Recent health care payment reforms aim to improve the alignment of Medicare payment strategies with goals to improve the quality of care provided, patient experiences with health care, and health outcomes, while also controlling costs. These efforts move Medicare away from the volume-based payment of traditional fee-for-service models and toward value-based purchasing, in which cost control is an explicit goal in addition to clinical and quality goals. Specific payment strategies include pay-for-performance and other quality incentive programs that tie financial rewards and sanctions to the quality and efficiency of care provided and accountable care organizations in which health care providers are held accountable for both the quality and cost of the care they deliver. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors is the first in a series of five reports commissioned to provide input into whether socioeconomic status (SES) and other social risk factors could be accounted for in Medicare payment and quality programs. This report focuses on defining SES and other social factors for the purposes of application to Medicare quality measurement and payment programs.
More than 2 million Americans below age 24 self-identify as being of American Indian or Alaska Native descent. Many of the serious behavioral, emotional, and physical health concerns facing young people today are especially prevalent with Native youth (e.g., depression, violence, and substance abuse). Adolescent Native Americans have death rates two to five times the rate of whites in the same age group because of higher levels of suicide and a variety of risky behaviors (e.g., drug and alcohol use, inconsistent school attendance). Violence, including intentional injuries, homicide, and suicide, accounts for three-quarters of deaths for Native American youth ages 12 to 20. Suicide is the second leading cause of death--and 2.5 times the national rate--for Native youth ages 15 to 24. Arrayed against these health problems are vital cultural strengths on which Native Americans can draw. At a workshop held in 2012, by the National Academies of Sciences, Engineering, and Medicine, presenters described many of these strengths, including community traditions and beliefs, social support networks, close-knit families, and individual resilience. In May 2014, the Academies held a follow-up workshop titled Advancing Health Equity for Native American Youth. Participants discussed issues related to (1) the visibility of racial and ethnic disparities in health and health care as a national problem, (2) the development of programs and strategies by and for Native and Indigenous communities to reduce disparities and build resilience, and (3) the emergence of supporting Native expertise and leadership. This report summarizes the presentations and discussions from the workshop.
Advancing the Discipline of Regulatory Science for Medical Product Development: An Update on Progress and a Forward-Looking Agenda: Workshop Summaryby Engineering Medicine National Academies of Sciences
The field of endeavors known as "regulatory science" has grown out of the need to link and integrate knowledge within and among basic science research, clinical research, clinical medicine, and other specific scientific disciplines whose focus, aggregation, and ultimate implementation could inform biomedical product development and regulatory decision making. Substantial efforts have been devoted to defining regulatory science and communicating its value and role across the scientific and regulatory ecosystems. Investments are also being made in technology infrastructure, regulatory systems, and workforce development to support and advance this burgeoning discipline. In October 2015, the National Academies of Sciences, Engineering, and Medicine held a public workshop to facilitate dialogue among stakeholders about the current state and scope of regulatory science, opportunities to address barriers to the discipline's success, and avenues for fostering collaboration across sectors. Participants explored key needs for strengthening the discipline of regulatory science, including considering what are the core components of regulatory science infrastructure to foster innovation in medical product development. This report summarizes the presentations and discussions from the workshop.
Arthur M. Sackler COLLOQUIA OF THE NATIONAL ACADEMY OF SCIENCES: Self-Organized Complexity in the Physical, Biological, and Social Sciencesby Engineering National Academies of Sciences
The National Academies Press (NAP)--publisher for the National Academies--publishes more than 200 books a year offering the most authoritative views, definitive information, and groundbreaking recommendations on a wide range of topics in science, engineering, and health. <P><P>Our books are unique in that they are authored by the nation's leading experts in every scientific field.
