmacological and nonpharmacological therapies. The magnitude and urgency of the twin problems of chronic pain and opioid addiction, combined with the changing landscape of pain management, prompted the National Academies of Sciences, Engineering, and Medicine to convene a workshop on December 4-5, 2018, in Washington, DC. The workshop brought together a diverse group of stakeholders to discuss the current status of nonpharmacological approaches to pain management, gaps, and future directions. This publication summarizes the presentations and discussions from the workshop."--

"This study was supported by contract 36C10X18C0019 between the National Academy of Sciences and the Department of Veterans Affairs"--Title page verso.

An international consensus policy to prevent the biological cross-contamination of planetary bodies exists and is maintained by the Committee on Space Research (COSPAR) of the International Council for Science, which is consultative to the United Nations Committee on the Peaceful Uses of Outer Space. Currently, COSPAR's planetary protection policy does not specify the status of sample-return missions from Phobos or Deimos, the moons of Mars. Although the moons themselves are not considered potential habitats for life or of intrinsic relevance to prebiotic chemical evolution, recent studies indicate that a significant amount of material recently ejected from Mars could be present on the surface of Phobos and, to a lesser extent, Deimos. This report reviews recent theoretical, experimental, and modeling research on the environments and physical conditions encountered by Mars ejecta during certain processes. It recommends whether missions returning samples from Phobos and/or Deimos should be classified as "restricted" or "unrestricted" Earth return in the framework of the planetary protection policy maintained by COSPAR. This report also considers the specific ways the classification of sample return from Deimos is a different case than sample return from Phobos. --

"A growing body of research indicates that social determinants of health have a significant impact on health care utilization and outcomes. Researchers and policymakers in the United States have spent decades exploring and discussing approaches to integrating health care and social services. While no nation has a truly integrated system, many other industrialized nations invest more heavily in social services than the United States, and are more effective in integrating these services with health care. Integrating health care and social services, such as accessible housing, meals and nutrition services, transportation, and caregiver training, is particularly important for those facing serious illness who typically encounter multiple chronic conditions, pain and other symptoms, functional dependency, frailty, and significant family caregiver needs. In an effort to better understand and facilitate discussions about the challenges and opportunities related to integrating health care and social services for people with serious illness, the National Academies of Sciences, Engineering, and Medicine held a full-day public workshop on July 19, 2018 in Washington, DC. The workshop featured a broad range of experts and stakeholders including researchers, policy analysts, patient and family caregiving advocates, and representatives of federal agencies. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

"Suicide prevention initiatives are part of much broader systems connected to activities such as the diagnosis of mental illness, the recognition of clinical risk, improving access to care, and coordinating with a broad range of outside agencies and entities around both prevention and public health efforts. Yet suicide is also an intensely personal issue that continues to be surrounded by stigma. On September 11-12, 2018, the National Academies of Sciences, Engineering, and Medicine held a workshop in Washington, DC, to discuss preventing suicide among people with serious mental illness. The workshop was designed to illustrate and discuss what is known, what is currently being done, and what needs to be done to identify and reduce suicide risk. Improving Care to Prevent Suicide Among People with Serious Mental Illness summarizes presentations and discussions of the workshop"--Publisher's description

"Continuing rapid developments in the life sciences offer the promise of providing tools to meet global challenges in health, agriculture, the environment, and economic development; some of the benefits are already being realized. However, such advances also bring with them new social, ethical, legal, and security challenges. Governance questions form an increasingly important part of the discussions about these advances--whether the particular issue under debate is the development of ethical principles for human genome editing, how to establish regulatory systems for the safe conduct of field trials of gene drive-modified organisms, or many others. However there are continuing concerns that the knowledge, tools, and techniques resulting from life sciences research could also enable the development of bioweapons or facilitate bioterrorism. Between June 10 and 13, 2018, more than 70 participants from 30 different countries and 5 international organizations took part in an international workshop, The Governance of Dual Use Research in the Life Sciences: Advancing Global Consensus on Research Oversight, in Zagreb, Croatia. Hosted by the Croatian Academy of Sciences and Arts, the workshop was a collaboration among the InterAcademy Partnership, the Croatian Academy, the Croatian Society for Biosafety and Biosecurity, and the U.S. National Academies of Sciences, Engineering, and Medicine. This publication summarizes the presentations and discussions from the workshop."--Publisher's description.

