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Lesbian Health: Current Assessment and Directions for the Future

by Institute of Medicine

Women's health, as a field of study, is a developing discipline. Health theories in general have been based on studies of men. However, in recent years, more attention has shifted to women's health, realizing the disparities between men and women in relation to their health. During the last two decades, a similar shift has occurred for a group of women--lesbian women--to further identify and specify their health needs.Over the past decade, lesbians have organized to call for attention to the health issues of this community, resulting in several federally funded research initiatives. This book offers a comprehensive view of what is known about lesbian health needs and what questions need further investigation, including:How do we define who is lesbian?Are there unique health issues for lesbians?Are lesbians at higher or lower risk for such health problems as AIDS, sexually transmitted diseases, breast cancer, mental disorders, and substance abuse?How does homophobia affect lesbian health and the funding of research on lesbian health?How do lesbian health needs fit into the health care system and the larger society?What risk and protective factors shape the physical and mental health of lesbians?The book discusses how to determine which questions to ask about sexual orientation, the need to obtain information without violating privacy, the importance of considering racial and ethnic diversity in the study of lesbians, strategies for exchanging information among researchers and disseminating findings to the public, and mechanisms for supporting greater numbers of researchers.Lesbian Health takes a frank look at the political pressures, community attitudes, and professional concerns uniquely affecting the study of lesbian health issues. The book explores many other issues including the potential for transferring findings in this field to other population groups, including other rare populations and women in general.

Reducing Stress Fracture in Physically Active Military Women

by Subcommittee on Body Composition Nutrition Health of Military Women

The incidence of stress fractures of the lower extremities during U.S. military basic training is significantly higher among female military recruits than among male recruits. The prevalence of this injury has a marked impact on the health of service personnel and imposes a significant financial burden on the military by delaying completion of the training of new recruits. In addition to lengthening training time, increasing program costs, and delaying military readiness, stress fractures may share their etiology with the longer-term risk of osteoporosis.As part of the Defense Women's Health Research Program, this book evaluates the impact of diet, genetic predisposition, and physical activity on bone mineral and calcium status in young servicewomen. It makes recommendations for reducing stress fractures and improving overall bone health through nutrition education and monitored physical training programs. The book also makes recommendations for future research to evaluate more fully the effects of fitness levels, physical activities, and other factors on stress fracture risk and bone health.

Antimicrobial Resistance: Issues and Options: Workshop Report

by Forum on Emerging Infections

Antibiotic resistance is neither a surprising nor a new phenomenon. It is an increasingly worrisome situation, however, because resistance is growing and accelerating while the world's tools for combating it decrease in power and number. In addition, the cost of the problem--especially of multidrug resistance--in terms of money, mortality, and disability are also rising. This book summarizes a workshop on antimicrobial resistance held by the Forum on Emerging Infections. The goal of the Forum on Emerging Infections is to provide an opportunity for representatives of academia, industry, government, and professional and interest groups to examine and discuss scientific and policy dilemmas of common interest that are specifically related to research on and the prevention, detection, and management of emerging infections. Organized as a topic-by-topic synthesis of presentations and exchanges during the workshop, the book highlights lessons learned, delineates a range of pivotal issues and the problems they raise, and proposes some simplified ideas about possible responses.

The Community Development Quota Program in Alaska

by Committee to Review the Community Development Quota Program

This book reviews the performance and effectiveness of the Community Development Quotas (CDQ) programs that were formed as a result of the Sustainable Fisheries Act of 1996. The CDQ program is a method of allocating access to fisheries to eligible communities with the intent of promoting local social and economic conditions through participation in fishing-related activities. The book looks at those Alaskan fisheries that have experience with CDQs, such as halibut, pollock, sablefish, and crab, and comments on the extent to which the programs have met their objectives--helping communities develop ongoing commercial fishing and processing activities, creating employment opportunities, and providing capital for investment in fishing, processing, and support projects such as infrastructure. It also considers how CDQ-type programs might apply in the Western Pacific.

Trends and Challenges in Aerospace Offsets: Proceedings and Papers

by National Research Council

The granting of offsets to promote exports of major aircraft systems has been a source of significant controversy. Critics believe that offsets undermine the U.S. manufacturing base; lead to the transfer of commercial technology, possibly affecting national security; and result in the loss of high-wage jobs. Defenders of the practice argue that offsets are a fact of commercial life and can result in net U.S. job gains.In an effort to focus the offsets debate on analytical issues, the White House National Economic Council asked the National Research Council to convene expert academicians, representatives from the aerospace industry, and top government officials to discuss the impact of offsets on the U.S. economy. To ensure a rigorous discussion encompassing all points of view, the conference included a series of papers outlining the positions of key participants. This resulting volume offers a comprehensive and up-to-date analysis of the impact of aerospace offsets.

