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Today in the United States, the professional health workforce is not consistently prepared to provide high quality health care and assure patient safety, even as the nation spends more per capita on health care than any other country. The absence of a comprehensive and well-integrated system of continuing education (CE) in the health professions is an important contributing factor to knowledge and performance deficiencies at the individual and system levels. To be most effective, health professionals at every stage of their careers must continue learning about advances in research and treatment in their fields (and related fields) in order to obtain and maintain up-to-date knowledge and skills in caring for their patients. Many health professionals regularly undertake a variety of efforts to stay up to date, but on a larger scale, the nation's approach to CE for health professionals fails to support the professions in their efforts to achieve and maintain proficiency. Redesigning Continuing Education in the Health Professions illustrates a vision for a better system through a comprehensive approach of continuing professional development, and posits a framework upon which to develop a new, more effective system. The book also offers principles to guide the creation of a national continuing education institute.
The NASA Institute for Advanced Concepts (NIAC) was formed in 1998 to provide an independent source of advanced aeronautical and space concepts that could dramatically impact how NASA develops and conducts its missions. Until the program's termination in August 2007, NIAC provided an independent open forum, a high-level point of entry to NASA for an external community of innovators, and an external capability for analysis and definition of advanced aeronautics and space concepts to complement the advanced concept activities conducted within NASA. Throughout its 9-year existence, NIAC inspired an atmosphere for innovation that stretched the imagination and encouraged creativity. As requested by Congress, this volume reviews the effectiveness of NIAC and makes recommendations concerning the importance of such a program to NASA and to the nation as a whole, including the proper role of NASA and the federal government in fostering scientific innovation and creativity and in developing advanced concepts for future systems. Key findings and recommendations include that in order to achieve its mission, NASA must have, and is currently lacking, a mechanism to investigate visionary, far-reaching advanced concepts. Therefore, a NIAC-like entity should be reestablished to fill this gap.
During geologic spans of time, Earth's shifting tectonic plates, atmosphere, freezing water, thawing ice, flowing rivers, and evolving life have shaped Earth's surface features. The resulting hills, mountains, valleys, and plains shelter ecosystems that interact with all life and provide a record of Earth surface processes that extend back through Earth's history. Despite rapidly growing scientific knowledge of Earth surface interactions, and the increasing availability of new monitoring technologies, there is still little understanding of how these processes generate and degrade landscapes. Landscapes on the Edge identifies nine grand challenges in this emerging field of study and proposes four high-priority research initiatives. The book poses questions about how our planet's past can tell us about its future, how landscapes record climate and tectonics, and how Earth surface science can contribute to developing a sustainable living surface for future generations.
Evaluating Testing, Costs, and Benefits of Advanced Spectroscopic Portals for Screening Cargo at Ports of Entry: Interim Report - (Abbreviated Version)by National Research Council of the National Academies
To improve screening of containerized cargo for nuclear and radiological material that might be entering the United States, the Department of Homeland Security (DHS) is seeking to deploy new radiation detectors, called advanced spectroscopic portals (ASPs). The ASPs are intended to replace some or all of the current system of radiation portal monitors (called PVT RPMs) used in conjunction with handheld radioisotope identifiers (RIIDs) to detect and identify radioactive material in cargo. The U.S. Congress required the Secretary of Homeland Security to certify that ASPs will provide a 'significant increase in operational effectiveness' over continued use of the existing screening devices before DHS can proceed with full-scale procurement of ASPs for deployment. Congress also directed DHS to request this National Research Council study to advise the Secretary of Homeland Security about testing, analysis, costs, and benefits of the ASPs prior to the certification decision. This interim report is based on testing done before 2008; on plans for, observations of, and preliminary results from tests done in 2008; and on the agency's draft cost-benefit analysis as of October 2008. The book provides advice on how DHS' Domestic Nuclear Detection Office (DNDO) can complete and make more rigorous its ASP evaluation for the Secretary and the nation.
In 2007 and 2008, the world witnessed a dramatic increase in food prices. The global financial crisis that began in 2008 compounded the burden of high food prices, exacerbating the problems of hunger and malnutrition in developing countries. The tandem food price and economic crises struck amidst the massive, chronic problem of hunger and undernutrition in developing countries. National governments and international actors have taken a variety of steps to mitigate the negative effects of increased food prices on particular groups. The recent abrupt increase in food prices, in tandem with the current global economic crisis, threatens progress already made in these areas, and could inhibit future efforts. The Institute of Medicine held a workshop, summarized in this volume, to describe the dynamic technological, agricultural, and economic issues contributing to the food price increases of 2007 and 2008 and their impacts on health and nutrition in resource-poor regions. The compounding effects of the current global economic downturn on nutrition motivated additional discussions on these dual crises, their impacts on the nutritional status of vulnerable populations, and opportunities to mitigate their negative nutritional effects.
