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Systems Engineering to Improve Traumatic Brain Injury Care in the Military Health System: Workshop Summaryby Institute of Medicine
This book makes a strong case for taking advantage of the best of two disciplines--health care and operational systems engineering (a combination of science and mathematics to describe, analyze, plan, design, and integrate systems with complex interactions among people, processes, materials, equipment, and facilities)-to improve the efficiency and quality of health care delivery, as well as health care outcomes. Those most interested in pursuing this approach include leaders in the U.S. Department of Defense (DOD) and Department of Veterans Affairs, who are committed to finding ways of improving the quality of care for military personnel, veterans, and their families. Intrigued by the possibilities, DOD decided to sponsor a series of workshops to explore the potential of operational systems engineering principals and tools for military health care, beginning with the diagnosis and care of traumatic brain injury (TBI), one of the most prevalent, difficult and challenging injuries suffered by warriors in Iraq and Afghanistan.
Toward Health Equity and Patient-centeredness: Integrating Health Literacy, Disparities Reduction, and Quality Improvementby Institute of Medicine
To receive the greatest value for health care, it is important to focus on issues of quality and disparity, and the ability of individuals to make appropriate decisions based on basic health knowledge and services. The Forum on the Science of Health Care Quality Improvement and Implementation, the Roundtable on Health Disparities, and the Roundtable on Health Literacy jointly convened the workshop "Toward Health Equity and Patient-Centeredness: Integrating Health Literacy, Disparities Reduction, and Quality Improvement" to address these concerns. During this workshop, speakers and participants explored how equity in care delivered and a focus on patients could be improved.
The current extinction crisis is of human making, and any favorable resolution of that biodiversity crisis--among the most dire in the 4-billion-year history of the Earth--will have to be initiated by mankind. Little time remains for the public, corporations, and governments to awaken to the magnitude of what is at stake. This book aims to assist that critical educational mission, synthesizing recent scientific information and ideas about threats to biodiversity in the past, present, and projected future. This is the second volume from the In the Light of Evolution series, based on a series of Arthur M. Sackler colloquia, and designed to promote the evolutionary sciences. Each installment explores evolutionary perspectives on a particular biological topic that is scientifically intriguing but also has special relevance to contemporary societal issues or challenges. Individually and collectively, the ILE series aims to interpret phenomena in various areas of biology through the lens of evolution, address some of the most intellectually engaging as well as pragmatically important societal issues of our times, and foster a greater appreciation of evolutionary biology as a consolidating foundation for the life sciences.
Advances and major investments in the field of neuroscience can enhance traditional behavioral science approaches to training, learning, and other applications of value to the Army. Neural-behavioral indicators offer new ways to evaluate how well an individual trainee has assimilated mission critical knowledge and skills, and can also be used to provide feedback on the readiness of soldiers for combat. Current methods for matching individual capabilities with the requirements for performing high-value Army assignments do not include neuropsychological, psychophysiological, neurochemical or neurogenetic components; simple neuropsychological testing could greatly improve training success rates for these assignments. Opportunities in Neuroscience for Future Army Applications makes 17 recommendations that focus on utilizing current scientific research and development initiatives to improve performance and efficiency, collaborating with pharmaceutical companies to employ neuropharmaceuticals for general sustainment or enhancement of soldier performance, and improving cognitive and behavioral performance using interdisciplinary approaches and technological investments. An essential guide for the Army, this book will also be of interest to other branches of military, national security and intelligence agencies, academic and commercial researchers, pharmaceutical companies, and others interested in applying the rapid advances in neuroscience to the performance of individual and group tasks.
In March 2008, the Committee on National Statistics of the National Academies held a workshop to assist the Bureau of Economic Analysis (BEA) with next steps as it develops plans to produce a satellite health care account. This account, designed to improve its measurement of economic activity in the medical care sector, will benefit health care policy. The purpose of the workshop, summarized in this volume, was to elicit expert guidance on strategies to implement the objectives of the BEA program. The ultimate objectives of the program are to: compile medical care spending information by type of disease-a system more directly useful for measuring health care inputs, outputs, and productivity than current estimates of spending by type of provider; produce a comprehensive set of accounts for health care-sector income, expenditure, and product; develop medical care price and real output measures that will help analysts to break out changes in the delivery of health care from changes in the prices of that care; and coordinate BEA and Centers for Medicare and Medicaid Services (CMS) health expenditure statistics.