An Assessment of the National Science Foundation's Science and Technology Centers Program
Barriers and Opportunities for 2-Year and 4-Year STEM Degrees: Systemic Change to Support Students’ Diverse Pathwaysby Engineering Medicine National Academies of Sciences
Nearly 40 percent of the students entering 2- and 4-year postsecondary institutions indicated their intention to major in science, technology, engineering, and mathematics (STEM) in 2012. But the barriers to students realizing their ambitions are reflected in the fact that about half of those with the intention to earn a STEM bachelor's degree and more than two-thirds intending to earn a STEM associate's degree fail to earn these degrees 4 to 6 years after their initial enrollment. Many of those who do obtain a degree take longer than the advertised length of the programs, thus raising the cost of their education. Are the STEM educational pathways any less efficient than for other fields of study? How might the losses be "stemmed" and greater efficiencies realized? These questions and others are at the heart of this study. Barriers and Opportunities for 2-Year and 4-Year STEM Degrees reviews research on the roles that people, processes, and institutions play in 2-and 4-year STEM degree production. This study pays special attention to the factors that influence students' decisions to enter, stay in, or leave STEM majors--quality of instruction, grading policies, course sequences, undergraduate learning environments, student supports, co-curricular activities, students' general academic preparedness and competence in science, family background, and governmental and institutional policies that affect STEM educational pathways. Because many students do not take the traditional 4-year path to a STEM undergraduate degree, Barriers and Opportunities describes several other common pathways and also reviews what happens to those who do not complete the journey to a degree. This book describes the major changes in student demographics; how students, view, value, and utilize programs of higher education; and how institutions can adapt to support successful student outcomes. In doing so, Barriers and Opportunities questions whether definitions and characteristics of what constitutes success in STEM should change. As this book explores these issues, it identifies where further research is needed to build a system that works for all students who aspire to STEM degrees. The conclusions of this report lay out the steps that faculty, STEM departments, colleges and universities, professional societies, and others can take to improve STEM education for all students interested in a STEM degree.
Biological, Social, And Organizational Components Of Success: For Women In Academic Science And Engineeringby Engineering Committee on Maximizing the Potential of Women in Academic Science
During the last 40 years, the number of women studying science and engineering (S&E) has increased dramatically. Nevertheless, women do not hold academic faculty positions in numbers that commensurate with their increasing share of the S&E talent pool. The discrepancy exists at both the junior and senior faculty levels. In December 2005, the National Research Council held a workshop to explore these issues. Experts in a number of disciplines met to address what sex-differences research tells us about capability, behavior, career decisions, and achievement; the role of organizational structures and institutional policy; cross-cutting issues of race and ethnicity; key research needs and experimental paradigms and tools; and the ramifications of their research for policy, particularly for evaluating current and potential academic faculty. Biological, Social, and Organizational Components of Success for Women in Academic Science and Engineering consists of three elements: an introduction, summaries of panel discussions including public comment sessions, and poster abstracts.
Although the United States is currently capitalizing on its investment in science and technology effectively, there remains much room for improvement. This volume identifies the ingredients for success in capitalizing on such investments to produce national benefits, assesses current U.S. performance, and identifies future challenges. The book cites specific examples and examines several cross-cutting issues. It explores the possibility that the national research portfolio is losing diversity as a result of less long-term research in critical fields such as networking and materials. It also examines the implications of imbalances in the supply of and demand for science and engineering talent in emerging interdisciplinary fields such as bioinformatics.
As science and technology advance, the needs of employers change, and these changes continually reshape the job market for scientists and engineers. Such shifts present challenges for students as they struggle to make well-informed education and career choices. Careers in Science and Engineering offers guidance to students on planning careers--particularly careers in nonacademic settings--and acquiring the education necessary to attain career goals. This booklet is designed for graduate science and engineering students currently in or soon to graduate from a university, as well as undergraduates in their third or fourth year of study who are deciding whether or not to pursue graduate education. The content has been reviewed by a number of student focus groups and an advisory committee that included students and representatives of several disciplinary societies. Careers in Science and Engineering offers advice on not only surviving but also enjoying a science- or engineering-related education and career-- how to find out about possible careers to pursue, choose a graduate school, select a research project, work with advisers, balance breadth against specialization, obtain funding, evaluate postdoctoral appointments, build skills, and more. Throughout, Careers in Science and Engineering lists resources and suggests people to interview in order to gather the information and insights needed to make good education and career choices. The booklet also offers profiles of science and engineering professionals in a variety of careers. Careers in Science and Engineering will be important to undergraduate and graduate students who have decided to pursue a career in science and engineering or related areas. It will also be of interest to faculty, counselors, and education administrators.
