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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.
Flows of the Columbia River, although modified substantially during the twentieth century, still vary considerably between seasons and between years. Lowest flows tend to occur during summer months when demand for irrigation water is at its highest and when water temperatures are greatest. These periods of low flows, high demand, and high temperature are critical periods for juvenile salmon migrating downstream through the Columbia River hydropower system. Although impacts on salmon of any individual water withdrawal may be small, the cumulative effects of numerous withdrawals will affect Columbia River flows and would pose increased risks to salmon survival. The body of scientific knowledge explaining salmon migratory behavior and physiology is substantial, but imperfect, and decision makers should acknowledge this and be willing to take action in the face of uncertainties. In order to provide a more comprehensive water permitting process, the State of Washington, Canada, other basin states, and tribal groups should establish a basin-wide forum to consider future water withdrawal application permits. If the State of Washington issues additional permits for water withdrawals from the Columbia River, those permits should contain provisions that allow withdrawals to be curtailed during critical high-demand periods.
The emergence of severe acute respiratory syndrome (SARS) in late 2002 and 2003 challenged the global public health community to confront a novel epidemic that spread rapidly from its origins in southern China until it had reached more than 25 other countries within a matter of months. In addition to the number of patients infected with the SARS virus, the disease had profound economic and political repercussions in many of the affected regions. Recent reports of isolated new SARS cases and a fear that the disease could reemerge and spread have put public health officials on high alert for any indications of possible new outbreaks. This report examines the response to SARS by public health systems in individual countries, the biology of the SARS coronavirus and related coronaviruses in animals, the economic and political fallout of the SARS epidemic, quarantine law and other public health measures that apply to combating infectious diseases, and the role of international organizations and scientific cooperation in halting the spread of SARS. The report provides an illuminating survey of findings from the epidemic, along with an assessment of what might be needed in order to contain any future outbreaks of SARS or other emerging infections.
Grants for research centers located in universities, medical centers, and other nonprofit research institutions account for about 9 percent of the National Institutes of Health budget. Centers are popular because they can bring visibility, focus, and increased resources to bear on specific diseases. However, congressional debate in 2001 over proposed legislation directing NIH to set up centers for muscular dystrophy research highlighted several areas of uncertainty about how to decide when centers are an appropriate research mechanism in specific cases. The debate also highlighted a growing trend among patient advocacy groups to regard centers as a key element of every disease research program, regardless of how much is known about the disease in question, the availability of experienced researchers, and other factors. This book examines the criteria and procedures used in deciding whether to establish new specialized research centers. It discusses the future role of centers in light of the growing trend of large-scale research in biomedicine, and it offers recommendations for improving the classification and tracking of center programs, clarifying and improving the decision process and criteria for initiating center programs, resolving the occasional disagreements over the appropriateness of centers, and evaluating the performance of center programs more regularly and systematically.
Infant formulas are unique because they are the only source of nutrition for many infants during the first 4 to 6 months of life. They are critical to infant health since they must safely support growth and development during a period when the consequences on inadequate nutrition are most severe. Existing guidelines and regulations for evaluating the safety of conventional food ingredients (e.g., vitamins and minerals) added to infant formulas have worked well in the past; however they are not sufficient to address the diversity of potential new ingredients proposed by manufacturers to develop formulas that mimic the perceived and potential benefits of human milk. This book, prepared at the request of the Food and Drug Administration (FDA) and Health Canada, addresses the regulatory and research issues that are critical in assessing the safety of the addition of new ingredients to infants.
Open Access And The Public Domain In Digital Data And Information For Science: Proceedings Of An International Symposiumby Julie M. Esanu U.S. National Committee for CODATA National Research Council Staff Paul F. Uhlir
This symposium, which was held on March 10-11, 2003, at UNESCO headquarters in Paris, brought together policy experts and managers from the government and academic sectors in both developed and developing countries to (1) describe the role, value, and limits that the public domain and open access to digital data and information have in the context of international research; (2) identify and analyze the various legal, economic, and technological pressures on the public domain in digital data and information, and their potential effects on international research; and (3) review the existing and proposed approaches for preserving and promoting the public domain and open access to scientific and technical data and information on a global basis, with particular attention to the needs of developing countries.