This book presents the proceedings of the fourth U.S.-Russian interacademy workshop on the general theme of countering terrorism, which was held in Moscow in March 2007. The fourth in a series, this volume continues to explore topics related to urban terrorism, but with a new emphasis on potential attacks involving biological agents, transportation networks, and energy systems. The other books in the series include: High Impact Terrorism: Proceedings of a Russian-American Workshop (2002) http://www.nap.edu/catalog.php?record_id=10968Terrorism: Reducing Vulnerabilities and Improving Responses: U.S.-Russian Workshop Proceedings (2004) http://www.nap.edu/catalog.php?record_id=11698Countering Urban Terrorism in Russia and the United States: Proceedings of a Workshop (2006)
Marine debris from ships and other ocean-based sources-including trash and lost fishing gear-contributes to the spoiling of beaches, fouling of surface waters and the seafloor, and harm to marine animals, among other effects. Unfortunately, international conventions and domestic laws intended to control marine debris have not been successful, in part because the laws, as written, provide little incentive to change behavior. This book identifies ways to reduce waste, improve waste disposal at ports, and strengthen the regulatory framework toward a goal of zero waste discharge into the marine environment. Progress will depend on a commitment to sustained funding and appropriate institutional support. The Interagency Marine Debris Coordinating Committee should, through planning and prioritization, target research to understand the sources, fates, and impacts of marine debris. It should support the establishment of scalable and statistically rigorous protocols that allow monitoring at a variety of temporal and spatial scales. These protocols should contain evaluative metrics that allow assessment of progress in marine debris mitigation. The United States, through leadership in the international arena, should provide technical assistance and support for the establishment of additional monitoring and research programs worldwide.
This book presents a scientific assessment of free-electron-laser technology for naval applications. The charge from the Office of Naval Research was to assess whether the desired performance capabilities are achievable or whether fundamental limitations will prevent them from being realized. The present study identifies the highest-priority scientific and technical issues that must be resolved along the development path to achieve a megawatt-class free-electron laser. In accordance with the charge, the committee considered (and briefly describes) trade-offs between free-electron lasers and other types of lasers and weapon systems to show the advantages free-electron lasers offer over other types of systems for naval applications as well as their drawbacks. The primary advantages of free-electron lasers are associated with their energy delivery at the speed of light, selectable wavelength, and all-electric nature, while the trade-offs for free-electron lasers are their size, complexity, and relative robustness. Also, Despite the significant technical progress made in the development of high-average-power free-electron lasers, difficult technical challenges remain to be addressed in order to advance from present capability to megawatt-class power levels.
Assessment Of Explosive Destruction Technologies For Specific Munitions At The Blue Grass And Pueblo Chemical Agent Destruction Pilot Plantsby National Research Council of the National Academies
The Army's ability to meet public and congressional demands to destroy expeditiously all of the U.S. declared chemical weapons would be enhanced by the selection and acquisition of appropriate explosive destruction technologies (EDTs) to augment the main technologies to be used to destroy the chemical weapons currently at the Blue Grass Army Depot (BGAD) in Kentucky and the Pueblo Chemical Depot (PCD) in Colorado. The Army is considering four EDTs for the destruction of chemical weapons: three from private sector vendors, and a fourth, Army-developed explosive destruction system (EDS). This book updates earlier evaluations of these technologies, as well as any other viable detonation technologies, based on several considerations including process maturity, process efficacy, process throughput, process safety, public and regulatory acceptability, and secondary waste issues, among others. It also provides detailed information on each of the requirements at BGAD and PCD and rates each of the existing suitable EDTs plus the Army's EDS with respect to how well it satisfies these requirements.
Science And Technology For America's Progress: Ensuring The Best Presidential Appointments In The New Administrationby National Academy Of Sciences National Academy of Engineering Institute of Medicine of the National Academies
The new Obama administration and the 110th Congress elected in November 2008 will face immediate challenges. Events will not permit a leisurely leadership transition. The prompt appointment of a Presidential science adviser and the nomination of top officials in the new administration with the knowledge and experience to address complex problems will be essential. The concerns of the nation regarding jobs and economic growth, health care, national security, energy, and the environment demand informed action. Each of these concerns-from national security, economic development, health care, and the environment, to education, energy, and natural resources-is touched in essential ways by the nation's science and technology enterprise. This is the fourth in a series of books from the National Academies on the presidential appointment process, each delivered during a presidential election year with the goal of providing recommendations to the President-elect about appointing his senior science and technology leadership and pursuing sustained improvements in the appointments process.
Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilitiesby National Research Council Institute of Medicien of the National Academies
For multi-user PDF licensing, please contact mailto:email@example.com customer service. Mental health and substance use disorders among children, youth, and young adults are major threats to the health and well-being of younger populations which often carryover into adulthood. The costs of treatment for mental health and addictive disorders, which create an enormous burden on the affected individuals, their families, and society, have stimulated increasing interest in prevention practices that can impede the onset or reduce the severity of the disorders. Prevention practices have emerged in a variety of settings, including programs for selected at-risk populations (such as children and youth in the child welfare system), school-based interventions, interventions in primary care settings, and community services designed to address a broad array of mental health needs and populations. Preventing Mental, Emotional, and Behavioral Disorders Among Young People updates a 1994 Institute of Medicine book, Reducing Risks for Mental Disorders, focusing special attention on the research base and program experience with younger populations that have emerged since that time. Researchers, such as those involved in prevention science, mental health, education, substance abuse, juvenile justice, health, child and youth development, as well as policy makers involved in state and local mental health, substance abuse, welfare, education, and justice will depend on this updated information on the status of research and suggested directions for the field of mental health and prevention of disorders.
During a wide-reaching catastrophic public health emergency or disaster, existing surge capacity plans may not be sufficient to enable healthcare providers to continue to adhere to normal treatment procedures and follow usual standards of care. This is a particular concern for emergencies that may severely strain resources across a large geographic area, such as a pandemic influenza or the detonation of a nuclear device. Under these circumstances, it may be impossible to provide care according to the standards of care used in non-disaster situations, and, under the most extreme circumstances, it may not even be possible to provide basic life sustaining interventions to all patients who need them. Although recent efforts to address these concerns have accomplished a tremendous amount in just a few years, a great deal remains to be done in even the most advanced plan. This workshop summary highlights the extensive work that is already occurring across the nation. Specifically, the book draws attention to existing federal, state, and local policies and protocols for crisis standards of care; discusses current barriers to increased provider and community engagement; relays examples of existing interstate collaborations; and presents workshop participants' ideas, comments, concerns, and potential solutions to some of the most difficult challenges.
The so-called nuclear renaissance has increased worldwide interest in nuclear power. This potential growth also has increased, in some quarters, concern that nonproliferation considerations are not being given sufficient attention. In particular, since introduction of many new power reactors will lead to requiring increased uranium enrichment services to provide the reactor fuel, the proliferation risk of adding enrichment facilities in countries that do not have them now led to proposals to provide the needed fuel without requiring indigenous enrichment facilities. Similar concerns exist for reprocessing facilities. Internationalization of the Nuclear Fuel Cycle summarizes key issues and analyses of the topic, offers some criteria for evaluating options, and makes findings and recommendations to help the United States, the Russian Federation, and the international community reduce proliferation and other risks, as nuclear power is used more widely. This book is intended for all those who are concerned about the need for assuring fuel for new reactors and at the same time limiting the spread of nuclear weapons. This audience includes the United States and Russia, other nations that currently supply nuclear material and technology, many other countries contemplating starting or growing nuclear power programs, and the international organizations that support the safe, secure functioning of the international nuclear fuel cycle, most prominently the International Atomic Energy Agency.
The Health Hazard Evaluation Program at NIOSH: Reviews of Research Programs of the National Institute for Occupational Safety and Healthby National Research Council Institute of Medicine of the National Academies
It is the unique mission of the Health Hazard Evaluation Program within the National Institute for Occupational Safety and Health (NIOSH) to respond to requests to investigate potential occupational health hazards. In contrast to other NIOSH programs, the Health Hazard Evaluation Program is not primarily a research program. Rather, it investigates and provides advice to workplaces in response to requests from employers, employees and their representatives, and federal agencies. The National Research Council was charged with evaluating the NIOSH Health Hazard Evaluation Program and determining whether program activities resulted in improvements in workplace practices and decreases in hazardous exposures that cause occupational illnesses. The program was found to play a key role in addressing existing widespread or emerging occupational health issues. This book makes several recommendations that could improve a very strong program including more systematic use of surveillance data to facilitate priority setting, and greater interaction with a broader array of workers, industries, and other government agencies.
