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Graduate Medical Education Outcomes and Metrics: Proceedings Of A Workshop
by Engineering Medicine National Academies of SciencesGraduate medical education (GME) is critical to the career development of individual physicians, to the functioning of many teaching institutions, and to the production of our physician workforce. However, recent reports have called for substantial reform of GME. The current lack of established GME outcome measures limits our ability to assess the impact of individual graduates, the performance of residency programs and teaching institutions, and the collective contribution of GME graduates to the physician workforce. To examine the opportunities and challenges in measuring and assessing GME outcomes, the National Academies of Sciences, Engineering, and Medicine held a workshop on October 10–11, 2017, in Washington, DC. Workshop participants discussed: meaningful and measurable outcomes of GME; possible metrics that could be used to track these GME outcomes; possible mechanisms for collecting, collating, analyzing, and reporting these data; and further work to accomplish this ambitious goal. This publication summarizes the presentations and discussions from the workshop.
The Next Generation of Biomedical and Behavioral Sciences Researchers: Breaking Through
by National Academies of Sciences Engineering MedicineSince the end of the Second World War, the United States has developed the world’s preeminent system for biomedical research, one that has given rise to revolutionary medical advances as well as a dynamic and innovative business sector generating high-quality jobs and powering economic output and exports for the U.S. economy. However, there is a growing concern that the biomedical research enterprise is beset by several core challenges that undercut its vitality, promise, and productivity and that could diminish its critical role in the nation’s health and innovation in the biomedical industry. Among the most salient of these challenges is the gulf between the burgeoning number of scientists qualified to participate in this system as academic researchers and the elusive opportunities to establish long-term research careers in academia. The patchwork of measures to address the challenges facing young scientists that has emerged over the years has allowed the U.S. biomedical enterprise to continue to make significant scientific and medical advances. These measures, however, have not resolved the structural vulnerabilities in the system, and in some cases come at a great opportunity cost for young scientists. These unresolved issues could diminish the nation’s ability to recruit the best minds from all sectors of the U.S. population to careers in biomedical research and raise concerns about a system that may favor increasingly conservative research proposals over high-risk, innovative ideas. The Next Generation of Biomedical and Behavioral Sciences Researchers: Breaking Through evaluates the factors that influence transitions into independent research careers in the biomedical and behavioral sciences and offers recommendations to improve those transitions. These recommendations chart a path to a biomedical research enterprise that is competitive, rigorous, fair, dynamic, and can attract the best minds from across the country.
Population Health in Challenging Times: Proceedings Of A Workshop
by National Academies of Sciences, Engineering, and Medicine Health and Medicine Division Board on Population Health and Public Health Practice Roundtable on Population Health ImprovementThe year 2020 presented extraordinary challenges to organizations working to improve population health - from public health agencies at all levels of government to health systems to community-based non-profit organizations responding to health-related social needs. To improve understanding of how different domains in the population health field are responding to and being changed by two major crises (racial injustice and the COVID-19 pandemic), the Roundtable on Population Health Improvement of the National Academies of Sciences, Engineering, and Medicine held a workshop from September 21-24, 2020, titled Population Health in Challenging Times: Insights from Key Domains. The workshop had sessions organized by themes: academic public health and population health; the social sector; health care, governmental public health; philanthropy; and cross-sector work. Each panel discussion highlighted difficulties and opportunities, both internal to the respective institutions and sectors, and at the interface with peers and partners, especially communities. This publication summarizes the presentations and panel discussions from the workshop.
Human-Automation Interaction Considerations for Unmanned Aerial System Integration into the National Airspace System: Proceedings Of A Workshop
by Engineering Medicine National Academies of SciencesPrior to 2012, unmanned aircraft systems (UAS) technology had been primarily used by the military and hobbyists, but it has more recently transitioned to broader application, including commercial and scientific applications, as well as to expanded military use. These new uses encroach on existing structures for managing the nation’s airspace and present significant challenges to ensure that UASs are coordinated safely and suitably with existing manned aircraft and air traffic management systems, particularly with the National Airspace System (NAS). Of particular concern is the interaction between human pilots, operators, or controllers and increasingly automated systems. Enhanced understanding of these interactions is essential to avoid unintended consequences, especially as new technologies emerge. In order to explore these issues, the National Academies of Sciences, Engineering, and Medicine organized a 2-day workshop in January 2018. This publication summarizes the presentations and discussions from the workshop.