The North Pacific Research Board (NPRB) was established in 1997 as custodian to a pool of funds intended for the study of the North Pacific Ocean, Bering Sea, and Arctic Ocean. The success of the NRPB is the development of a high quality, long-range science plan that provides a better understanding of ecosystems and their fisheries in the region. This report provides a framework to help the NPRB identify appropriate science themes and mechanisms for administering and distributing the funds. It contains extensive input from residents of Alaskan communities, to help scientists understand and address issues of importance to the local communities. The book makes specific recommendations on long-term research priorities, the NPRB management structure and the development of future programs.
Since 1997, the Institute of Medicine has issued a series of nutrient reference values that are collectively termed Dietary Reference Intakes (DRIs). The DRIs offer quantitative estimates of nutrient intakes to be used for planning and assessing diets. Using the information from these reports, this newest volume in the DRI series focuses on how the DRIs, and the science for each nutrient in the DRI reports, can be used to develop current and appropriate reference values for nutrition labeling and food fortification. Focusing its analysis on the existing DRIs, the book examines the purpose of nutrition labeling, current labeling practices in the United States and Canada, food fortification practices and policies, and offers recommendations as a series of guiding principles to assist the regulatory agencies that oversee food labeling and fortification in the United States and Canada. The overarching goal of the information in this book is to provide updated nutrition labeling that consumers can use to compare products and make informed food choices. Diet-related chronic diseases are a leading cause of preventable deaths in the United States and Canada and helping customers make healthy food choices has never been more important.
Improving Medical Education: Enhancing the Behavioral and Social Science Content of Medical School Curriculaby Institute of Medicine of the National Academies
Roughly half of all deaths in the United States are linked to behavioral and social factors. The leading causes of preventable death and disease in the United States are smoking, sedentary lifestyle, along with poor dietary habits, and alcohol consumption. To make measurable improvements in the health of Americans, physicians must be equipped with the knowledge and skills from the behavioral and social sciences needed to recognize, understand, and effectively respond to patients as individuals, not just to their symptoms. What are medical schools teaching students about the behavioral and social sciences? In the report, the committee concluded that there is inadequate information available to sufficiently describe behavioral and social science curriculum content, teaching techniques, and assessment methodologies in U.S. medical schools and recommends development of a new national behavioral and social science database. The committee also recommended that the National Board of Medical Examiners ensure that the U.S. Medical Licensing Examination adequately cover the behavioral and social science subject matter recommended in this report.
Partnerships For Reducing Landslide Risk: Assessment of the National Landslide Hazards Mitigation Strategyby Committee on the Review of the National Landslide Hazards Mitigation Strategy
Landslides occur in all geographic regions of the nation in response to a wide range of conditions and triggering processes that include storms, earthquakes, and human activities. Landslides in the United States result in an estimated average of 25 to 50 deaths annually and cost $1 to 3 billion per year. In addition to direct losses, landslides also cause significant environmental damage and societal disruption. This report reviews the U.S. Geological Survey’s (USGS) National Landslide Hazards Mitigation Strategy, which was created in response to a congressional directive for a national approach to reducing losses from landslides. Components of the strategy include basic research activities, improved public policy measures, and enhanced mitigation of landslides.The NRC report commends the USGS for creating a national approach based on partnerships with federal, state, local, and non-governmental entities, and finds that the plan components are the essential elements of a national strategy. The report recommends that the plan should promote the use of risk analysis techniques, and should play a vital role in evaluating methods, setting standards, and advancing procedures and guidelines for landslide hazard maps and assessments. The NRC panel suggests that substantially increased funding will be required to implement a national landslide mitigation program, and that as part of a 10-year program the funding mix should transition from research and guideline development to partnership-based implementation of loss reduction measures.