Disposal of Surplus Plutonium at the Waste Isolation Pilot Plant: Interim Report evaluates the general viability of the U.S. Department of Energy's National Nuclear Security Administration's (DOE-NNSA's) conceptual plans for disposing of 34 metric tons (MT) of surplus plutonium in the Waste Isolation Pilot Plant (WIPP), a deep geologic repository near Carlsbad, New Mexico. This report evaluates DOE-NNSA's plans to ship, receive, and emplace surplus plutonium in WIPP and its understanding of the impacts of these plans on WIPP and WIPP-bound waste streams. This report, the first of two to be issued during this study, provides a preliminary assessment of the general viability of DOE-NNSA's conceptual plans, focusing on some of the barriers to their implementation.

An Assessment of Four Divisions of the Physical Measurement Laboratory at the National Institute of Standards and Technology: Fiscal Year 2018 assesses the scientific and technical work performed by four divisions of the National Institute of Standards and Technology (NIST) Physical Measurement Laboratory. This publication reviews technical reports and technical program descriptions prepared by NIST staff and summarizes the findings of the authoring panel.

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

This title revisits "America's Lab Report: Investigations in High School Science" in order to consider its discussion of laboratory experiences and teacher and school readiness in an updated context. It considers how to engage today's middle- and high-school students in doing science and engineering through an analysis of evidence and examples.

To achieve goals for climate and economic growth, "negative emissions technologies" (NETs) that remove and sequester carbon dioxide from the air will need to play a significant role in mitigating climate change. Unlike carbon capture and storage technologies that remove carbon dioxide emissions directly from large point sources such as coal power plants, NETs remove carbon dioxide directly from the atmosphere or enhance natural carbon sinks. Storing the carbon dioxide from NETs has the same impact on the atmosphere and climate as simultaneously preventing an equal amount of carbon dioxide from being emitted. Recent analyses found that deploying NETs may be less expensive and less disruptive than reducing some emissions, such as a substantial portion of agricultural and land-use emissions and some transportation emissions. In 2015, the National Academies published Climate Intervention: Carbon Dioxide Removal and Reliable Sequestration, which described and initially assessed NETs and sequestration technologies. This report acknowledged the relative paucity of research on NETs and recommended development of a research agenda that covers all aspects of NETs from fundamental science to full-scale deployment. To address this need, Negative Emissions Technologies and Reliable Sequestration: A Research Agenda assesses the benefits, risks, and "sustainable scale potential" for NETs and sequestration. This report also defines the essential components of a research and development program, including its estimated costs and potential impact.

The Forum on Cyber Resilience of the National Academies of Sciences, Engineering, and Medicine hosted the Workshop on Recoverability as a First-Class Security Objective on February 8, 2018, in Washington, D.C. The workshop featured presentations from several experts in industry, research, and government roles who spoke about the complex facets of recoverability--that is, the ability to restore normal operations and security in a system affected by software or hardware failure or a deliberate attack. This publication summarizes the presentations and discussions from the workshop.

How we raise young children is one of today's most highly personalized and sharply politicized issues, in part because each of us can claim some level of "expertise." The debate has intensified as discoveries about our development--in the womb and in the first months and years--have reached the popular media. How can we use our burgeoning knowledge to assure the well-being of all young children, for their own sake as well as for the sake of our nation? Drawing from new findings, this book presents important conclusions about nature-versus-nurture, the impact of being born into a working family, the effect of politics on programs for children, the costs and benefits of intervention, and other issues. The committee issues a series of challenges to decision makers regarding the quality of child care, issues of racial and ethnic diversity, the integration of children's cognitive and emotional development, and more. Authoritative yet accessible, From Neurons to Neighborhoods presents the evidence about "brain wiring" and how kids learn to speak, think, and regulate their behavior. It examines the effect of the climate--family, child care, community--within which the child grows.