Decrypting the Encryption Debate: A Framework For Decision Makers
by Engineering Medicine National Academies of SciencesEncryption protects information stored on smartphones, laptops, and other devices - in some cases by default. Encrypted communications are provided by widely used computing devices and services - such as smartphones, laptops, and messaging applications - that are used by hundreds of millions of users. Individuals, organizations, and governments rely on encryption to counter threats from a wide range of actors, including unsophisticated and sophisticated criminals, foreign intelligence agencies, and repressive governments. Encryption on its own does not solve the challenge of providing effective security for data and systems, but it is an important tool. At the same time, encryption is relied on by criminals to avoid investigation and prosecution, including criminals who may unknowingly benefit from default settings as well as those who deliberately use encryption. Thus, encryption complicates law enforcement and intelligence investigations. When communications are encrypted "end-to-end," intercepted messages cannot be understood. When a smartphone is locked and encrypted, the contents cannot be read if the phone is seized by investigators. Decrypting the Encryption Debate reviews how encryption is used, including its applications to cybersecurity; its role in protecting privacy and civil liberties; the needs of law enforcement and the intelligence community for information; technical and policy options for accessing plaintext; and the international landscape. This book describes the context in which decisions about providing authorized government agencies access to the plaintext version of encrypted information would be made and identifies and characterizes possible mechanisms and alternative means of obtaining information.
2017-2018 Assessment of the Army Research Laboratory: Interim Report
by National Academies of Sciences Engineering MedicineThe National Academies of Sciences, Engineering, and Medicine's Army Research Laboratory Technical Assessment Board (ARLTAB) provides biennial assessments of the scientific and technical quality of the research, development, and analysis programs at the Army Research Laboratory (ARL), focusing on ballistics sciences, human sciences, information sciences, materials sciences, and mechanical sciences. This interim report summarizes the findings of the ARLTAB for the first year of this biennial assessment; the current report addresses approximately half the portfolio for each campaign; the remainder will be assessed in 2018.
Review of the Draft Fourth National Climate Assessment
by National Academies of Sciences Engineering MedicineClimate change poses many challenges that affect society and the natural world. With these challenges, however, come opportunities to respond. By taking steps to adapt to and mitigate climate change, the risks to society and the impacts of continued climate change can be lessened. The National Climate Assessment, coordinated by the U.S. Global Change Research Program, is a mandated report intended to inform response decisions. Required to be developed every four years, these reports provide the most comprehensive and up-to-date evaluation of climate change impacts available for the United States, making them a unique and important climate change document. The draft Fourth National Climate Assessment (NCA4) report reviewed here addresses a wide range of topics of high importance to the United States and society more broadly, extending from human health and community well-being, to the built environment, to businesses and economies, to ecosystems and natural resources. This report evaluates the draft NCA4 to determine if it meets the requirements of the federal mandate, whether it provides accurate information grounded in the scientific literature, and whether it effectively communicates climate science, impacts, and responses for general audiences including the public, decision makers, and other stakeholders.
Strategies for Effective Improvements to the BioWatch System: Proceedings Of A Workshop
by National Academies of Sciences Engineering MedicineBioWatch is the Department of Homeland Security’s (DHS’s) system for detecting an aerosolized biological attack using collectors that are positioned strategically across the country to continuously monitor the air for biological threats. As currently deployed, BioWatch collectors draw air through filters that field technicians collect daily and transport to laboratories, where professional technicians analyze the material collected on the filter for evidence of biological threats. As part of the BioWatch program’s efforts to enhance its effectiveness and capabilities, particularly with regard to detecting biological threats in challenging indoor environments, DHS requested the National Academies of Sciences, Engineering, and Medicine hold a workshop to explore alternative and effective biodetection systems for aerosolized biological agents that would meet BioWatch’s technical and operational requirements, integrate into the existing system architecture and public health infrastructure, and be deployable by 2027. This publication summarizes the presentations and discussions from the workshop.