Hydrologic Sciences: Taking Stock and Looking Ahead

by Proceedings of the 1997 Abel Wolman Distinguished Lecture Symposium on the Hydrologic Sciences

Hydrologic science, an important, interdisciplinary science dealing with the occurrence, distribution, and properties of water on Earth, is key to understanding and resolving many contemporary, large-scale environmental issues. The Water Science and Technology Board used the opportunity of its 1997 Abel Wolman Distinguished Lecture to assess the vitality of the hydrologic sciences by the hydrologic community. The format included focus by lecturer Thomas Dunne on the intellectual vitality of the hydrologic sciences, followed by a symposium featuring several invited papers and discussions.Hydrologic Sciences is a compilation of the Wolman Lecture and the papers, preceded by a summarizing overview. The volume stresses a number of needs for furtherance of hydrologic science, including development of a coherent body of transferable theory and an intellectual center for the science, communication across multiple geo- and environmental science disciplines, appropriate measurements and observations, and provision of central guidance for the field.

Assessing Readiness in Military Women: The Relationship of Body Composition, Nutrition, and Health

by Committee on Body Composition Nutrition Health of Military Women

U.S. military personnel are required to adhere to standards of body composition, fitness, and appearance to achieve and maintain readiness--that is, the maintenance of optimum health and performance so they are ready for deployment at any moment. In 1992, the Committee on Military Nutrition Research reviewed the existing standards and found, among other things, that the standards for body composition required for women to achieve an appearance goal seemed to conflict with those necessary to ensure the ability to perform many types of military tasks. This report addresses that conflict, and reviews and makes recommendations about current policies governing body composition and fitness, as well as postpartum return-to-duty standards, Military Recommended Dietary Allowances, and physical activity and nutritional practices of military women to determine their individual and collective impact on the health, fitness, and readiness of active-duty women.

Research Reactor Aluminum Spent Fuel : Treatment Options for Disposal

by Board on Radioactive Waste Management

The U.S. Department of Energy (DOE) is preparing an environmental impact statement (EIS) for management of aluminum spent fuel from foreign and domestic research reactors, much of which is highly enriched in uranium-235. This EIS will assess the need for additional treatment and storage facilities at the Savannah River Site to accommodate the receipt of this fuel, and it also will assess and select a treatment technology to prepare this fuel for interim storage and eventual shipment to a repository for disposal.This National Research Council book, which was prepared at the request of DOE's Savannah River Office, provides a technical assessment of the technologies, costs, and schedules developed by DOE for eight alternative treatment options and the baseline reprocessing option. It also provides comments on DOE's aluminum spent fuel disposal program, a program that is slated to last for about 40 years and cost in excess of $2 billion.

A Strategy for Research in Space Biology and Medicine in the New Century

by Committee on Space Biology Medicine

Construction of the international space station, scheduled to start in late 1998, ushers in a new era for laboratory sciences in space. This is especially true for space life sciences, which include not only the use of low gravity as an experimental parameter to study fundamental biological processes but also the study of the serious physiological changes that occur in astronauts as they remain in space for increasingly longer missions.This book addresses both of these aspects and provides a comprehensive review of ground-based and space research in eleven disciplines, ranging from bone physiology to plant biology. It also offers detailed, prioritized recommendations for research during the next decade, which are expected to have a considerable impact on the direction of NASA's research program. The volume is also a valuable reference tool for space and life scientists.

Adequacy of the VA Persian Gulf Registry and Uniform Case Assessment Protocol

by Committee on the Evaluation of the Department of Veterans Affairs Uniform Case Assessment Protocol

As mandated in Public Law 103-446, the Department of Veterns Affairs (VA) asked the Institute of Medicine (IOM) to review its Uniform Case Assessment Protocol (UCAP) for Persian Gulf veterans. The purpose of the program is to provide a systematic, comprehensive medical protocol for the diagnosis of health problems of Persian Gulf veterans. This report is the third in a series of studies by IOM reviewing the protocols used by the VA and the Department of Defense to diagnose the health complaints of Gulf veterans. The committee reviews and makes recommendations concerning the adequacy of the medical protocol and its implementation by the VA, as well as the VA's outreach and education efforts aimed at informing Persian Gulf veterans and their care providers of the purpose and availability of this program. In addition, the report contains as appendixes the findings and recommendations of the previous reports, as well as those of two related IOM reports on Health Consequences of Service During the Persian Gulf War.

