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Enabling Precision Medicine: Proceedings of a Workshop
by National Academies of Sciences Engineering MedicineThose involved in the drug development process face challenges of efficiency and overall sustainability due in part to high research costs, lengthy development timelines, and late-stage drug failures. Novel clinical trial designs that enroll participants based on their genetics represent a potentially disruptive change that could improve patient outcomes, reduce costs associated with drug development, and further realize the goals of precision medicine. On March 8, 2017, the Forum on Drug Discovery, Development, and Translation and the Roundtable on Genomics and Precision Health of the National Academies of Sciences, Engineering, and Medicine hosted the workshop Enabling Precision Medicine: The Role of Genetics in Clinical Drug Development. Participants examined successes, challenges, and possible best practices for effectively using genetic information in the design and implementation of clinical trials to support the development of precision medicines, including exploring the potential advantages and disadvantages of such trials across a variety of disease areas. This publication summarizes the presentations and discussions from the workshop.
Principles and Practices for Federal Program Evaluation: Proceedings of a Workshop
by National Academies of Sciences Engineering MedicineIn October 2016, the National Academies of Sciences, Engineering, and Medicine convened a 1-day public workshop on Principles and Practices for Federal Program Evaluation. The workshop was organized to consider ways to bolster the integrity and protect the objectivity of the evaluation function in federal agencies—a process that is essential for evidence-based policy making. This publication summarizes the presentations and discussions from the workshop.
A Proposed Framework for Identifying Potential Biodefense Vulnerabilities Posed by Synthetic Biology: Interim Report
by National Academies of Sciences Engineering MedicineBuilding on an increasingly sophisticated understanding of naturally occurring biological processes, researchers have developed technologies to predictably modify or create organisms or biological components. This research, known collectively as synthetic biology, is being pursued for a variety of purposes, from reducing the burden of disease to improving agricultural yields to remediating pollution. While synthetic biology is being pursued primarily for beneficial and legitimate purposes, it is possible to imagine malicious uses that could threaten human health or military readiness and performance. Making informed decisions about how to address such concerns requires a comprehensive, realistic assessment. To this end, the U.S. Department of Defense, working with other agencies involved in biodefense, asked the National Academies of Sciences, Engineering, and Medicine to develop a framework to guide an assessment of the security concerns related to advances in synthetic biology, to assess the level of concern warranted for various advances and identify areas of vulnerability, and to prioritize options to address these vulnerabilities. This interim report proposes a framework for identifying and prioritizing potential areas of concern associated with synthetic biology—a tool to aid the consideration of concerns related to synthetic biology. The framework describes categories of synthetic biology technologies and applications—such as genome editing, directed evolution, and automated biological design—and provides a set of initial questions to guide the assessment of concern related to these technologies and applications.
Software Update as a Mechanism for Resilience and Security: Proceedings of a Workshop
by National Academies of Sciences Engineering MedicineSoftware update is an important mechanism by which security changes and improvements are made in software, and this seemingly simple concept encompasses a wide variety of practices, mechanisms, policies, and technologies. To explore the landscape further, the Forum on Cyber Resilience hosted a workshop featuring invited speakers from government, the private sector, and academia. This publication summarizes the presentations and discussions from the workshop.
A Smarter National Surveillance System for Occupational Safety and Health in the 21st Century
by Engineering Medicine National Academies of SciencesThe workplace is where 156 million working adults in the United States spend many waking hours, and it has a profound influence on health and well-being. Although some occupations and work-related activities are more hazardous than others and face higher rates of injuries, illness, disease, and fatalities, workers in all occupations face some form of work-related safety and health concerns. Understanding those risks to prevent injury, illness, or even fatal incidents is an important function of society. Occupational safety and health (OSH) surveillance provides the data and analyses needed to understand the relationships between work and injuries and illnesses in order to improve worker safety and health and prevent work-related injuries and illnesses. Information about the circumstances in which workers are injured or made ill on the job and how these patterns change over time is essential to develop effective prevention programs and target future research. The nation needs a robust OSH surveillance system to provide this critical information for informing policy development, guiding educational and regulatory activities, developing safer technologies, and enabling research and prevention strategies that serves and protects all workers. A Smarter National Surveillance System for Occupational Safety and Health in the 21st Century provides a comprehensive assessment of the state of OSH surveillance. This report is intended to be useful to federal and state agencies that have an interest in occupational safety and health, but may also be of interest broadly to employers, labor unions and other worker advocacy organizations, the workers’ compensation insurance industry, as well as state epidemiologists, academic researchers, and the broader public health community. The recommendations address the strengths and weaknesses of the envisioned system relative to the status quo and both short- and long-term actions and strategies needed to bring about a progressive evolution of the current system.