One major goal of post-genomic biology is to understand the function of genes. Many gene functions are comprehensible only within the context of chemical communication, and this symposium seeks to highlight emerging research on genomics and chemical communication and catalyze further development of this highly productive interface. Many of the most abundantly represented genes in the genomes characterized to date encode proteins mediating interactions among organisms, including odorant receptors and binding proteins, enzymes involved in biosynthesis of pheromones and toxins, and enzymes catalyzing the detoxification of defense compounds. Determining the molecular underpinnings of the component elements of chemical communication systems in all of their forms has the potential to explain a vast array of ecological, physiological, and evolutionary phenomena; by the same token, ecologists who elucidate the environmental challenges faced by the organisms are uniquely well-equipped to characterize natural ligands for receptors and substrates for enzymes. Thus, partnerships between genome biologists and chemical ecologists will likely be extremely synergistic. To date, these groups have rarely had opportunities to interact within a single forum. Such interactions are vital given the considerable practical benefits potentially stemming from these studies, including the development of biorational products for agricultural and forest pest management, for disease treatment, and for improving the quality of ecosystem health.
Effects of the Deletion of Chemical Agent Washout on Operations at the Blue Grass Chemical Agent Destruction Pilot Plantby Engineering Medicine National Academies of Sciences
The United States manufactured significant quantities of chemical weapons during the Cold War and the years prior. Because the chemical weapons are aging, storage constitutes an ongoing risk to the facility workforces and to the communities nearby. In addition, the Chemical Weapons Convention treaty stipulates that the chemical weapons be destroyed. The United States has destroyed approximately 90 percent of the chemical weapons stockpile located at seven sites. As part of the effort to destroy its remaining stockpile, the Department of Defense is building the Blue Grass Chemical Agent Destruction Pilot Plant (BGCAPP) on the Blue Grass Army Depot (BGAD), near Richmond, Kentucky. The stockpile stored at BGAD consists of rockets and projectiles containing the nerve agents GB and VX and the blister agent mustard. Continued storage poses a risk to the BGAD workforce and the surrounding community because these munitions are several decades old and are developing leaks. Due to public opposition to the use of incineration to destroy the BGAD stockpile, Congress mandated that non- incineration technologies be identified for use at BGCAPP. As a result, the original BGCAPP design called for munitions to be drained of agent and then for the munition bodies to be washed out using high-pressure hot water. However as part of a larger package of modifications called Engineering Change Proposal 87 (ECP-87), the munition washout step was eliminated. Effects of the Deletion of Chemical Agent Washout on Operations at the Blue Grass Chemical Agent Destruction Pilot Plant examines the impacts of this design change on operations at BGCAPP and makes recommendations to guide future decision making.
Evaluating And Improving Undergraduate Teaching: In Science, Technology, Engineering, And Mathematicsby Technology Engineering Committee on Recognizing Evaluating Rewarding Developing Excellence in Teaching of Undergraduate Science Mathematics
Economic, academic, and social forces are causing undergraduate schools to start a fresh examination of teaching effectiveness. Administrators face the complex task of developing equitable, predictable ways to evaluate, encourage, and reward good teaching in science, math, engineering, and technology.Evaluating, and Improving Undergraduate Teaching in Science, Technology, Engineering, and Mathematics offers a vision for systematic evaluation of teaching practices and academic programs, with recommendations to the various stakeholders in higher education about how to achieve change.What is good undergraduate teaching? This book discusses how to evaluate undergraduate teaching of science, mathematics, engineering, and technology and what characterizes effective teaching in these fields.Why has it been difficult for colleges and universities to address the question of teaching effectiveness? The committee explores the implications of differences between the research and teaching cultures-and how practices in rewarding researchers could be transferred to the teaching enterprise.How should administrators approach the evaluation of individual faculty members? And how should evaluation results be used? The committee discusses methodologies, offers practical guidelines, and points out pitfalls.Evaluating, and Improving Undergraduate Teaching in Science, Technology, Engineering, and Mathematics provides a blueprint for institutions ready to build effective evaluation programs for teaching in science fields.
Although women have made important inroads in science and engineering since the early 1970s, their progress in these fields has stalled over the past several years. This study looks at women in science and engineering careers in the 1970s and 1980s, documenting differences in career outcomes between men and women and between women of different races and ethnic backgrounds.The panel presents what is known about the following questions and explores their policy implications: In what sectors are female Ph.D.s employed? What salary disparities exist between men and women in these fields? How is marital status associated with career attainment? Does it help a career to have a postdoctoral appointment? How well are female scientists and engineers represented in management?Within the broader context of education and the labor market, the book provides detailed comparisons between men and women Ph.D.s in a number of measures: financial support for education, academic rank achieved, salary, and others. The study covers engineering; the mathematical, physical, life, and social and behavioral sciences; medical school faculty; and recipients of National Institutes of Health grants.Findings and recommendations in this volume will be of interest to practitioners, faculty, and students in science and engineering as well as education administrators, employers, and researchers in these fields.