Although asbestos is no longer mined in the United States, prior and ongoing exposures to asbestos continue to contribute to respiratory diseases, including mesothelioma, lung cancer, and asbestosis. To examine ongoing issues and concerns in this field, the National Institute for Occupational Safety and Health (NIOSH) drafted a research roadmap, Asbestos Fibers and Other Elongated Mineral Particles: State of the Science and Roadmap for Research, that provides an overview of the state of the science and a plan for future research in areas including toxicology, mineralogy, epidemiology, and exposure assessment. The focus of the proposed research is on clarifying the relationship between human health effects and the physical and chemical characteristics of a wide range of elongate mineral particles. In 2008, NIOSH asked the Institute of Medicine and the National Research Council to form a committee to provide a review of the scientific and technical quality of the January 2009 draft NIOSH Roadmap document. The present volume provides the committee's assessment of the Roadmap and recommendations for strengthening its utility for NIOSH, other federal agencies, the private sector, and other stakeholders.
The goal of eliminating disparities in health care in the United States remains elusive. Even as quality improves on specific measures, disparities often persist. Addressing these disparities must begin with the fundamental step of bringing the nature of the disparities and the groups at risk for those disparities to light by collecting health care quality information stratified by race, ethnicity and language data. Then attention can be focused on where interventions might be best applied, and on planning and evaluating those efforts to inform the development of policy and the application of resources. A lack of standardization of categories for race, ethnicity, and language data has been suggested as one obstacle to achieving more widespread collection and utilization of these data. Race, Ethnicity, and Language Data identifies current models for collecting and coding race, ethnicity, and language data; reviews challenges involved in obtaining these data, and makes recommendations for a nationally standardized approach for use in health care quality improvement.
Two Centuries of Darwin is the outgrowth of an Arthur M. Sackler Colloquium, sponsored by the National Academy of Sciences on January 16-17, 2009. In the chapters of this book, leading evolutionary biologists and science historians reflect upon and commemorate the Darwinian Revolution. They canvass modern research approaches and current scientific thought on each of the three main categories of selection (natural, artificial, and sexual) that Darwin addressed during his career. Although Darwin's legacy is associated primarily with the illumination of natural selection in The Origin, he also contemplated and wrote extensively about what we now term artificial selection and sexual selection. In a concluding section of this book, several science historians comment on Darwin's seminal contributions. Two Centuries of Darwin is the third book of the In the Light of Evolution series. Each installment in the series explores evolutionary perspectives on a particular biological topic that is scientifically intriguing but also has special relevance to contemporary societal issues or challenges. The ILE series aims to interpret phenomena in various areas of biology through the lens of evolution and address some of the most intellectually engaging, as well as pragmatically important societal issues of our times.
Systems for Research and Evaluation for Translating Genome-Based Discoveries for Health: Workshop Summaryby Institute of Medicine of the National Academies
With the advent of genome-wide association studies, numerous associations between specific gene loci and complex diseases have been identified--for breast cancer, coronary artery disease, and asthma, for example. This rapidly advancing field of genomics has stirred great interest in "personalized" health care from both the public and private sectors. The hope is that using genomic information in clinical care will lead to reduced health care costs and improved health outcomes as therapies are tailored to the genetic susceptibilities of patients. A variety of genetically based health care innovations have already reached the marketplace, but information about the clinical use of these treatments and diagnostics is limited. Currently data do not provide information about how a genomic test impacts clinical care and patient health outcomes--other approaches are needed to garner such information. This volume summarizes a workshop to address central questions related to the development of systems to evaluate clinical use of health care innovations that stem from genome-based research: What are the practical realities of creating such systems? What different models could be used? What are the strengths and weaknesses of each model? How effectively can such systems address questions about health outcomes?
Health literacy--the ability for individuals to obtain, process, and understand basic health information and services to facilitate appropriate health decisions--is increasingly recognized as an important facet of health care and health outcomes. Although research on health literacy has grown tremendously in the past decade, there is no widely agreed-upon framework for health literacy as a determinant of health outcomes. Most instruments focus on assessing an individual's health literacy, yet the scope of health literacy reaches far beyond an individual's skills and abilities. Health literacy occurs in the context of the health care system, and therefore measures of health literacy must also assess the demands and complexities of the health care systems with which patients interact. For example, measures are needed to determine how well the system has been organized so that it can be navigated by individuals with different levels of health literacy and how well health organizations are doing at making health information understandable and actionable. To examine what is known about measures of health literacy, the Institute of Medicine convened a workshop. The workshop, summarized in this volume, reviews the current status of measures of health literacy, including those used in the health care setting; discusses possible surrogate measures that might be used to assess health literacy; and explores ways in which health literacy measures can be used to assess patient-centered approaches to care.