Adaptability of the US Engineering and Technical Workforce: Proceedings Of A Workshop
by National Academies of Sciences Engineering MedicineIn 2015 the National Academy of Engineering (NAE) released the report Making Value for America: Embracing the Future of Manufacturing, Technology, and Work. That study observed that technological developments, reengineered operations, and economic forces are transforming the way products and services are conceived, designed, made, distributed, and supported, a transformation that is having profound effects on the world of work. Jobs consisting of repetitive tasks are being disrupted by automation or offshored to lower-cost producers. Workers are being asked to upgrade their skills to become more productive and adaptable. So far these changes have been most notable in manufacturing and high-technology services, but they are poised to also transform enterprises in energy, health care, education, and other sectors. To explore the effects of these changes on the workforce and on individual workers, the NAE held a workshop November 2–3, 2017, entitled “Preparing the Engineering and Technical Workforce for Adaptability and Resilience to Change.” The first goal of the workshop was to increase stakeholders’ understanding of both the importance of workforce adaptability and the definition and characteristics of adaptability. The second goal was to provide an opportunity to share best practices for fostering adaptability and to identify needs for future study and development. This publication summarizes the presentations and discussions from the workshop.
The Frontiers of Machine Learning: 2017 Raymond And Beverly Sackler U. S. -u. K. Scientific Forum
by National Academy of SciencesThe field of machine learning continues to advance at a rapid pace owing to increased computing power, better algorithms and tools, and greater availability of data. Machine learning is now being used in a range of applications, including transportation and developing automated vehicles, healthcare and understanding the genetic basis of disease, and criminal justice and predicting recidivism. As the technology advances, it promises additional applications that can contribute to individual and societal well-being. The Raymond and Beverly Sackler U.S.-U.K. Scientific Forum “The Frontiers of Machine Learning” took place on January 31 and February 1, 2017, at the Washington, D.C., headquarters of the National Academies of Sciences, Engineering, and Medicine. Participants included industry leaders, machine learning researchers, and experts in privacy and the law, and this report summarizes their high-level interdisciplinary discussions.
Global Harmonization of Methodological Approaches to Nutrient Intake Recommendations: Proceedings Of A Workshop
by National Academies of Sciences Engineering MedicineThe National Academies of Sciences, Engineering, and Medicine convened a public workshop in September 2017 to explore the evidence for achieving global harmonization of methodological approaches to establishing nutrient intake recommendations. Participants reviewed current nutrient intake recommendations, discussed the feasibility of harmonizing approaches to setting such recommendations globally, examined the development of principles by which they may be applied in diverse contexts that relate to individuals or populations, or regulatory purposes, and examined perceptions and acceptance of nutrient intake recommendations by different stakeholders. This publication summarizes the presentations and discussions from the workshop.
Review of Report and Approach to Evaluating Long-Term Health Effects in Army Test Subjects: Interim Report
by National Academies of Sciences Engineering MedicineBetween 1942 and 1975, the U.S. Army conducted tests with human subjects to study the effects of a variety of agents, including chemical warfare and biological agents. The potential long-term health effects on the test subjects from their exposures have been evaluated periodically, most recently in a report titled Assessment of Potential Long-Term Health Effects on Army Human Test Subjects of Relevant Biological and Chemical Agents, Drugs, Medications and Substances: Literature Review and Analysis (the Report), which was prepared by a contractor to assist the Army with making determinations about providing medical care to former test subjects. In response to a request by the Army, the National Academies of Sciences, Engineering, and Medicine formed a committee that was tasked with examining whether the Report appropriately identified potential long-term health effects from exposure to the test agents and whether an adequate weight-of-evidence approach was used to characterize the strength of the associations between the agents and their potential health effects. The committee was made aware at its first meeting on November 30, 2017, that the Army had already begun to receive applications for medical care and that some determinations may need to be made before the committee’s evaluation of the Report was completed. Because of this urgency, the Army developed a process by which applications for medical care will be reviewed, and as a result, the committee was given the additional task of reviewing the Army’s Memorandum that describes the approach that will be used by the Army to evaluate agent- and outcome-specific associations. This interim report was prepared to facilitate the Army’s deliberations. A review of the Report is presented first, followed by a review of the Memorandum.