Enhancing the Resilience of the Nation’s Electricity System
by National Academies of Sciences Engineering MedicineAmericans’ safety, productivity, comfort, and convenience depend on the reliable supply of electric power. The electric power system is a complex “cyber-physical” system composed of a network of millions of components spread out across the continent. These components are owned, operated, and regulated by thousands of different entities. Power system operators work hard to assure safe and reliable service, but large outages occasionally happen. Given the nature of the system, there is simply no way that outages can be completely avoided, no matter how much time and money is devoted to such an effort. The system’s reliability and resilience can be improved but never made perfect. Thus, system owners, operators, and regulators must prioritize their investments based on potential benefits. Enhancing the Resilience of the Nation’s Electricity System focuses on identifying, developing, and implementing strategies to increase the power system’s resilience in the face of events that can cause large-area, long-duration outages: blackouts that extend over multiple service areas and last several days or longer. Resilience is not just about lessening the likelihood that these outages will occur. It is also about limiting the scope and impact of outages when they do occur, restoring power rapidly afterwards, and learning from these experiences to better deal with events in the future.
Report Series: Getting Ready for the Next Planetary Science Decadal Survey
by National Academies of Sciences Engineering MedicineThis study discusses the publicly available studies of future flagship- and New Frontiers-class missions NASA initiated since the completion of Vision and Voyages. The report considers the priority areas as defined in Vision and Voyages where publicly available mission studies have not been undertaken; appropriate mechanisms by which mission-study gaps might be filled in the near- to mid-term future; and other activities that might be undertaken in the near- to mid-term future to optimize and/or expedite the work of the next planetary science decadal survey committee.
Facilitating Health Communication with Immigrant, Refugee, and Migrant Populations Through the Use of Health Literacy and Community Engagement Strategies: Proceedings of a Workshop
by National Academies of Sciences Engineering MedicineThe increasingly diverse ethnic composition of the United States population has created a profound and ongoing demographic shift, and public health and health care organizations face many challenges as they move to address and adapt to this change. To better understand how the public health and health care communities can meet the challenges of serving an increasingly diverse population, the Roundtable on Health Literacy conducted a public workshop on facilitating health communication with immigrant, refugee, and migrant populations through the use of health literate approaches. The goal of the workshop was to identify approaches that will enable organizations that serve these ethnically and culturally diverse populations in a manner that allows all members of these communities to obtain, process, and understand basic health information and the services needed to make appropriate health and personal decisions. This publication summarizes the presentations and discussions from the workshop.
Protecting the Health and Well-Being of Communities in a Changing Climate: Proceedings Of A Workshop
by National Academies of Sciences Engineering MedicineOn March 13, 2017, the Roundtable on Environmental Health Sciences, Research, and Medicine and the Roundtable on Population Health Improvement jointly convened a 1-day public workshop in Washington, DC, to explore potential strategies for public health, environmental health, health care, and related stakeholders to help communities and regions to address and mitigate the health effects of climate change. Participants discussed the perspectives of civic, government, business, and health-sector leaders, and existing research, best practices, and examples that inform stakeholders and practitioners on approaches to support mitigation of and adaptation to climate change and its effects on population health. This publication summarizes the presentations and discussions from the workshop.