On March 10-11, 2016, the National Academies of Sciences, Engineering, and Medicine held a public symposium on potential U.S. government policies for the oversight of gain-of- function (GOF) research. This was the Academies' second meeting held at the request of the U.S. government to provide a mechanism to engage the life sciences community and the broader public and solicit feedback on optimal approaches to ensure effective federal oversight of GOF research as part of a broader U.S. government deliberative process. The first symposium, held in December 2014, examined the underlying scientific and technical questions surrounding the potential risks and benefits of GOF research involving pathogens with pandemic potential. The second symposium focused on discussion of the draft recommendations regarding GOF research of a Working Group of the National Science Advisory Board for Biosecurity. This report summarizes the key issues and ideas identified during the second symposium.
Since the 2014 Ebola outbreak many public- and private-sector leaders have seen a need for improved management of global public health emergencies. The effects of the Ebola epidemic go well beyond the three hardest-hit countries and beyond the health sector. Education, child protection, commerce, transportation, and human rights have all suffered. The consequences and lethality of Ebola have increased interest in coordinated global response to infectious threats, many of which could disrupt global health and commerce far more than the recent outbreak. In order to explore the potential for improving international management and response to outbreaks the National Academy of Medicine agreed to manage an international, independent, evidence-based, authoritative, multistakeholder expert commission. As part of this effort, the Institute of Medicine convened four workshops in summer of 2015 to inform the commission report. The presentations and discussions from the Workshop on Research and Development of Medical Products are summarized in this report.
Optical science and engineering affect almost every aspect of our lives. Millions of miles of optical fiber carry voice and data signals around the world. Lasers are used in surgery of the retina, kidneys, and heart. New high-efficiency light sources promise dramatic reductions in electricity consumption. Night-vision equipment and satellite surveillance are changing how wars are fought. Industry uses optical methods in everything from the production of computer chips to the construction of tunnels. Harnessing Light surveys this multitude of applications, as well as the status of the optics industry and of research and education in optics, and identifies actions that could enhance the field's contributions to society and facilitate its continued technical development.
The Institute of Medicine Roundtable on Health Literacy convened a 1-day public workshop to explore the relationship between palliative care and health literacy, and the importance of health literate communication in providing high-quality delivery of palliative care. Health Literacy and Palliative Care summarizes the discussions that occurred throughout the workshop and highlights the key lessons presented, practical strategies, and the needs and opportunities for improving health literacy in the United States.
In April 2015, the Institute of Medicine convened a workshop to explore the potential uses of simulation and other types of modeling for the purpose of selecting and refining potential strategies, ranging from interventions to investments, to improve the health of communities and the nation's health. Participants worked to identify how modeling could inform population health decision making based on lessons learned from models that have been, or have not been, used successfully, opportunities and barriers to incorporating models into decision making, and data needs and opportunities to leverage existing data and to collect new data for modeling. This report summarizes the presentations and discussions from this workshop.
The National Academies Press (NAP)--publisher for the National Academies--publishes more than 200 books a year offering the most authoritative views, definitive information, and groundbreaking recommendations on a wide range of topics in science, engineering, and health. Our books are unique in that they are authored by the nation's leading experts in every scientific field.
The U. S. Army Corps of Engineers (Corps) is responsible for construction, operations, and maintenance of much of the nation's water resources infrastructure. This infrastructure includes flood control levees, multi-purpose dams, locks, navigation channels, port and harbor facilities, and beach protection infrastructure. The Corps of Engineers also regulates the dredging and filling of wetlands subject to federal jurisdictions. Along with its programs for flood damage reduction and support of commercial navigation, ecosystem restoration was added as a primary Corps mission area in 1996. The National Research Council (NRC) Committee on U. S. Army Corps of Engineers on Water Resources Science, Engineering, and Planning was convened by the NRC at the request of the Corps of Engineers to provide independent advice to the Corps on an array of strategic and planning issues. National Water Resources Challenges Facing the U. S. Army Corps of Engineers surveys the key water resources challenges facing the Corps, the limits of what might be expected today from the Corps, and future prospects for the agency. This report presents several findings, but no recommendations, to the Corps of Engineers based on initial investigations and discussions with Corps leadership. National Water Resources Challenges Facing the U. S. Army Corps of Engineers can serve as a foundational resource for the Corps of Engineers, U. S. Congress, federal agencies, and Corps project co-sponsors, among others.