There is great enthusiasm over the use of emerging interactive health information technologies-often referred to as eHealth-and the potential these technologies have to improve the quality, capacity, and efficiency of the health care system. However, many doctors, advocacy groups, policy makers and consumers are concerned that electronic health systems might help individuals and communities with greater resources while leaving behind those with limited access to technology. In order to address this problem, the Institute of Medicine's Roundtable on Health Literacy held a workshop to explore the current status of communication technology, the challenges for its use in populations with low health literacy, and the strategies for increasing the benefit of these technologies for populations with low health literacy. The summary of the workshop, "Health Literacy, eHealth, and Communication: Putting the Consumer First," includes participants' comments on these issues.
Changes over time in the levels and patterns of crime have significant consequences that affect not only the criminal justice system but also other critical policy sectors. Yet compared with such areas as health status, housing, and employment, the nation lacks timely information and comprehensive research on crime trends. Descriptive information and explanatory research on crime trends across the nation that are not only accurate, but also timely, are pressing needs in the nation's crime-control efforts. In April 2007, the National Research Council held a two-day workshop to address key substantive and methodological issues underlying the study of crime trends and to lay the groundwork for a proposed multiyear NRC panel study of these issues. Six papers were commissioned from leading researchers and discussed at the workshop by experts in sociology, criminology, law, economics, and statistics. The authors revised their papers based on the discussants' comments, and the papers were then reviewed again externally. The six final workshop papers are the basis of this volume, which represents some of the most serious thinking and research on crime trends currently available.
A Constrained Space Exploration Technology Program: A Review of NASA's Exploration Technology Development Programby National Research Council of the National Academies
In January 2004, President George W. Bush announced the Vision for Space Exploration (VSE), which instructed NASA to "Extend human presence across the solar system, starting with a human return to the Moon by the year 2020, in preparation for human exploration of Mars and other destinations," among other objectives. As acknowledged in the VSE, significant technology development will be necessary to accomplish the goals it articulates. NASA's Exploration Technology Development Program (ETDP) is designed to support, develop, and ultimately provide the necessary technologies to meet the goals of the VSE. This book, a review of the ETDP, is broadly supportive of the intent and goals of the VSE, and finds the ETDP is making progress towards the stated goals of technology development. However, the ETDP is operating within significant constraints which limit its ability to successfully accomplish those goals-the still dynamic nature of the Constellation Program requirements, the constraints imposed by a limited budget, the aggressive time scale of early technology deliverables, and the desire to fully employ the NASA workforce.
This book is the second biennial evaluation of progress being made in the Comprehensive Everglades Restoration Plan (CERP), a multibillion-dollar effort to restore historical water flows to the Everglades and return the ecosystem closer to its natural state. Launched in 2000 by the U.S. Army Corps of Engineers and the South Florida Water Management District, CERP is a multiorganization planning process that includes approximately 50 major projects to be completed over the next several decades. Progress Toward Restoring the Everglades: The Second Biennial Review 2008 concludes that budgeting, planning, and procedural matters are hindering a federal and state effort to restore the Florida Everglades ecosystem, which is making only scant progress toward achieving its goals. Good science has been developed to support restoration efforts, but future progress is likely to be limited by the availability of funding and current authorization mechanisms. Despite the accomplishments that lay the foundation for CERP construction, no CERP projects have been completed to date. To begin reversing decades of decline, managers should address complex planning issues and move forward with projects that have the most potential to restore the natural ecosystem.
Today, the nation faces an array of housing and urban policy challenges. No federal department other than HUD focuses explicitly on the well-being of urban places or on the spatial relationships among people and economic activities in urban areas. If HUD, Congress, mayors, and other policy makers are to respond effectively to urban issues, they need a much more robust and effective Office of Policy Development and Research (PD&R). PD&R conducts independent research and program evaluation, funds data collection and research by outside organizations, and provides policy advice to the Secretary and to other offices in HUD. Most of PD&R’s work is of high quality, relevant, timely, and useful. With adequate resources, PD&R could lead the nation’s ongoing process of learning, debate, and experimentation about critical housing and urban development challenges. Rebuilding the Research Capacity at HUD makes seven major recommendations about PD&R’s resources and responsibilities, including more active engagement with policy makers, formalizing various informal practices, strengthening surveys and data sets, and more. Acknowledging that the current level of funding for PD&R is inadequate, the book also makes several additional recommendations to help enable PD&R to reach its full potential.
To determine whether the air quality inside armored-vehicle cabins can meet exposure guidelines under deployment conditions, the Army assessed possible synergistic toxic effects from potentially harmful substances. This book, the final of two reports on the subject from the National Research Council, addresses whether the approach discussed in the technical context section of the Army's proposed guidance is appropriate, or whether an alternative assessment method should be developed. Combined Exposures to Hydrogen Cyanide and Carbon Monoxide in Army Operations provides several conclusions and recommendations, including the use of alternative instrumentation for monitoring gas, conducting experiments on human subjects, and seeking advice from additional groups involved with personnel training and field deployment.