Elementary-Particle Physics: Revealing the Secrets of Energy and Matter

by Committee on Elementary-Particle Physics

Part of the Physics in a New Era series of assessments of the various branches of the field, Elementary-Particle Physics reviews progress in the field over the past 10 years and recommends actions needed to address the key questions that remain unanswered. It explains in simple terms the present picture of how matter is constructed. As physicists have probed ever deeper into the structure of matter, they have begun to explore one of the most fundamental questions that one can ask about the universe: What gives matter its mass? A new international accelerator to be built at the European laboratory CERN will begin to explore some of the mechanisms proposed to give matter its heft. The committee recommends full U.S. participation in this project as well as various other experiments and studies to be carried out now and in the longer term.

The Unpredictable Certainty: Information Infrastructure Through 2000

by NII 2000 Steering Committee

We have available an impressive array of information technology. We can transmit literature, movies, music, and talk. Government, businesses, and individuals are eager to go on-line to buy, sell, teach, learn, and more. How, then, should we go about developing an infrastructure for on- line communication among everyone everywhere? The Unpredictable Certainty explores the national information infrastructure (NII) as the collection of all public and private information services. But how and when will the NII become a reality? How will more and better services reach the home, small businesses, and remote locations? The Unpredictable Certainty examines who will finance the NII, exploring how technology companies decide to invest in deployment and the the vain search for "killer apps" (applications that drive markets). It discusses who will pay for ongoing services and how they will pay, looking at past cost/price models relevant to the future. The Unpredictable Certainty discusses the underlying technologies, appliances, and services needed before the NII becomes a reality; reviews key features of important technologies; and analyzes current levels of deployment in telephone, cable and broadcast television, and wireless systems, and the difficulties in interconnection. The volume explores the challenge of open interfaces that stimulate new applications but also facilitate competition, the trend toward the separation of infrastructure from specific services, the tension between mature services and new contenders, the growth of the Internet, and more. The roles governments at different levels might play in fostering NII deployment are outlined, including R&D and the use of information infrastructure for better delivery of government services and information.

Fostering Research on the Economic and Social Impacts of Information Technology: Report Of A Workshop

by Steering Committee on Research Opportunities Relating to Economic Social Impacts of Computing Communications

The tremendous growth in use of information technology (IT) has led to an increased interest in understanding its social and economic impacts. This book presents examples of crosscutting research that has been conducted to understand the impact of information technology on personal, community, and business activities. It explores ways in which the use of methodology from economics and social sciences contributes to important advances in understanding these impacts.The book discusses significant research issues and concerns and suggests approaches for fostering increased interdisciplinary research on the impacts of information technology and making the results of this research more accessible to the public and policymakers. This volume is expected to influence funding priorities and levels of support for interdisciplinary research of this kind.

Review of Northeast Fishery Stock Assessments

by Committee to Review Northeast Fishery Stock Assessments

The collapse of cod, flounder, and haddock fish stocks in the Northeast United States has caused widespread concern among managers and fishers in the United States and Canada. The diminishing stocks have forced managers to take strict regulatory measures. Numerous questions have been raised about the adequacy of stock assessment science used to evaluate the status of these stocks and the appropriateness of the management measures taken. Based on these concerns, Congress mandated that a scientific review of the methodology and data used to evaluate these stocks be conducted. In this volume, the committee concludes that although there are improvements to be made in data collection, modeling uncertainty, and communicating between fishers, managers, and scientists, the scientific methods used in the Northeast stock assessments are sound. Recommendations are made on how the stock assessment process can be improved.

Prevention of Micronutrient Deficiencies: Tools for Policymakers and Public Health Workers

by Committee on Micronutrient Deficiencies

Micronutrient malnutrition affects approximately 2 billion people worldwide. The adverse effects of micronutrient deficiencies are profound and include premature death, poor health, blindness, growth stunting, mental retardation, learning disabilities, and low work capacity. Preventing Micronutrient Deficiencies provides a conceptual framework based on past experience that will allow funders to tailor programs to existing regional/country capabilities and to incorporate within these programs the capacity to address multiple strategies (i.e., supplementation/fortification/food-based approaches/public health measures) and multiple micronutrient deficiencies.The book does not offer recommendations on how to alleviate specific micronutrient deficiencies--such recommendations are already available through the publications of diverse organizations, including the U.S. Agency for International Development, the Micronutrient Initiative, World Bank, United Nations Childrens' Fund, and the World Health Organization. Instead, this volume examines key elements in the design and implementation of micronutrient interventions, including such issues as:The importance of iron, vitamin A, and iodine to health. Populations at risk for micronutrient deficiency. Options for successful interventions and their cost. The feasibility of involving societal sectors in the planning and implementation of interventions. Characteristics of successful interventions.The book also contains three in-depth background papers that address the prevention of deficiencies of iron, vitamin A, and iodine.