"Modern science is ever more driven by computations and simulations. In particular, the state of the art in space and Earth science often arises from complex simulations of climate, space weather, and astronomical phenomena. At the same time, scientific work requires data processing, presentation, and analysis through broadly available proprietary and community software. Implicitly or explicitly, software is central to science. Scientific discovery, understanding, validation, and interpretation are all enhanced by access to the source code of the software used by scientists. This report investigates and recommends options for NASA's Science Mission Directorate (SMD) as it considers how to establish a policy regarding open source software to complement its existing policy on open data. In particular, the report reviews existing data and software policies and the lessons learned from the implementation of those policies, summarizes community perspectives, and presents policy options and recommendations for implementing an open source software policy for NASA SMD."--Publisher's description.

"Solving problems related to use of water resources will be of paramount importance in coming decades as increasing pressure from growing populations, climate change, extreme weather, and aging water-related infrastructure threaten water availability and quality. The Water Mission Area (WMA) of the U.S. Geological Survey (USGS) has a long-established reputation for collecting and delivering high-quality, unbiased scientific information related to the nation's water resources. WMA observations help inform decisions ranging from rapid responses during emergencies such as hurricanes, floods, and forest fires, to the long-term management of water resources. Produced at the request of USGS, this report identifies the nation's highest-priority water science and resources challenges over the next 25 years. Future Water Priorities for the Nation summarizes WMA's current water science and research portfolio, and recommends strategic opportunities for WMA to more effectively address the most pressing challenges"--

Is rapid world population growth actually coming to an end? As population growth and its consequences have become front-page issues, projections of slowing growth from such institutions as the United Nations and the World Bank have been called into question. Beyond Six Billion asks what such projections really say, why they say it, whether they can be trusted, and whether they can be improved. The book includes analysis of how well past U.N. and World Bank projections have panned out, what errors have occurred, and why they have happened. Focusing on fertility as one key to accurate projections, the committee examines the transition from high, constant fertility to low fertility levels and discusses whether developing countries will eventually attain the very low levels of births now observed in the industrialized world. Other keys to accurate projections, predictions of lengthening life span and of the impact of international migration on specific countries, are also explored in detail. How good are our methods of population forecasting? How can we cope with the inevitable uncertainty? What population trends can we anticipate? Beyond Six Billion illuminates not only the forces that shape population growth but also the accuracy of the methods we use to quantify these forces and the uncertainty surrounding projections. The Committee on Population was established by the National Academy of Sciences (NAS) in 1983 to bring the knowledge and methods of the population sciences to bear on major issues of science and public policy. The committee's work includes both basic studies of fertility, health and mortality, and migration; and applied studies aimed at improving programs for the public health and welfare in the United States and in developing countries. The committee also fosters communication among researchers in different disciplines and countries and policy makers in government, international agencies, and private organizations. The work of the committee is made possible by funding from several government agencies and private foundations.