A Review of the Citrus Greening Research and Development Efforts Supported by the Citrus Research and Development Foundation: Fighting A Ravaging Disease
by National Academies of Sciences Engineering MedicineHuanglongbing (HLB) or citrus greening, first observed more than a hundred years ago in Asia, is the most serious disease threat to the citrus-growing industry worldwide due to its complexity, destructiveness, and incalcitrance to management. First detected in Florida in 2005, HLB is now widespread in the state and threatens the survival of the Florida citrus industry despite substantial allocation of research funds by Florida citrus growers and federal and state agencies. As the HLB epidemic raged in 2008, Florida citrus growers began allocating funds for HLB research in hopes of finding short-, medium-, and long-term solutions. This effort created the Citrus Research and Development Foundation (CRDF), an organization with oversight responsibility for HLB research and development efforts in Florida. This report provides an independent review of the portfolio of research projects that have been or continue to be supported by the CRDF. It seeks to identify ways to retool HLB research—which, despite significantly increasing understanding of the factors involved in HLB, has produced no major breakthroughs in controlling the disease—and accelerate the development of durable tools and strategies that could help abate the damage caused by HLB and prevent the possible collapse of the Florida citrus industry.
Discovering the Deep Blue Sea: Research, Innovation, Social Engagement
by The National Academies Keck Futures InitiativeThe 14th annual National Academies Keck Futures Initiative (NAKFI), “Discovering the Deep Blue Sea: Research, Innovation, and Social Engagement”, brought together 170 marine scientists, professional artists, engineers, biomedical researchers, oceanographers, music professors, and undergraduate design students. The attendees collaborated to find solutions to overarching social and scientific research problems tied to five sub-topics: aquaculture and energy; technology; climate-related change; biodiversity; and communication, adaption, and resilience. This publication summarizes the presentations and discussions from this event.
Opportunities for Improving Programs and Services for Children with Disabilities
by National Academies of Sciences Engineering MedicineAlthough the general public in the United States assumes children to be generally healthy and thriving, a substantial and growing number of children have at least one chronic health condition. Many of these conditions are associated with disabilities and interfere regularly with children’s usual activities, such as play or leisure activities, attending school, and engaging in family or community activities. In their most severe forms, such disorders are serious lifelong threats to children’s social, emotional well-being and quality of life, and anticipated adult outcomes such as for employment or independent living. However, pinpointing the prevalence of disability among children in the U.S. is difficult, as conceptual frameworks and definitions of disability vary among federal programs that provide services to this population and national surveys, the two primary sources for prevalence data. Opportunities for Improving Programs and Services for Children with Disabilities provides a comprehensive analysis of health outcomes for school-aged children with disabilities. This report reviews and assesses programs, services, and supports available to these children and their families. It also describes overarching program, service, and treatment goals; examines outreach efforts and utilization rates; identifies what outcomes are measured and how they are reported; and describes what is known about the effectiveness of these programs and services.
Aging and Disability: Beyond Stereotypes To Inclusion: Proceedings Of A Workshop
by National Academies of Sciences Engineering MedicineMany different groups of people are subject to stereotypes. Positive stereotypes (e.g., “older and wiser”) may provide a benefit to the relevant groups. However, negative stereotypes of aging and of disability continue to persist and, in some cases, remain socially acceptable. Research has shown that when exposed to negative images of aging, older persons demonstrate poor physical and cognitive performance and function, while those who are exposed to positive images of aging (or who have positive self-perceptions of aging) demonstrate better performance and function. Furthermore, an individual’s expectations about and perceptions of aging can predict future health outcomes. To better understand how stereotypes affect older adults and individuals with disabilities, the National Academies of Sciences, Engineering, and Medicine, with support from AARP, convened a public workshop on October 10, 2017. This publication summarizes the presentations and discussions from the workshop.