Because of the pervasive and substantial decline of Atlantic salmon populations in Maine over the past 150 years, and because they are close to extinction, a comprehensive statewide action should be taken now to ensure their survival. The populations of Atlantic salmon have declined drastically, from an estimated half million adult salmon returning to U. S. rivers each year in the early 1800s to perhaps as few as 1,000 in 2001. The report recommends implementing a formalized decision-making approach to establish priorities, evaluate options and coordinate plans for conserving and restoring the salmon.
This new report provides a framework within which to assess compliance with core international labor standards and succeeds in taking an enormous step toward interpreting all relevant information into one central database. At the request of the Bureau of International Labor Affairs at the U.S. Department of Labor, the National Research Council’s Committee on Monitoring International Labor Standards was charged with identifying relevant and useful sources of country-level data, assessing the quality of such data, identifying innovative measures to monitor compliance, exploring the relationship between labor standards and human capital, and making recommendations on reporting procedures to monitor compliance. The result of the committee’s work is in two parts—this report and a database structure. Together, they offer a first step toward the goal of providing an empirical foundation to monitor compliance with core labor standards. The report provides a comprehensive review of extant data sources, with emphasis on their relevance to defined labor standards, their utility to decision makers in charge of assessing or monitoring compliance, and the cautions necessary to understand and use the quantitative information.
Funded by the U. S. Department of Defense, this report was written to assist the Defense Advanced Research Projects Agency in its efforts to develop more effective, flexible explosive and bomb detection systems. The study describes the characteristics of explosives, bombs, and their components that are or might be used to provide a signature for exploitation in detection technology; considers scientific techniques for exploiting these characteristics to detect explosives and explosive devices, discusses the potential for integrating such techniques into detection systems, allowing sufficient sensitivity without an unacceptable false-positive rate; and proposes additional research in practical explosives and bomb technology in the near, mid, and long term. No subject index. Annotation ©2005 Book News, Inc. , Portland, OR (booknews. com)
In Meeting Psychosocial Needs of Women with Breast Cancer, the National Cancer Policy Board of the Institute of Medicine examines the psychosocial consequences of the cancer experience. The book focuses specifically on breast cancer in women because this group has the largest survivor population (over 2 million) and this disease is the most extensively studied cancer from the standpoint of psychosocial effects. The book characterizes the psychosocial consequences of a diagnosis of breast cancer, describes psychosocial services and how they are delivered, and evaluates their effectiveness. It assesses the status of professional education and training and applied clinical and health services research and proposes policies to improve the quality of care and quality of life for women with breast cancer and their families. Because cancer of the breast is likely a good model for cancer at other sites, recommendations for this cancer should be applicable to the psychosocial care provided generally to individuals with cancer. For breast cancer, and indeed probably for any cancer, the report finds that psychosocial services can provide significant benefits in quality of life and success in coping with serious and life-threatening disease for patients and their families.
New and improved therapies to treat and protect against drug dependence and abuse are urgently needed. In the United States alone about 50 million people regularly smoke tobacco and another 5 million are addicted to other drugs. In a given year, millions of these individuals attempt—with or without medical assistance—to quit using drugs, though relapse remains the norm. Furthermore, each year several million teenagers start smoking and nearly as many take illicit drugs for the first time. Research is advancing on promising new means of treating drug addiction using immunotherapies and sustained-release (depot) medications. The aim of this research is to develop medications that can block or significantly attenuate the psychoactive effects of such drugs as cocaine, nicotine, heroin, phencyclidine, and methamphetamine for weeks or months at a time. This represents a fundamentally new therapeutic approach that shows promise for treating drug addiction problems that were difficult to treat in the past. Despite their potential benefits, however, several characteristics of these new methods pose distinct behavioral, ethical, legal, and social challenges that require careful scrutiny. Such issues can be considered unique aspects of safety and efficacy that are fundamentally related to the distinct nature and properties of these new types of medications.