Total quality management (TQM), reengineering, the workplace of the twenty-first century--the 1990s have brought a sense of urgency to organizations to change or face stagnation and decline, according to Enhancing Organizational Performance. Organizations are adopting popular management techniques, some scientific, some faddish, often without introducing them properly or adequately measuring the outcome. Enhancing Organizational Performance reviews the most popular current approaches to organizational change--total quality management, reengineering, and downsizing--in terms of how they affect organizations and people, how performance improvements can be measured, and what questions remain to be answered by researchers. The committee explores how theory, doctrine, accepted wisdom, and personal experience have all served as sources for organization design. Alternative organization structures such as teams, specialist networks, associations, and virtual organizations are examined. Enhancing Organizational Performance looks at the influence of the organization's norms, values, and beliefs--its culture--on people and their performance, identifying cultural "levers" available to organization leaders. And what is leadership? The committee sorts through a wealth of research to identify behaviors and skills related to leadership effectiveness. The volume examines techniques for developing these skills and suggests new competencies that will become required with globalization and other trends. Mergers, networks, alliances, coalitions--organizations are increasingly turning to new intra- and inter-organizational structures. Enhancing Organizational Performance discusses how organizations cooperate to maximize outcomes. The committee explores the changing missions of the U.S. Army as a case study that has relevance to any organization. Noting that a musical greeting card contains more computing power than existed in the entire world before 1950, the committee addresses the impact of new technologies on performance. With examples, insights, and practical criteria, Enhancing Organizational Performance clarifies the nature of organizations and the prospects for performance improvement. This book will be important to corporate leaders, executives, and managers; faculty and students in organizational performance and the social sciences; business journalists; researchers; and interested individuals.

The brain ... There is no other part of the human anatomy that is so intriguing. How does it develop and function and why does it sometimes, tragically, degenerate? The answers are complex. In Discovering the Brain, science writer Sandra Ackerman cuts through the complexity to bring this vital topic to the public. The 1990s were declared the "Decade of the Brain" by former President Bush, and the neuroscience community responded with a host of new investigations and conferences. Discovering the Brain is based on the Institute of Medicine conference, Decade of the Brain: Frontiers in Neuroscience and Brain Research. Discovering the Brain is a "field guide" to the brain--an easy-to-read discussion of the brain's physical structure and where functions such as language and music appreciation lie. Ackerman examines: How electrical and chemical signals are conveyed in the brain. The mechanisms by which we see, hear, think, and pay attention--and how a "gut feeling" actually originates in the brain. Learning and memory retention, including parallels to computer memory and what they might tell us about our own mental capacity. Development of the brain throughout the life span, with a look at the aging brain. Ackerman provides an enlightening chapter on the connection between the brain's physical condition and various mental disorders and notes what progress can realistically be made toward the prevention and treatment of stroke and other ailments. Finally, she explores the potential for major advances during the "Decade of the Brain," with a look at medical imaging techniques--what various technologies can and cannot tell us--and how the public and private sectors can contribute to continued advances in neuroscience. This highly readable volume will provide the public and policymakers--and many scientists as well--with a helpful guide to understanding the many discoveries that are sure to be announced throughout the "Decade of the Brain."

"Medium- and heavy-duty trucks, motor coaches, and transit buses - collectively, "medium- and heavy-duty vehicles," or MHDVs - are used in every sector of the economy. The fuel consumption and greenhouse gas emissions of MHDVs have become a focus of legislative and regulatory action in the past few years. Reducing the Fuel Consumption and Greenhouse Gas Emissions of Medium- and Heavy-Duty Vehicles, Phase Two is a follow-on to the National Research Council's 2010 report, Technologies and Approaches to Reducing the Fuel Consumption of Medium-and Heavy-Duty Vehicles. That report provided a series of findings and recommendations on the development of regulations for reducing fuel consumption of MHDVs. This report comprises the first periodic, five-year follow-on to the 2010 report. Reducing the Fuel Consumption and Greenhouse Gas Emissions of Medium- and Heavy-Duty Vehicles, Phase Two reviews NHTSA fuel consumption regulations and considers the technological, market and regulatory factors that may be of relevance to a revised and updated regulatory regime taking effect for model years 2019-2022. The report analyzes and provides options for improvements to the certification and compliance procedures for medium- and heavy-duty vehicles; reviews an updated analysis of the makeup and characterization of the medium- and heavy-duty truck fleet; examines the barriers to and the potential applications of natural gas in class 2b through class 8 vehicles; and addresses uncertainties and performs sensitivity analyses for the fuel consumption and cost/benefit estimates."--Publisher's description.