Global Roadmap for Healthy Longevity
by National Academy of Medicine Commission for a Global Roadmap for Healthy LongevityWith unprecedented global aging, societies must undertake all-of-society efforts to maximize the benefits and minimize the burdens of aging populations. The Global Roadmap for Healthy Longevity (Global Roadmap) describes a realistic vision of healthy longevity that could be achieved by 2050. The vision includes full inclusion of people of all ages, regardless of health or functional status, in all aspects of society and societies characterized by social cohesion and equity. To achieve the vision, Global Roadmap recommends changes that need to be made to health systems, social infrastructure, physical environments, education, work, and retirement. In some cases, the recommended changes benefit older people most directly, but when older people thrive, people of all ages benefit. If taken up, the recommendations of this report can support individuals of all ages in all corners of the globe to live long, meaningful, and purpose-driven lives by 2050.
High-Performance Bolting Technology for Offshore Oil and Natural Gas Operations
by National Academies of Sciences Engineering MedicineCommercially significant amounts of crude oil and natural gas lie under the continental shelf of the United States. Advances in locating deposits, and improvements in drilling and recovery technology, have made it technically and economically feasible to extract these resources under harsh conditions. But extracting these offshore petroleum resources involves the possibility, however remote, of oil spills, with resulting damage to the ocean and the coastline ecosystems and risks to life and limb of those performing the extraction. The environmental consequences of an oil spill can be more severe underwater than on land because sea currents can quickly disperse the oil over a large area and, thus, cleanup can be problematic. Bolted connections are an integral feature of deep-water well operations. High-Performance Bolting Technology for Offshore Oil and Natural Gas Operations summarizes strategies for improving the reliability of fasteners used in offshore oil exploration equipment, as well as best practices from other industrial sectors. It focuses on critical bolting—bolts, studs, nuts, and fasteners used on critical connections.
COVID-19 and the Present and Future of Black Communities: Proceedings Of A Workshop
by National Academies of Sciences, Engineering, and Medicine Policy and Global Affairs Health and Medicine Division Roundtable on Black Men and Black Women in Science, Engineering, and MedicineWhile the COVID-19 pandemic has had devastating health and economic impacts in the United States, communities of color, especially Black communities, have been disproportionately affected. On June 23, 2020, the Roundtable on Black Men and Black Women in Science, Engineering, and Medicine of the National Academies of Sciences, Engineering, and Medicine convened a virtual workshop to discuss the landscape of COVID-19, including how systemic racism contributes to the disproportionate effects related to infection rates and mortality of this virus and other health conditions. Presenters highlighted relevant research and creative responses from many perspectives, including how Black scientists, engineers, and doctors are contributing to solutions and are ready to do more. National Academies leaders and members also discussed the role of the National Academies in addressing the pandemic and underlying issues of systemic racism that have led to health disparities in the United States. This publication summarizes the presentation and discussion of the workshop.
Modernizing Crime Statistics: New Systems For Measuring Crime
by National Academies of Sciences Engineering MedicineTo derive statistics about crime – to estimate its levels and trends, assess its costs to and impacts on society, and inform law enforcement approaches to prevent it - a conceptual framework for defining and thinking about crime is virtually a prerequisite. Developing and maintaining such a framework is no easy task, because the mechanics of crime are ever evolving and shifting: tied to shifts and development in technology, society, and legislation. Interest in understanding crime surged in the 1920s, which proved to be a pivotal decade for the collection of nationwide crime statistics. Now established as a permanent agency, the Census Bureau commissioned the drafting of a manual for preparing crime statistics—intended for use by the police, corrections departments, and courts alike. The new manual sought to solve a perennial problem by suggesting a standard taxonomy of crime. Shortly after the Census Bureau issued its manual, the International Association of Chiefs of Police in convention adopted a resolution to create a Committee on Uniform Crime Records —to begin the process of describing what a national system of data on crimes known to the police might look like. Report 1 performed a comprehensive reassessment of what is meant by crime in U.S. crime statistics and recommends a new classification of crime to organize measurement efforts. This second report examines methodological and implementation issues and presents a conceptual blueprint for modernizing crime statistics.