Many racial and ethnic groups in the United States, including blacks, Hispanics, Asians, American Indians, and others, have historically faced severe discrimination—pervasive and open denial of civil, social, political, educational, and economic opportunities. Today, large differences among racial and ethnic groups continue to exist in employment, income and wealth, housing, education, criminal justice, health, and other areas. While many factors may contribute to such differences, their size and extent suggest that various forms of discriminatory treatment persist in U.S. society and serve to undercut the achievement of equal opportunity. Measuring Racial Discrimination considers the definition of race and racial discrimination, reviews the existing techniques used to measure racial discrimination, and identifies new tools and areas for future research. The book conducts a thorough evaluation of current methodologies for a wide range of circumstances in which racial discrimination may occur, and makes recommendations on how to better assess the presence and effects of discrimination.
The United States is rapidly transforming into one of the most racially and ethnically diverse nations in the world. Groups commonly referred to as minorities--including Asian Americans, Pacific Islanders, African Americans, Hispanics, American Indians, and Alaska Natives--are the fastest growing segments of the population and emerging as the nation's majority. Despite the rapid growth of racial and ethnic minority groups, their representation among the nation’s health professionals has grown only modestly in the past 25 years. This alarming disparity has prompted the recent creation of initiatives to increase diversity in health professions. In the Nation's Compelling Interest considers the benefits of greater racial and ethnic diversity, and identifies institutional and policy-level mechanisms to garner broad support among health professions leaders, community members, and other key stakeholders to implement these strategies. Assessing the potential benefits of greater racial and ethnic diversity among health professionals will improve the access to and quality of healthcare for all Americans.
For years proposals for gun control and the ownership of firearms have been among the most contentious issues in American politics. For public authorities to make reasonable decisions on these matters, they must take into account facts about the relationship between guns and violence as well as conflicting constitutional claims and divided public opinion. In performing these tasks, legislators need adequate data and research to judge both the effects of firearms on violence and the effects of different violence control policies. Readers of the research literature on firearms may sometimes find themselves unable to distinguish scholarship from advocacy. Given the importance of this issue there is a pressing need for a clear and unbiased assessment of the existing portfolio of data and research. Firearms and Violence uses conventional standards of science to examine three major themes - firearms and violence, the quality of research, and the quality of data available. The book assesses the strengths and limitations of current databases, examining current research studies on firearm use and the efforts to reduce unjustified firearm use and suggests ways in which they can be improved.
In response to a Congressional mandate, the National Research Council conducted a review of the Small Business Innovation Research Program (SBIR) at the five federal agencies with SBIR programs with budgets in excess of $100 million (DOD, NIH, NASA, DOE, and NSF). The project was designed to answer questions of program operation and effectiveness, including the quality of the research projects being conducted under the SBIR program, the commercialization of the research, and the program's contribution to accomplishing agency missions. The first in a series to be published in response to the Congressional request, this report summarizes the presentations at a symposium convened at the beginning of the project. The report provides a comprehensive overview of the SBIR program’s operations at the five agencies responsible for 96 percent of the program’s operations.
Recent and forecasted advances in microbiology, molecular biology, and analytical chemistry have made it timely to reassess the current paradigm of relying predominantly or exclusively on traditional bacterial indicators for all types of waterborne pathogens. Nonetheless, indicator approaches will still be required for the foreseeable future because it is not practical or feasible to monitor for the complete spectrum of microorganisms that may occur in water, and many known pathogens are difficult to detect directly and reliably in water samples. This comprehensive report recommends the development and use of a "tool box" approach by the U. S Environmental Protection Agency and others for assessing microbial water quality in which available indicator organisms (and/or pathogens in some cases) and detection method(s) are matched to the requirements of a particular application. The report further recommends the use of a phased, three-level monitoring framework to support the selection of indicators and indicator approaches.