Biowatch and Public Health Surveillance: Evaluating Systems for the Early Detection of Biological Threats - Abbreviated Versionby Institute of Medicine National Research Council of the National Academies
Following the attacks of September 11, 2001 and the anthrax letters, the ability to detect biological threats as quickly as possible became a top priority. In 2003 the Department of Homeland Security (DHS) introduced the BioWatch program--a federal monitoring system intended to speed detection of specific biological agents that could be released in aerosolized form during a biological attack. The present volume evaluates the costs and merits of both the current BioWatch program and the plans for a new generation of BioWatch devices. BioWatch and Public Health Surveillance also examines infectious disease surveillance through hospitals and public health agencies in the United States, and considers whether BioWatch and traditional infectious disease surveillance are redundant or complementary.
The Socioeconomic Effects of Public Sector Information on Digital Networks: Toward a Better Understanding of Different Access and Reuse Policies - Workshop Summaryby National Research Council of the National Academies
While governments throughout the world have different approaches to how they make their public sector information (PSI) available and the terms under which the information may be reused, there appears to be a broad recognition of the importance of digital networks and PSI to the economy and to society. However, despite the huge investments in PSI and the even larger estimated effects, surprisingly little is known about the costs and benefits of different information policies on the information society and the knowledge economy. By understanding the strengths and weaknesses of the current assessment methods and their underlying criteria, it should be possible to improve and apply such tools to help rationalize the policies and to clarify the role of the internet in disseminating PSI. This in turn can help promote the efficiency and effectiveness of PSI investments and management, and to improve their downstream economic and social results. The workshop that is summarized in this volume was intended to review the state of the art in assessment methods and to improve the understanding of what is known and what needs to be known about the effects of PSI activities.
Great advances have been made in our understanding of the climate system over the past few decades, and remotely sensed data have played a key role in supporting many of these advances. Improvements in satellites and in computational and data-handling techniques have yielded high quality, readily accessible data. However, rapid increases in data volume have also led to large and complex datasets that pose significant challenges in data analysis. Uncertainty characterization is needed for every satellite mission and scientists continue to be challenged by the need to reduce the uncertainty in remotely sensed climate records and projections. The approaches currently used to quantify the uncertainty in remotely sensed data lack an overall mathematically based framework. An additional challenge is characterizing uncertainty in ways that are useful to a broad spectrum of end-users. In December 2008, the National Academies held a workshop, summarized in this volume, to survey how statisticians, climate scientists, and remote sensing experts might address the challenges of uncertainty management in remote sensing of climate data. The workshop emphasized raising and discussing issues that could be studied more intently by individual researchers or teams of researchers, and setting the stage for possible future collaborative activities.
From September 2007 to June 2008 the Space Studies Board conducted an international public seminar series, with each monthly talk highlighting a different topic in space and Earth science. The principal lectures from the series are compiled in Forging the Future of Space Science. The topics of these events covered the full spectrum of space and Earth science research, from global climate change, to the cosmic origins of life, to the exploration of the Moon and Mars, to the scientific research required to support human spaceflight. The prevailing messages throughout the seminar series as demonstrated by the lectures in this book are how much we have accomplished over the past 50 years, how profound are our discoveries, how much contributions from the space program affect our daily lives, and yet how much remains to be done. The age of discovery in space and Earth science is just beginning. Opportunities abound that will forever alter our destiny.
The Department of Defense (DOD) spends over $300 billion each year to develop, produce, field and sustain weapons systems (the U.S. Air Force over $100 billion per year). DOD and Air Force acquisitions programs often experience large cost overruns and schedule delays leading to a loss in confidence in the defense acquisition system and the people who work in it. Part of the DOD and Air Force response to these problems has been to increase the number of program and technical reviews that acquisition programs must undergo. This book looks specifically at the reviews that U.S. Air Force acquisition programs are required to undergo and poses a key question: Can changes in the number, content, or sequence of reviews help Air Force program managers more successfully execute their programs? This book concludes that, unless they do it better than they are now, Air Force and DOD attempts to address poor acquisition program performance with additional reviews will fail. This book makes five recommendations that together form a gold standard for conduct of reviews and if implemented and rigorously managed by Air Force and DOD acquisition executives can increase review effectiveness and efficiency. The bottom line is to help program managers successfully execute their programs.