Graduate STEM Education for the 21st Century
by National Academies of Sciences Engineering MedicineThe U.S. system of graduate education in science, technology, engineering, and mathematics (STEM) has served the nation and its science and engineering enterprise extremely well. Over the course of their education, graduate students become involved in advancing the frontiers of discovery, as well as in making significant contributions to the growth of the U.S. economy, its national security, and the health and well-being of its people. However, continuous, dramatic innovations in research methods and technologies, changes in the nature and availability of work, shifts in demographics, and expansions in the scope of occupations needing STEM expertise raise questions about how well the current STEM graduate education system is meeting the full array of 21st century needs. Indeed, recent surveys of employers and graduates and studies of graduate education suggest that many graduate programs do not adequately prepare students to translate their knowledge into impact in multiple careers. Graduate STEM Education for the 21st Century examines the current state of U.S. graduate STEM education. This report explores how the system might best respond to ongoing developments in the conduct of research on evidence-based teaching practices and in the needs and interests of its students and the broader society it seeks to serve. This will be an essential resource for the primary stakeholders in the U.S. STEM enterprise, including federal and state policymakers, public and private funders, institutions of higher education, their administrators and faculty, leaders in business and industry, and the students the system is intended to educate.
Report 2 on Tracking and Assessing Governance and Management Reform in the Nuclear Security Enterprise
by National Academies of Sciences Engineering MedicineThe congressionally mandated report A New Foundation for the Nuclear Enterprise (the “Augustine-Mies” report), released in November 2014, concluded that “the existing governance structures and many of the practices of the [nuclear security] enterprise are inefficient and ineffective, thereby putting the entire enterprise at risk over the long term.” Following the release of the Augustine-Mies report, the National Defense Authorization Act for Fiscal Year 2016 called for DOE to develop an implementation plan for responding to the recommendations in that and similar reports. The NDAA also called for a 4 1⁄2-year study, joint between the National Academies of Sciences, Engineering, and Medicine and the National Academy of Public Administration, to evaluate the implementation plan, to track the actions proposed in that plan, and to assess progress. This report is the second in a series of reports to be issued over 2017–2020 as part of that study.
Gulf Research Program Annual Report 2020
by National Academies of Sciences, Engineering, and Medicine Gulf Research ProgramEach year, the Gulf Research Program (GRP) produces an annual report to summarize how funds were used. These reports review accomplishments, highlight activities, and, over time, will assess metrics to determine how the program is progressing in accomplishing its goals. The 2020 annual report is the seventh report in this series. The GRP is an independent, science-based program founded in 2013. Through grants, fellowships, and other activities, it seeks to enhance oil system safety and the protection of human health and the environment in the Gulf of Mexico region and other areas along the U.S. outer continental shelf with offshore oil and gas operations.
Long-Term Survivorship Care After Cancer Treatment: Proceedings Of A Workshop
by National Academies of Sciences Engineering MedicineThe 2006 Institute of Medicine (IOM) consensus study report From Cancer Patient to Cancer Survivor: Lost in Transition made recommendations to improve the quality of care that cancer survivors receive, in recognition that cancer survivors are at risk for significant physical, psychosocial, and financial repercussions from cancer and its treatment. Since then, efforts to recognize and address the unique needs of cancer survivors have increased, including an emphasis on improving the evidence base for cancer survivorship care and identifying best practices in the delivery of high-quality cancer survivorship care. To examine progress in cancer survivorship care since the Lost in Transition report, the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine held a workshop in July 2017, in Washington, DC. Workshop participants highlighted potential opportunities to improve the planning, management, and delivery of cancer survivorship care. This publication summarizes the presentations and discussions from the workshop.
Enabling Novel Treatments for Nervous System Disorders by Improving Methods for Traversing the Blood–Brain Barrier: Proceedings of a Workshop
by National Academies of Sciences Engineering MedicineDespite substantial advances in developing treatments for the serious illnesses that affect people worldwide, there remains a tremendous unmet need in the treatment of complex neurologic diseases, including neuropsychiatric and neurodegenerative disorders. Chief among the challenges that have hindered the development of therapeutics for central nervous system (CNS) disorders is the blood–brain barrier (BBB). The Forum on Neuroscience and Nervous System Disorders of the National Academies of Sciences, Engineering, and Medicine convened a workshop to explore the challenges associated with the BBB that have thus far stymied development of CNS drugs, examine new technologies that could address these challenges, and highlight potential opportunities for moving the field forward. This publication summarizes the presentations and discussions from the workshop.