Responding to the Threat of Sea Level Rise: Proceedings of a Forum
by National Academy of EngineeringThe future rate and extent of sea level rise are highly uncertain, and responses to higher water levels will need to reflect this uncertainty. Sea level rise was a major topic of the annual meeting of the National Academy of Engineering on October 9–10, 2016, and the second day featured a forum on adaptation to it. This summary of the forum, which also incorporates material from Robert J. Nicholls’ plenary presentation, outlines a rich and challenging set of problems for engineers, scientists, and those who work with them.
Biomarkers of Neuroinflammation: Proceedings Of A Workshop
by National Academies of Sciences Engineering MedicineNeuroinflammation is a burgeoning area of interest in academia and biopharma, with a broadly acknowledged role in many central nervous system (CNS) disorders. However, there is little agreement on the pathophysiological mechanisms that underlie the manifestations of neuroinflammation in the CNS compartment and how neuroinflammation operates as a driver and also as a consequence of disease in the brain. Moreover, another unclear area is how to translate increased understanding of the mechanisms that underlie neuroinflammation and its manifestations in the CNS to therapeutics. To address these gaps in understanding mechanisms and how to translate that understanding into therapeutics, the Forum on Neuroscience and Nervous System Disorders of the National Academies of Sciences, Engineering, and Medicine convened a workshop on March 20-21, 2017, bringing together key leaders in the field from industry, academia, and governmental agencies to explore the role and mechanisms of neuroinflammation in a variety of CNS diseases. The workshop also considered strategies to advance the identification and validation of biomarkers of neuroinflammation that could accelerate development of therapies, bringing much-needed treatments to patients with disorders ranging from neuroinflammatory diseases such as multiple sclerosis (MS) to neuropsychiatric disorders such as depression. This publication summarizes the presentations and discussions from the workshop.
The Challenge of Treating Obesity and Overweight: Proceedings of a Workshop
by National Academies of Sciences Engineering MedicineThe Roundtable on Obesity Solutions of the National Academies of Sciences, Engineering, and Medicine held a workshop in Washington, DC, on April 6, 2017, titled The Challenge of Treating Obesity and Overweight: A Workshop. The discussions covered treatments for obesity, overweight, and severe obesity in adults and children; emerging treatment opportunities; the development of a workforce for obesity treatments; payment and policy considerations; and promising paths to move forward. This publication summarizes the presentations and discussions from the workshop.
Examining Challenges and Possible Strategies to Strengthen U.S. Health Security: Proceedings Of A Workshop
by National Academies of Sciences Engineering MedicineAs the United States continues to adapt to a more digital, mobile, and interconnected world, health care and public health professionals have sought to better prepare for and respond to long-standing and emerging threats to the nation’s health security. Health security is the collective effort to prevent, protect against, mitigate, respond to, and recover from the health consequences of natural, man-made, and technological disasters. Although substantial progress has been made in the past 15 years toward improving health care and public health systems and capacities for health security threats, many complex challenges persist, and often the nation’s preparedness efforts are not sufficient. On March 8–9, 2017, the National Academies of Sciences, Engineering, and Medicine’s Forum on Medical and Public Health Preparedness for Disasters and Emergencies hosted a two-day public workshop to acknowledge these persistent issues; to evaluate past, and perhaps inadequate, approaches to addressing them; and to discuss intentional and innovative new solutions. This publication summarizes the presentations and discussions from the workshop.
Powering Science: NASA’s Large Strategic Science Missions
by National Academies of Sciences Engineering MedicineNASA’s Science Mission Directorate (SMD) currently operates over five dozen missions, with approximately two dozen additional missions in development. These missions span the scientific fields associated with SMD’s four divisions—Astrophysics, Earth Science, Heliophysics, and Planetary Sciences. Because a single mission can consist of multiple spacecraft, NASA-SMD is responsible for nearly 100 operational spacecraft. The most high profile of these are the large strategic missions, often referred to as “flagships.” Large strategic missions are essential to maintaining the global leadership of the United States in space exploration and in science because only the United States has the budget, technology, and trained personnel in multiple scientific fields to conduct missions that attract a range of international partners. This report examines the role of large, strategic missions within a balanced program across NASA-SMD space and Earth sciences programs. It considers the role and scientific productivity of such missions in advancing science, technology and the long-term health of the field, and provides guidance that NASA can use to help set the priority of larger missions within a properly balanced program containing a range of mission classes.