The rapid conversion of land to urban and suburban areas has profoundly altered how water flows during and following storm events, putting higher volumes of water and more pollutants into the nation's rivers, lakes, and estuaries. These changes have degraded water quality and habitat in virtually every urban stream system. The Clean Water Act regulatory framework for addressing sewage and industrial wastes is not well suited to the more difficult problem of stormwater discharges. This book calls for an entirely new permitting structure that would put authority and accountability for stormwater discharges at the municipal level. A number of additional actions, such as conserving natural areas, reducing hard surface cover (e.g., roads and parking lots), and retrofitting urban areas with features that hold and treat stormwater, are recommended.
Beryllium is a lightweight metal that is used for its exceptional strength and high heat-absorbing capability. Beryllium and its alloys can be found in many important technologies in the defense and aeronautics industries, such as nuclear devices, satellite systems, radar systems, and aircraft bushings and bearings. Pulmonary disease associated with exposure to beryllium has been recognized and studied since the early 1940s, and an occupational guideline for limiting exposure to beryllium has been in place since 1949. Over the last few decades, much has been learned about chronic beryllium disease and factors that contribute to its occurrence in exposed people. Despite reduced workplace exposure, chronic beryllium disease continues to occur. Those developments have led to debates about the adequacy of the long-standing occupational exposure limit for protecting worker health. This book, requested by the U.S. Air Force to help to determine the steps necessary to protect its workforce from the effects of beryllium used in military aerospace applications, reviews the scientific literature on beryllium and outlines an exposure and disease management program for its protecting workers.
The water impounded behind a dam can be used to generate power and to provide water for drinking, irrigation, commerce, industry, and recreation. However, if a dam fails, the water that would be unleashed has the energy and power to cause mass destruction downstream, killing and injuring people and destroying property, agriculture, industry, and local and regional economies. The U.S. Bureau of Reclamation (Reclamation) is responsible for managing and operating some of this nation’s largest and most critical dams. The failure of one or more of these dams as the result of a malicious act would come with little warning and a limited time for evacuation. In the years since the 9/11 attacks, Reclamation has invested significant resources to establish and build a security program. Reclamation is now ready to evaluate the results of these efforts and determine how best to move forward to develop a security program that is robust and sustainable. This book assesses Reclamation’s security program and determines its level of preparedness to deter, respond to, and recover from malicious acts to its physical infrastructure and to the people who use and manage it.
Standards-based accountability has become a central feature of the public education system in each state and is a theme of national discussions about how achievement for all students can be improved and achievement gaps narrowed. Questions remain, however, about the implementation of standards and accountability systems and about whether their potential benefits have been fully realized. Each of the 50 states has adopted its own set of standards, and though there is overlap among them, there is also wide variation in the ways states have devised and implemented their systems. This variety may have both advantages and disadvantages, but it nevertheless raises a fundamental question: Is the establishment of common K-12 academic standards, which states could voluntarily adopt, the logical next step for standards-based reform? The goal of this book is not to answer the policy question of whether or not common standards would be a good idea. Rather, the book provides an objective look at the available evidence regarding the ways in which standards are currently functioning, the strategies that might be used to pursue common standards, and the issues that doing so might present.
A Survey of Attitudes and Actions on Dual Use Research in the Life Sciences: A Collaborative Effort of the National Research Council and the American Association for the Advancement of Scienceby National Research Council of the National Academies
The same technologies that fuel scientific advances also pose potential risks--that the knowledge, tools, and techniques gained through legitimate biotechnology research could be misused to create biological weapons or for bioterrorism. This is often called the dual use dilemma of the life sciences. Yet even research with the greatest potential for misuse may offer significant benefits. Determining how to constrain the danger without harming essential scientific research is critical for national security as well as prosperity and well-being. This book discusses a 2007 survey of American Association for the Advancement of Science (AAAS) members in the life sciences about their knowledge of dual use issues and attitudes about their responsibilities to help mitigate the risks of misuse of their research. Overall, the results suggest that there may be considerable support for approaches to oversight that rely on measures that are developed and implemented by the scientific community itself. The responses also suggest that there is a need to clarify the scope of research activities of concern and to provide guidance about what actions scientists can take to reduce the risk that their research will be misused by those with malicious intent.
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