Water is our most fundamental natural resource, a resource that is limited. Challenges to our nation's water resources continue to grow, driven by population growth, ecological needs, climate change, and other pressures. The nation needs more and improved water science and information to meet these challenges. Toward a Sustainable and Secure Water Future reviews the United States Geological Survey's (USGS) Water Resource Discipline (WRD), one of the nation's foremost water science organizations. This book provides constructive advice to help the WRD meet the nation's water needs over the coming decades. Of interest primarily to the leadership of the USGS WRD, many findings and recommendations also target the USGS leadership and the Department of Interior (DOI), because their support is necessary for the WRD to respond to the water needs of the nation.
The Bureau of Justice Statistics (BJS) of the U.S. Department of Justice is one of the smallest of the U.S. principal statistical agencies but shoulders one of the most expansive and detailed legal mandates among those agencies. Ensuring the Quality, Credibility, and Relevance of U.S. Justice Statistics examines the full range of BJS programs and suggests priorities for data collection. BJS's data collection portfolio is a solid body of work, well justified by public information needs or legal requirements and a commendable effort to meet its broad mandate given less-than-commensurate fiscal resources. The book identifies some major gaps in the substantive coverage of BJS data, but notes that filling those gaps would require increased and sustained support in terms of staff and fiscal resources. In suggesting strategic goals for BJS, the book argues that the bureau's foremost goal should be to establish and maintain a strong position of independence. To avoid structural or political interference in BJS work, the report suggests changing the administrative placement of BJS within the Justice Department and making the BJS directorship a fixed-term appointment. In its thirtieth year, BJS can look back on a solid body of accomplishment; this book suggests further directions for improvement to give the nation the justice statistics--and the BJS--that it deserves.
Access to oral health services is a problem for all segments of the U.S. population, and especially problematic for vulnerable populations, such as rural and underserved populations. The many challenges to improving access to oral health services include the lack of coordination and integration among the oral health, public health, and medical health care systems; misaligned payment and education systems that focus on the treatment of dental disease rather than prevention; the lack of a robust evidence base for many dental procedures and workforce models; and regulatory barriers that prevent the exploration of alternative models of care. This volume, the summary of a three-day workshop, evaluates the sufficiency of the U.S. oral health workforce to consider three key questions: What is the current status of access to oral health services for the U.S. population? What workforce strategies hold promise to improve access to oral health services? How can policy makers, state and federal governments, and oral health care providers and practitioners improve the regulations and structure of the oral health care system to improve access to oral health services?
The last century witnessed dramatic changes in the practice of health care, and coming decades promise advances that were not imaginable even in the relatively recent past. Science and technology continue to offer new insights into disease pathways and treatments, as well as mechanisms of protecting health and preventing disease. Genomics and proteomics are bringing personalized risk assessment, prevention, and treatment options within reach; health information technology is expediting the collection and analysis of large amounts of data that can lead to improved care; and many disciplines are contributing to a broadening understanding of the complex interplay among biology, environment, behavior, and socioeconomic factors that shape health and wellness. On February 25 - 27, 2009, the Institute of Medicine (IOM) convened the Summit on Integrative Medicine and the Health of the Public in Washington, DC. The summit brought together more than 600 scientists, academic leaders, policy experts, health practitioners, advocates, and other participants from many disciplines to examine the practice of integrative medicine, its scientific basis, and its potential for improving health. This publication summarizes the background, presentations, and discussions that occurred during the summit.
When Drakes Estero, which lies within the Point Reyes National Seashore (PRNS) about 25 miles northwest of San Francisco, California, was designated by Congress in 1976 as Potential Wilderness, it contained a commercial shellfish mariculture operation. Oyster mariculture began in Drakes Estero with the introduction of the nonnative Pacific oyster in 1932, and has been conducted continuously from that date forward. Hence, the cultural history of oyster farming predates the designation of Point Reyes as a National Seashore in 1962. Nevertheless, with the approach of the 2012 expiration date of the current National Park Service (NPS) Reservation of Use and Occupancy (RUO) and Special Use Permit (SUP) that allows Drakes Bay Oyster Company (DBOC) to operate within the estero, NPS has expressed concern over the scope and intensity of impacts of the shellfish culture operations on the estero's ecosystem. Public debate over whether scientific information justifies closing the oyster farm led to the request for this study to help clarify the scientific issues raised with regard to the shellfish mariculture activities in Drakes Estero.