Animal Models for Microbiome Research: Advancing Basic And Translational Science: Proceedings Of A Workshop
by National Academies of Sciences Engineering MedicineThe surface of the human body and its mucous membranes are heavily colonized by microorganisms. Our understanding of the contributions that complex microbial communities make to health and disease is advancing rapidly. Most microbiome research to date has focused on the mouse as a model organism for delineating the mechanisms that shape the assembly and dynamic operations of microbial communities. However, the mouse is not a perfect surrogate for studying different aspects of the microbiome and how it responds to various environmental and host stimuli, and as a result, researchers have been conducting microbiome studies in other animals. To examine the different animal models researchers employ in microbiome studies and to better understand the strengths and weaknesses of each of these model organisms as they relate to human and nonhuman health and disease, the Roundtable on Science and Welfare in Laboratory Animal Use of the National Academies of Sciences, Engineering, and Medicine convened a workshop in December 2016. The workshop participants explored how to improve the depth and breadth of analysis of microbial communities using various model organisms, the challenges of standardization and biological variability that are inherent in gnotobiotic animal-based research, the predictability and translatability of preclinical studies to humans, and strategies for expanding the infrastructure and tools for conducting studies in these types of models. This publication summarizes the presentations and discussions from the workshop.
Searching for Life Across Space and Time: Proceedings of a Workshop
by National Academies of Sciences Engineering MedicineThe search for life is one of the most active fields in space science and involves a wide variety of scientific disciplines, including planetary science, astronomy and astrophysics, chemistry, biology, chemistry, and geoscience. In December 2016, the Space Studies Board hosted a workshop to explore the possibility of habitable environments in the solar system and in exoplanets, techniques for detecting life, and the instrumentation used. This publication summarizes the presentations and discussions from the workshop.
U.S.-Iran Engagement in Science, Engineering, and Health (2010-2016): A Resilient Program but an Uncertain Future
by National Academies of Sciences Engineering MedicineIn 2010, the National Research Council published the report U.S-Iran Engagement in Science, Engineering, and Medicine (2000-2009). The review of the program described in detail the National Academies’ science, technology, and health cooperation program carried out jointly with partners in Iran (otherwise known as science-engagement). The purpose of this new publication is to document the history and details of the National Academies’ program of science-engagement from 2010 through 2016, while providing a perspective in considering future science-engagement. A variety of cooperative activities, and particularly workshops that dominated science-engagement during that period, are highlighted.
Reducing the Threat of Improvised Explosive Device Attacks by Restricting Access to Explosive Precursor Chemicals
by National Academies of Sciences Engineering MedicineImprovised explosive devices (IEDs) are a type of unconventional explosive weapon that can be deployed in a variety of ways, and can cause loss of life, injury, and property damage in both military and civilian environments. Terrorists, violent extremists, and criminals often choose IEDs because the ingredients, components, and instructions required to make IEDs are highly accessible. In many cases, precursor chemicals enable this criminal use of IEDs because they are used in the manufacture of homemade explosives (HMEs), which are often used as a component of IEDs. Many precursor chemicals are frequently used in industrial manufacturing and may be available as commercial products for personal use. Guides for making HMEs and instructions for constructing IEDs are widely available and can be easily found on the internet. Other countries restrict access to precursor chemicals in an effort to reduce the opportunity for HMEs to be used in IEDs. Although IED attacks have been less frequent in the United States than in other countries, IEDs remain a persistent domestic threat. Restricting access to precursor chemicals might contribute to reducing the threat of IED attacks and in turn prevent potentially devastating bombings, save lives, and reduce financial impacts. Reducing the Threat of Improvised Explosive Device Attacks by Restricting Access to Explosive Precursor Chemicals prioritizes precursor chemicals that can be used to make HMEs and analyzes the movement of those chemicals through United States commercial supply chains and identifies potential vulnerabilities. This report examines current United States and international regulation of the chemicals, and compares the economic, security, and other tradeoffs among potential control strategies.