Nutrient Requirements of Swine: Tenth Revised Edition, 1998

by Subcommittee on Swine Nutrition

The tenth edition of this essential reference presents new knowledge about the nutritional needs of swine that consider such factors as growth rate, carcass leanness, gender, health, environment, and repartitioning agents. New sections are presented on requirements for amino acids and other nutrients. In addition, an original modeling approach to arriving at energy and amino acid needs for given animals is incorporated in this revision. The book comes with a CD-ROM that allows users to create tables of nutrient requirements for swine of a specific body weight and level of productivity. Nutrient Requirements of Swine covers: Biological concepts that underlie nutrient needs for growth and function. New data on amino acid and energy requirements and the factors that shape them. New findings on lysine and the bioavailability of amino acids. New research results on minerals and vitamins. Nutrient composition of an expanded list of feedstuffs. The role of water in swine physiology, including factors that affect the quality of drinking water. Expanded tables of feed ingredients and their nutrient composition provide bioavailability estimates, fatty acid composition of fats typically used in swine diets, and important information on estimating the amino acid content of crude protein.

Harnessing Light: Optical Science and Engineering for the 21st Century

by Committee on Optical Science Engineering

Optical science and engineering affect almost every aspect of our lives. Millions of miles of optical fiber carry voice and data signals around the world. Lasers are used in surgery of the retina, kidneys, and heart. New high-efficiency light sources promise dramatic reductions in electricity consumption. Night-vision equipment and satellite surveillance are changing how wars are fought. Industry uses optical methods in everything from the production of computer chips to the construction of tunnels. Harnessing Light surveys this multitude of applications, as well as the status of the optics industry and of research and education in optics, and identifies actions that could enhance the field's contributions to society and facilitate its continued technical development.

Brucellosis in the Greater Yellowstone Area

by Board On Agriculture

Brucellosis, a bacterial disease, was first noted in the Greater Yellowstone Area in 1917 and has been a chronic presence there since then. This book reviews existing scientific knowledge regarding brucellosis transmission among wildlife, particularly bison, elk, and cattle, in the Greater Yellowstone Area. It examines the mechanisms of transmission, risk of infection, and vaccination strategies. The book also assesses the actual infection rate among bison and elk and describes what is known about the prevalence of Brucella abortus among other wildlife.

Contraceptive Research, Introduction, and Use: Lessons from Norplant

by Subcommittee for Workshop on Implant Contraceptives: An Illuminating Case Study in Current Dilemmas Possibilities

As the first real contraceptive innovation in over 20 years, and as a long-acting method requiring clinical intervention for application and removal, the implantable contraceptive Norplant has raised a wide range of issues that could offer valuable lessons about the problems to be addressed if other new contraceptive technologies are to enter the marketplace. In April 1997 an Institute of Medicine workshop on implant contraceptives reviewed newly available data on Norplant's efficacy, safety, and use; identified lessons to be learned about the method's development, introduction, use, and market experience; and explored approaches to developing and introducing new contraceptives based on those lessons. This resulting book contains an examination of Norplant's efficacy and safety, its user populations, training for insertion and removal, consumer perspectives (quality of care, informed decisionmaking, and consumer involvement), and new approaches to contraceptive development and introduction. An appendix contains summaries of 17 workshop presentations.

Microelectromechanical Systems: Advanced Materials and Fabrication Methods

by Committee on Advanced Materials Fabrication Methods for Microelectromechanical Systems

Microelectromenchanical systems (MEMS) is a revolutionary field that adapts for new uses a technology already optimized to accomplish a specific set of objectives. The silicon-based integrated circuits process is so highly refined it can produce millions of electrical elements on a single chip and define their critical dimensions to tolerances of 100-billionths of a meter. The MEMS revolution harnesses the integrated circuitry know-how to build working microsystems from micromechanical and microelectronic elements. MEMS is a multidisciplinary field involving challenges and opportunites for electrical, mechanical, chemical, and biomedical engineering as well as physics, biology, and chemistry. As MEMS begin to permeate more and more industrial procedures, society as a whole will be strongly affected because MEMS provide a new design technology that could rival--perhaps surpass--the societal impact of integrated circuits.