From 1962 to 1971, the U.S. military sprayed herbicides over Vietnam to strip the thick jungle canopy that could conceal opposition forces, to destroy crops that those forces might depend on, and to clear tall grasses and bushes from the perimeters of U.S. base camps and outlying fire-support bases. In response to concerns and continuing uncertainty about the long-term health effects of the sprayed herbicides on Vietnam veterans, Veterans and Agent Orange provides a comprehensive evaluation of scientific and medical information regarding the health effects of exposure to Agent Orange and other herbicides used in Vietnam. The 2008 report is the eighth volume in this series of biennial updates. It will be of interest to policy makers and physicians in the federal government, veterans and their families, veterans' organizations, researchers, and health professionals.
As the human population grows--tripling in the past century while, simultaneously, quadrupling its demand for water--Earth's finite freshwater supplies are increasingly strained, and also increasingly contaminated by domestic, agricultural, and industrial wastes. Today, approximately one-third of the world's population lives in areas with scarce water resources. Nearly one billion people currently lack access to an adequate water supply, and more than twice as many lack access to basic sanitation services. It is projected that by 2025 water scarcity will affect nearly two-thirds of all people on the planet. Recognizing that water availability, water quality, and sanitation are fundamental issues underlying infectious disease emergence and spread, the Institute of Medicine held a two-day public workshop, summarized in this volume. Through invited presentations and discussions, participants explored global and local connections between water, sanitation, and health; the spectrum of water-related disease transmission processes as they inform intervention design; lessons learned from water-related disease outbreaks; vulnerabilities in water and sanitation infrastructure in both industrialized and developing countries; and opportunities to improve water and sanitation infrastructure so as to reduce the risk of water-related infectious disease.
The United States is increasingly dependent on information and information technology for both civilian and military purposes, as are many other nations. Although there is a substantial literature on the potential impact of a cyberattack on the societal infrastructure of the United States, little has been written about the use of cyberattack as an instrument of U.S. policy. Cyberattacks--actions intended to damage adversary computer systems or networks--can be used for a variety of military purposes. But they also have application to certain missions of the intelligence community, such as covert action. They may be useful for certain domestic law enforcement purposes, and some analysts believe that they might be useful for certain private sector entities who are themselves under cyberattack. This report considers all of these applications from an integrated perspective that ties together technology, policy, legal, and ethical issues. Focusing on the use of cyberattack as an instrument of U.S. national policy, Technology, Policy, Law and Ethics Regarding U.S. Acquisition and Use of Cyberattack Capabilities explores important characteristics of cyberattack. It describes the current international and domestic legal structure as it might apply to cyberattack, and considers analogies to other domains of conflict to develop relevant insights. Of special interest to the military, intelligence, law enforcement, and homeland security communities, this report is also an essential point of departure for nongovernmental researchers interested in this rarely discussed topic.
Data suggest that exposure to secondhand smoke can result in heart disease in nonsmoking adults. Recently, progress has been made in reducing involuntary exposure to secondhand smoke through legislation banning smoking in workplaces, restaurants, and other public places. The effect of legislation to ban smoking and its effects on the cardiovascular health of nonsmoking adults, however, remains a question. Secondhand Smoke Exposure and Cardiovascular Effects reviews available scientific literature to assess the relationship between secondhand smoke exposure and acute coronary events. The authors, experts in secondhand smoke exposure and toxicology, clinical cardiology, epidemiology, and statistics, find that there is about a 25 to 30 percent increase in the risk of coronary heart disease from exposure to secondhand smoke. Their findings agree with the 2006 Surgeon General's Report conclusion that there are increased risks of coronary heart disease morbidity and mortality among men and women exposed to secondhand smoke. However, the authors note that the evidence for determining the magnitude of the relationship between chronic secondhand smoke exposure and coronary heart disease is not very strong. Public health professionals will rely upon Secondhand Smoke Exposure and Cardiovascular Effects for its survey of critical epidemiological studies on the effects of smoking bans and evidence of links between secondhand smoke exposure and cardiovascular events, as well as its findings and recommendations.
Health is a highly valued, visible, and concrete investment that has the power to both save lives and enhance the credibility of the United States in the eyes of the world. While the United States has made a major commitment to global health, there remains a wide gap between existing knowledge and tools that could improve health if applied universally, and the utilization of these known tools across the globe. The U.S. Commitment to Global Health concludes that the U.S. government and U.S.-based foundations, universities, nongovernmental organizations, and commercial entities have an opportunity to improve global health. The book includes recommendations that these U.S. institutions increase the utilization of existing interventions to achieve significant health gains; generate and share knowledge to address prevalent health problems in disadvantaged countries; invest in people, institutions, and capacity building with global partners; increase the quantity and quality of U.S. financial commitments to global health; and engage in respectful partnerships to improve global health. In doing so, the U.S. can play a major role in saving lives and improving the quality of life for millions around the world.
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