Peer Review of a Report on Strategies to Improve Patient Safety
by National Academies of Sciences, Engineering, and Medicine Health and Medicine Division Board on Health Care Services Committee for a Peer Review of a Report on Strategies to Improve Patient SafetyIn response to a congressional mandate under the Patient Safety and Quality Improvement Act of 2005, the National Academies of Sciences, Engineering, and Medicine was asked to review the Agency for Healthcare Research and Quality (AHRQ) draft report Strategies to Improve Patient Safety: Draft Report to Congress for Public Comment and Review by the National Academy of Medicine. The National Academies convened a committee of four subject-matter experts with experience in clinical patient safety, patient-safety research, health information technology, safety science, clinical medicine, and implementation science to conduct a peer review of the draft report. This committee had less than three months to review the AHRQ draft report and comment on additional effective strategies for improving patient safety, new evidence of effectiveness for safety strategies, potential implementation methods that were not mentioned, and any general technical corrections. The Patient Safety and Quality Improvement Act of 2005 created valuable national resources as part of the tools needed for systemic change. The committee offers these additional strategies to improve patient safety for consideration in the revision of the AHRQ draft report to Congress.
The 2014 Redesign of the Survey of Income and Program Participation: An Assessment
by National Academies of Sciences Engineering MedicineThe Survey of Income and Program Participation (SIPP) is a national, longitudinal household survey conducted by the Census Bureau. SIPP serves as a tool to evaluate the effectiveness of government-sponsored social programs and to analyze the impacts of actual or proposed modifications to those programs. SIPP was designed to fill a need for data that would give policy makers and researchers a much better grasp of how effectively government programs were reaching their target populations, how participation in different programs overlapped, and to what extent and under what circumstances people transitioned into and out of these programs. SIPP was also designed to answer questions about the short-term dynamics of employment, living arrangements, and economic well-being. The Census Bureau has reengineered SIPP—fielding the initial redesigned survey in 2014. This report evaluates the new design compared with the old design. It compares key estimates across the two designs, evaluates the content of the redesigned SIPP and the impact of the new design on respondent burden, and considers content changes for future improvement of SIPP.
Integrating Social and Behavioral Sciences Within the Weather Enterprise
by National Academies of Sciences Engineering MedicineOur ability to observe and forecast severe weather events has improved markedly over the past few decades. Forecasts of snow and ice storms, hurricanes and storm surge, extreme heat, and other severe weather events are made with greater accuracy, geographic specificity, and lead time to allow people and communities to take appropriate protective measures. Yet hazardous weather continues to cause loss of life and result in other preventable social costs. There is growing recognition that a host of social and behavioral factors affect how we prepare for, observe, predict, respond to, and are impacted by weather hazards. For example, an individual’s response to a severe weather event may depend on their understanding of the forecast, prior experience with severe weather, concerns about their other family members or property, their capacity to take the recommended protective actions, and numerous other factors. Indeed, it is these factors that can determine whether or not a potential hazard becomes an actual disaster. Thus, it is essential to bring to bear expertise in the social and behavioral sciences (SBS)—including disciplines such as anthropology, communication, demography, economics, geography, political science, psychology, and sociology—to understand how people’s knowledge, experiences, perceptions, and attitudes shape their responses to weather risks and to understand how human cognitive and social dynamics affect the forecast process itself. Integrating Social and Behavioral Sciences Within the Weather Enterprise explores and provides guidance on the challenges of integrating social and behavioral sciences within the weather enterprise. It assesses current SBS activities, describes the potential value of improved integration of SBS and barriers that impede this integration, develops a research agenda, and identifies infrastructural and institutional arrangements for successfully pursuing SBS-weather research and the transfer of relevant findings to operational settings.
