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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.
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.
For the last two decades, the United States has been destroying its entire stockpile of chemical agents. At the facilities where these agents are being destroyed, effluent gas streams pass through large activated carbon filters before venting to ensure that any residual trace vapors of chemical agents and other pollutants do not escape into the atmosphere in exceedance of regulatory limits. All the carbon will have to be disposed of for final closure of these facilities to take place. In March 2008, the Chemical Materials Agency asked the National Research Council to study, evaluate, and recommend the best methods for proper and safe disposal of the used carbon from the operational disposal facilities. This volume examines various approaches to handling carbon waste streams from the four operating chemical agent disposal facilities. The approaches that will be used at each facility will ultimately be chosen bearing in mind local regulatory practices, facility design and operations, and the characteristics of agent inventories, along with other factors such as public involvement regarding facility operations.
Unlike many other areas in health care, the practice of oncology presents unique challenges that make assessing and improving value especially complex. First, patients and professionals feel a well-justified sense of urgency to treat for cure, and if cure is not possible, to extend life and reduce the burden of disease. Second, treatments are often both life sparing and highly toxic. Third, distinctive payment structures for cancer medicines are intertwined with practice. Fourth, providers often face tremendous pressure to apply the newest technologies to patients who fail to respond to established treatments, even when the evidence supporting those technologies is incomplete or uncertain, and providers may be reluctant to stop toxic treatments and move to palliation, even at the end of life. Finally, the newest and most novel treatments in oncology are among the most costly in medicine. This volume summarizes the results of a workshop that addressed these issues from multiple perspectives, including those of patients and patient advocates, providers, insurers, health care researchers, federal agencies, and industry. Its broad goal was to describe value in oncology in a complete and nuanced way, to better inform decisions regarding developing, evaluating, prescribing, and paying for cancer therapeutics.
The adverse effects of extreme space weather on modern technology--power grid outages, high-frequency communication blackouts, spacecraft anomalies--are well known and well documented, and the physical processes underlying space weather are also generally well understood. Less well documented and understood, however, are the potential economic and societal impacts of the disruption of critical technological systems by severe space weather. This volume, an extended four-color summary of the book, http://www.nap.edu/catalog.php?record_id=12507Severe Space Weather Events--Understanding Societal and Economic Impacts, addresses the questions of space weather risk assessment and management. The workshop on which the books are based brought together representatives of industry, the government, and academia to consider both direct and collateral effects of severe space weather events, the current state of the space weather services infrastructure in the United States, the needs of users of space weather data and services, and the ramifications of future technological developments for contemporary society's vulnerability to space weather. The workshop concluded with a discussion of un- or underexplored topics that would yield the greatest benefits in space weather risk management.
Scientific and Humane Issues in the Use of Random-Source Dogs and Cats in Research examines the value of random-source animals in biomedical research and the role of Class B dealers who acquire and resell live dogs and cats to research institutions. Findings include that, while some random-source dogs and cats may be necessary and desirable for National Institutes of Health (NIH)-funded research, there is no clear need to obtain those animals from Class B dealers. Several options for random-source animal acquisition already exist and additional options are recommended, which would further ensure the welfare of these animals and foster a positive public image for NIH. While the scientific community has recognized and responded to concerns for humane treatment of animals in research, government oversight has thus far been unable to fully enforce the Animal Welfare Act in regard to Class B dealers of live animals. Although the animals acquired by Class B dealers are destined for research--and NIH research in particular--the standard of care while in the possession of some Class B dealers requires an inordinate amount of government enforcement and is not commensurate with the policies of most NIH-funded research laboratories. This dichotomy of standards reflects poorly on public perceptions of NIH and jeopardizes animal welfare. This book will be crucial for NIH and other groups using random-source animals in research, including veterinary schools and research facilities. Animal welfare advocates, policy makers, and concerned pet owners will also find this a vital and informative work for reconciling the needs of research with the welfare of animals.
For much of the past 60 years, the U.S. research community dominated the discovery of new crystalline materials and the growth of large single crystals, placing the country at the forefront of fundamental advances in condensed-matter sciences and fueling the development of many of the new technologies at the core of U.S. economic growth. The opportunities offered by future developments in this field remain as promising as the achievements of the past. However, the past 20 years have seen a substantial deterioration in the United States' capability to pursue those opportunities at a time when several European and Asian countries have significantly increased investments in developing their own capacities in these areas. This book seeks both to set out the challenges and opportunities facing those who discover new crystalline materials and grow large crystals and to chart a way for the United States to reinvigorate its efforts and thereby return to a position of leadership in this field.
Sustainable Critical Infrastruture Systems: A Framework for Meeting 21st Century Imperatives - Report of a Workshopby National Research Council of the National Academies
For the people of the United States, the 20th century was one of unprecedented population growth, economic development, and improved quality of life. The critical infrastructure systems-water, wastewater, power, transportation, and telecommunications-built in the 20th century have become so much a part of modern life that they are taken for granted. By 2030, 60 million more Americans will expect these systems to deliver essential services. Large segments and components of the nation's critical infrastructure systems are now 50 to 100 years old, and their performance and condition are deteriorating. Improvements are clearly necessary. However, approaching infrastructure renewal by continuing to use the same processes, practices, technologies, and materials that were developed in the 20th century will likely yield the same results: increasing instances of service disruptions, higher operating and repair costs, and the possibility of catastrophic, cascading failures. If the nation is to meet some of the important challenges of the 21st century, a new paradigm for the renewal of critical infrastructure systems is needed. This book discusses the essential components of this new paradigm, and outlines a framework to ensure that ongoing activities, knowledge, and technologies can be aligned and leveraged to help meet multiple national objectives.
Many nations are currently adopting a variety of directed strategies to launch and support research parks
Focusing on Children's Health: Community Approaches to Addressing Health Disparities - Workshop Summaryby Institute of Medicine
Socioeconomic conditions are known to be major determinants of health at all stages of life, from pregnancy through childhood and adulthood. "Life-course epidemiology" has added a further dimension to the understanding of the social determinants of health by showing an association between early-life socioeconomic conditions and adult health-related behaviors, morbidity, and mortality. Sensitive and critical periods of development, such as the prenatal period and early childhood, present significant opportunities to influence lifelong health. Yet simply intervening in the health system is insufficient to influence health early in the life course. Community-level approaches to affect key determinants of health are also critical. Many of these issues were raised in the 1995 National Academies book, http://www.nap.edu/catalog.php?record_id=10886 Children's Health, the Nation's Wealth. The present volume builds upon this earlier book with presentations and examples from the field. Focusing on Children's Health describes the evidence linking early childhood life conditions and adult health; discusses the contribution of the early life course to observed racial and ethnic disparities in health; and highlights successful models that engage both community factors and health care to affect life course development.
Faculty in all disciplines must continually prioritize their time to reflect the many demands of their faculty obligations, but they must also prioritize their efforts in ways that will improve the prospects of career advancement. The current perception is that research contributions are the most important measure with respect to faculty promotion and tenure decisions, and that teaching effectiveness is less valued--regardless of the stated weighting of research, teaching and service. In addition, methods for assessing research accomplishments are well established, even though imperfect, whereas metrics for assessing teaching, learning, and instructional effectiveness are not as well defined or well established. Developing Metrics for Assessing Engineering Instruction provides a concise description of a process to develop and institute a valid and acceptable means of measuring teaching effectiveness in order to foster greater acceptance and rewards for faculty efforts to improve their performance of the teaching role that makes up a part of their faculty responsibility. Although the focus of this book is in the area of engineering, the concepts and approaches are applicable to all fields in higher education.
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