Children&#39s health has clearly improved over the past several decades. Significant and positive gains have been made in lowering rates of infant mortality and morbidity from infectious diseases and accidental causes, improved access to health care, and reduction in the effects of environmental contaminants such as lead. Yet major questions still remain about how to assess the status of children's health, what factors should be monitored, and the appropriate measurement tools that should be used. Children's Health, the Nation's Wealth: Assessing and Improving Child Health provides a detailed examination of the information about children's health that is needed to help policy makers and program providers at the federal, state, and local levels. In order to improve children's health -- and, thus, the health of future generations -- it is critical to have data that can be used to assess both current conditions and possible future threats to children's health. This compelling book describes what is known about the health of children and what is needed to expand the knowledge. By strategically improving the health of children, we ensure healthier future generations to come.
To maintain their own health and the health of their families and communities, consumers rely heavily on the health information that is available to them. This information is at the core of the partnerships that patients and their families forge with today’s complex modern health systems. This information may be provided in a variety of forms – ranging from a discussion between a patient and a health care provider to a health promotion advertisement, a consent form, or one of many other forms of health communication common in our society. Yet millions of Americans cannot understand or act upon this information. To address this problem, the field of health literacy brings together research and practice from diverse fields including education, health services, and social and cultural sciences, and the many organizations whose actions can improve or impede health literacy. Health Literacy: Prescription to End Confusion examines the body of knowledge that applies to the field of health literacy, and recommends actions to promote a health literate society. By examining the extent of limited health literacy and the ways to improve it, we can improve the health of individuals and populations.
Emerging and currently available technologies offer great promise for helping older adults, even those without serious disabilities, to live healthy, comfortable, and productive lives. What technologies offer the most potential benefit? What challenges must be overcome, what problems must be solved, for this promise to be fulfilled? How can federal agencies like the National Institute on Aging best use their resources to support the translation from laboratory findings to useful, marketable products and services? Technology for Adaptive Aging is the product of a workshop that brought together distinguished experts in aging research and in technology to discuss applications of technology to communication, education and learning, employment, health, living environments, and transportation for older adults. It includes all of the workshop papers and the report of the committee that organized the workshop. The committee report synthesizes and evaluates the points made in the workshop papers and recommends priorities for federal support of translational research in technology for older adults.
The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act gives funding to cities, states, and other public and private entities to provide care and support services to individuals with HIV and AIDS who have low-incomes and little or no insurance. The CARE Act is a discretionary program that relies on annual appropriations from Congress to provide care for low-income, uninsured, or underinsured individuals who have no other resources to pay for care. Despite its successes, funding has been insufficient to address all of the inequalities and gaps in coverage for people with HIV. In response to a congressional mandate, an Institute of Medicine committee was formed to reevaluate whether CARE allocation strategies are an equitable and efficient way of distributing resources to jurisdictions with the greatest needs and to assess whether quality of care can be refined and expanded. Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Actproposes several types of analyses that could be used to guide the evaluation and improvement of allocation formulas, as well as a framework for assessing quality of care provided to HIV-infected persons.
Mirroring a worldwide phenomenon in industrialized nations, the U.S. is experiencing a change in its demographic structure known as population aging. Concern about the aging population tends to focus on the adequacy of Medicare and Social Security, retirement of older Americans, and the need to identify policies, programs, and strategies that address the health and safety needs of older workers. Older workers differ from their younger counterparts in a variety of physical, psychological, and social factors. Evaluating the extent, causes, and effects of these factors and improving the research and data systems necessary to address the health and safety needs of older workers may significantly impact both their ability to remain in the workforce and their well being in retirement. Health and Safety Needs of Older Workers provides an image of what is currently known about the health and safety needs of older workers and the research needed to encourage social polices that guarantee older workers a meaningful share of the nation’s work opportunities.
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