Obesity in the Early Childhood Years: State of the Science and Implementation of Promising Solutions: Workshop Summaryby Engineering Medicine National Academies of Sciences
Among the many troubling aspects of the rising prevalence of obesity in the United States and elsewhere in recent years, the growth of early childhood overweight and obesity stands out. To explore what is known about effective and innovative interventions to counter obesity in young children, the National Academies of Sciences, Engineering, and Medicine's Roundtable on Obesity Solutions held a workshop in October 2015. The workshop brought together many of the leading researchers on obesity in young children to describe the state of the science and potential solutions based on that research. Participants explored sustainable collaborations and new insights into the implementation of interventions and policies, particularly those related to nutrition and physical activity, for the treatment and prevention of obesity in young children. Obesity in the Early Childhood Years summarizes the presentations and discussions from the workshop.
A report on Observations on the President's Fiscal Year 1999 Federal Science and Technology Budget
Living independently and participating in one's community are priorities for many people. In many regions across the United States, there are programs that support and enable people with disabilities and older adults to live where they choose and with whom they choose and to participate fully in their communities. Tremendous progress has been made. However, in many cases, the programs themselves - and access to them - vary not only between states but also within states. Many programs are small, and even when they prove to be successful they are still not scaled up to meet the needs of the many people who would benefit from them. The challenges can include insufficient workforce, insufficient funding, and lack of evidence demonstrating effectiveness or value. To get a better understanding of the policies needed to maximize independence and support community living and of the research needed to support implementation of those policies, the National Academies of Sciences, Engineering, and Medicine convened a public workshop in October 2015. Participants explored policies in place that promote independence and community living for older adults and people with physical disabilities, and identified policies and gaps in policies that can be barriers to independence and the research needed to support changing those policies. This report summarizes the presentations and discussions from the workshop.
Health care is in the midst of a dramatic transformation in the United States. Spurred by technological advances, economic imperatives, and governmental policies, information technologies are rapidly being applied to health care in an effort to improve access, enhance quality, and decrease costs. At the same time, the use of technologies by the consumers of health care is changing how people interact with the health care system and with health information. These changes in health care have the potential both to exacerbate and to diminish the stark disparities in health and well-being that exist among population groups in the United States. If the benefits of technology flow disproportionately to those who already enjoy better coverage, use, and outcomes than disadvantaged groups, heath disparities could increase. But if technologies can be developed and implemented in such a way to improve access and enhance quality for the members of all groups, the ongoing transformation of health care could reduce the gaps among groups while improving health care for all. To explore the potential for further insights into, and opportunities to address, disparities in underserved populations the National Academies of Sciences, Engineering, and Medicine held a workshop in October 2014. The workshop focused on (1) how communities are using digital health technologies to improve health outcomes for racial and ethnic minority populations, (2) how community engagement can improve access to high-quality health information for members of these groups, and (3) on models of successful technology-based strategies to reduce health disparities. This report summarizes the presentations and discussions at the workshop.
U.S. strength in science, technology, engineering, and mathematics (STEM) disciplines has formed the basis of innovations, technologies, and industries that have spurred the nation's economic growth throughout the last 150 years. Universities are essential to the creation and transfer of new knowledge that drives innovation. This knowledge moves out of the university and into broader society in several ways -- through highly skilled graduates (i.e. human capital); academic publications; and the creation of new products, industries, and companies via the commercialization of scientific breakthroughs. Despite this, our understanding of how universities receive, interpret, and respond to industry signaling demands for STEM-trained workers is far from complete. Promising Practices for Strengthening the Regional STEM Workforce Development Ecosystem reviews the extent to which universities and employers in five metropolitan communities (Phoenix, Arizona; Cleveland, Ohio; Montgomery, Alabama; Los Angeles, California; and Fargo, North Dakota) collaborate successfully to align curricula, labs, and other undergraduate educational experiences with current and prospective regional STEM workforce needs. This report focuses on how to create the kind of university-industry collaboration that promotes higher quality college and university course offerings, lab activities, applied learning experiences, work-based learning programs, and other activities that enable students to acquire knowledge, skills, and attributes they need to be successful in the STEM workforce. The recommendations and findings presented will be most relevant to educators, policy makers, and industry leaders.
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