Halcion: An Independent Assessment of Safety and Efficacy Data

by Committee on Halcion: An Assessment of Data Adequacy Confidence

Regulatory agencies within the United States and the United Kingdom, among several other countries, have reviewed extensively the safety and efficacy of Halcion (triazolam)--a once commonly used hypnotic drug. Concerns began to emerge about the safety of Halcion when a Dutch physician reported a possible link between it and a syndrome that included such effects as depression, amnesia, hallucinations, and increased anxiety. In addition, in 1991 its manufacturer, Upjohn, noted that "errors had been identified in a report of one of the clinical studies included in the original" application for approval. Since then, the drug has been removed from the market in several countries, whereas in the United States and Canada, the drug's labeling has been modified to reduce the recommended dose and duration of treatment and to heighten awareness of possible side effects. Yet different data and analyses have resulted in conflicting messages that are difficult to reconcile and interpret. In response to a request from the Food and Drug Administration to resolve these controversial issues related to the safety and efficacy of Halcion, this IOM book assesses the adequacy of the drug's clinical trials; the quality and quantity of data on adverse reactions; overall confidence in the data on effectiveness, adverse events, and side effects at different doses; and whether additional studies are needed.

Pacific Partnerships for Health: Charting a Course for the 21st Century

by Jill C. Feasley Robert S. Lawrence

The U.S.-Associated Pacific Basin consists of six island jurisdictions: American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, the Federated States of Micronesia, Republic of the Marshall Islands, and the Republic of Palau. This book examines one aspect of the ties and U.S. involvement with this part of the world--its role in the region's health care delivery system. Although the health status of the islanders and the challenges faced by the health care systems naturally vary within and among the jurisdictions, in general, almost all health indicators for the islanders are worse than those of mainland Americans. The health systems in the area must deal with conditions normally seen in developing countries (e.g., malnutrition, tuberculosis, dengue fever, and cholera) and in developed countries alike (e.g., diabetes, heart disease, and cancer). In examining the strengths and weaknesses of the area's systems, the volume provides a regional health overview and assessments of health care in individual jurisdictions, evaluates the Pacific Basin Medical Officers Training Program, and lays out a strategic plan for future health services in the U.S.-Associated Pacific Basin.

Orphans and Incentives: Developing Technologies to Address Emerging Infections: Workshop Report

by Forum on Emerging Infections

Infectious diseases remain a leading cause of prolonged illness, premature mortality, and soaring health costs. In the United States in 1995, infectious diseases were the third leading cause of death, right behind heart disease and cancer. Mortality is mounting over time, owing to HIV/AIDS, pneumonia, and septicemia, with drug resistance playing an ever-increasing role in each of these disease categories. This book, a report from a Forum on Emerging Infections workshop, focuses on product areas where returns from the market might be perceived as being too small or too complicated by other factors to compete in industrial portfolios with other demands for investment. Vaccines are quintessential examples of such products. The lessons learned fall into four areas, including what makes intersectoral collaboration a reality, the notion of a product life cycle, the implications of divergent sectoral mandates and concepts of risk, and the roles of advocacy and public education. The summary contains an examination of the Children's Vaccine Initiative and other models, an industry perspective on the emerging infections agenda, and legal and regulatory issues.

Aging of U.S. Air Force Aircraft: Final Report

by Committee on Aging of U.S. Air Force Aircraft

Many of the aircraft that form the backbone of the U.S. Air Force operational fleet are 25 years old or older. A few of these will be replaced with new aircraft, but many are expected to remain in service an additional 25 years or more. This book provides a strategy to address the technical needs and priorities associated with the Air Force's aging airframe structures. It includes a detailed summary of the structural status of the aging force, identification of key technical issues, recommendations for near-term engineering and management actions, and prioritized near-term and long-term research recommendations.

Energy-Efficient Technologies for the Dismounted Soldier

by Committee on Electric Power for the Dismounted Soldier

This book documents electric power requirements for the dismounted soldier on future Army battlefields, describes advanced energy concepts, and provides an integrated assessment of technologies likely to affect limitations and needs in the future. It surveys technologies associated with both supply and demand, including energy sources and systems; low-power electronics and design; communications, computers, displays, and sensors; and networks, protocols, and operations. The advanced concepts discussed are predicated on continued development by the Army of soldier systems similar to the Land Warrior system on which the committee based its projections on energy use.

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