A Decision Framework for Managing the Spirit Lake and Toutle River System at Mount St. Helens
by National Academies of Sciences Engineering MedicineThe 1980 eruption of Mount St. Helens in southwest Washington State radically changed the physical and socio-economic landscapes of the region. The eruption destroyed the summit of the volcano, sending large amounts of debris into the North Fork Toutle River, and blocking the sole means of drainage from Spirit Lake 4 miles north of Mount St. Helens. As a result of the blockage, rising lake levels could cause failure of the debris blockage, putting the downstream population of approximately 50,000 at risk of catastrophic flooding and mud flows. Further, continued transport of sediment to the river from volcanic debris deposits surrounding the mountain reduces the flood carrying capacity of downstream river channels and leaves the population vulnerable to chronic flooding. The legacy of the 1980 eruption and the prospect of future volcanic, seismic, and flood events mean that risk management in the Spirit Lake Toutle River system will be challenging for decades to come. This report offers a decision framework to support the long-term management of risks related to the Spirit Lake and Toutle River system in light of the different regional economic, cultural, and social priorities, and the respective roles of federal, tribal, state, and local authorities, as well as other entities and groups in the region. It also considers the history and adequacy of characterization, monitoring, and management associated with the Spirit Lake debris blockage and outflow tunnel, other efforts to control transport of water and sediment from the 1980 and later eruptions, and suggests additional information needed to support implementation of the recommended decision framework.
Securing Advanced Manufacturing in the United States: Proceedings of a Workshop
by National Academies of Sciences Engineering MedicineThe Manufacturing USA initiative seeks to reinforce U.S.-based advanced manufacturing through partnerships among industry, academia, and government. Started in 2012 and established with bipartisan support by the Revitalize American Manufacturing and Innovation Act of 2014, the initiative envisages a nationwide network of research centers for manufacturing innovation. As of May 2017, 14 manufacturing innovation institutes had been established to facilitate the movement of early-stage research into proven capabilities ready for adoption by U.S. manufacturers. To better understand the role and experiences of the Manufacturing USA institutes to date, a committee of the Innovation Policy Forum of the National Academies of Sciences, Engineering, and Medicine convened a workshop on May 23, 2017 drawing together institute directors and manufacturing policy experts along with leaders from industry, academia, and government. Participants addressed the role of the manufacturing institutes in increasing advanced manufacturing in the United States, examined selected foreign programs designed to support advanced manufacturing, and reviewed recent assessments of existing institutes. This publication summarizes the presentations and discussions from the workshop.
Training the Future Child Health Care Workforce to Improve the Behavioral Health of Children, Youth, and Families: Proceedings of a Workshop
by National Academies of Sciences Engineering MedicineIncreasing numbers of evidence-based interventions have proven effective in preventing and treating behavioral disorders in children. However, the adoption of these interventions in the health care system and other systems that affect the lives of children has been slow. Moreover, with few exceptions, current training in many fields that involve the behavioral health of children falls short of meeting the needs that exist. In general, this training fails to recognize that behavioral health disorders are among the largest challenges in child health and that changing cognitive, affective, and behavioral health outcomes for children will require new and more integrated forms of care at a population level in the United States. To examine the need for workforce development across the range of health care professions working with children and families, as well as to identify innovative training models and levers to enhance training, the Forum on Promoting Children’s Cognitive, Affective, and Behavioral Health held a workshop in November 2016. Workshop panelists and participants discussed the needs for workforce development across the range of health care professions working with children, youth, and families, and identified innovative training models and levers for change to enhance training. This publication summarizes the presentations and discussions from the workshop.
Engineering Societies and Undergraduate Engineering Education: Proceedings of a Workshop
by National Academy of EngineeringEngineering professional societies in the United States are engaged in a wide range of activities involving undergraduate education. However, these activities generally are not coordinated and have not been assessed in such a way that information about their procedures and outcomes can be shared. Nor have they been assessed to determine whether they are optimally configured to mesh with corresponding initiatives undertaken by industry and academia. Engineering societies work largely independently on undergraduate education, leaving open the question of how much more effective their efforts could be if they worked more collaboratively—with each other as well as with academia and industry. To explore the potential for enhancing societies’ role at the undergraduate level, the National Academy of Engineering held a workshop on the engagement of engineering societies in undergraduate engineering education. This publication summarizes the presentations and discussions from the workshop.