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Social isolation and loneliness are serious yet underappreciated public health risks that affect a significant portion of the older adult population. Approximately one-quarter of community-dwelling Americans aged 65 and older are considered to be socially isolated, and a significant proportion of adults in the United States report feeling lonely. People who are 50 years of age or older are more likely to experience many of the risk factors that can cause or exacerbate social isolation or loneliness, such as living alone, the loss of family or friends, chronic illness, and sensory impairments. Over a life course, social isolation and loneliness may be episodic or chronic, depending upon an individual's circumstances and perceptions. A substantial body of evidence demonstrates that social isolation presents a major risk for premature mortality, comparable to other risk factors such as high blood pressure, smoking, or obesity. As older adults are particularly high-volume and high-frequency users of the health care system, there is an opportunity for health care professionals to identify, prevent, and mitigate the adverse health impacts of social isolation and loneliness in older adults. Social Isolation and Loneliness in Older Adults summarizes the evidence base and explores how social isolation and loneliness affect health and quality of life in adults aged 50 and older, particularly among low income, underserved, and vulnerable populations. This report makes recommendations specifically for clinical settings of health care to identify those who suffer the resultant negative health impacts of social isolation and loneliness and target interventions to improve their social conditions. Social Isolation and Loneliness in Older Adults considers clinical tools and methodologies, better education and training for the health care workforce, and dissemination and implementation that will be important for translating research into practice, especially as the evidence base for effective interventions continues to flourish.

Emissions associated with oil and gas exploration, development, and production on the Gulf waters can result in increased levels of air pollutants that contribute to a range of air quality impacts in the Gulf of Mexico Region (GOMR). "Criteria air pollutants", such as carbon monoxide, lead, nitrogen dioxide, ozone, particulate matter, and sulfur dioxide, are considered harmful to public health and the environment. The Bureau of Ocean Energy Management (BOEM) manages the U.S. outer continental shelf oil and gas resources and is required to help manage air quality in the GOMR. Review of the Bureau of Ocean Energy Management "Air Quality Modeling in the Gulf of Mexico Region" Study reviews and provides feedback on the BOEM's Air Quality Modeling in the Gulf of Mexico Region Study. This independent technical review of the study explores whether the study meets its goals, accurately reflects the scientific literature, uses reasonable data and modeling analyses, approaches quantitative modeling appropriately, documents findings in a consistent, transparent, and credible way, and aligns with necessary guidelines.

Advanced aerial mobility is a newly emerging industry that aims to develop and operate new air vehicles potentially capable of safe, reliable, and low-noise vertical flight. The world has seen a recent increase in the adoption of electric vertical lift aircraft for urban, suburban and rural operations. These new innovations and technologies change the way that we move cargo and people, affecting industries across the economy. These changes will challenge today's airspace monitoring systems and regulatory environment. The U.S. government and its regulatory agencies need technical guidance to facilitate the development of these technologies, and to create the regulatory framework to foster the growth of this vertical flight industry to the benefit of the aviation industry. Advancing Aerial Mobility evaluates the potential benefits and challenges associated with this emerging industry. This report provides recommendations that seek to foster an environment in which the nation can maintain its leading position in developing, deploying, and embracing these new technologies. This publication presents a national vision for advanced aerial mobility, market evolution, and safety and security management.

"Patterns of food consumption and nutritional intake strongly affect the population's health and well-being. The Food Economics Division of USDA's Economic Research Service (ERS) engages in research and data collection to inform policy making related to the leading federal nutrition assistance programs managed by USDA's Food and Nutrition Service. The ERS uses the Consumer Food Data System to understand why people choose foods, how food assistance programs affect these choices, and the health impacts of those choices. At the request of ERS, A Consumer Food Data System for 2030 and Beyond provides a blueprint for ERS's Food Economics Division for its data strategy over the next decade. This report explores the quality of data collected, the data collection process, and the kinds of data that may be most valuable to researchers, policy makers, and program administrators going forward. The recommendations of A Consumer Food Data System for 2030 and Beyond will guide ERS to provide and sustain a multisource, interconnected, reliable data system."--

Careers in science, engineering, and medicine offer opportunities to advance knowledge, contribute to the well-being of communities, and support the security, prosperity, and health of the United States. But many women do not pursue or persist in these careers, or advance to leadership positions - not because they lack the talent or aspirations, but because they face barriers, including: implicit and explicit bias; sexual harassment; unequal access to funding and resources; pay inequity; higher teaching and advising loads; and fewer speaking invitations, among others. There are consequences from this underrepresentation of women for the nation as well: a labor shortage in many science, engineering, and medical professions that cannot be filled unless institutions and organizations recruit from a broad and diverse talent pool; lost opportunities for innovation and economic gain; and lost talent as a result of discrimination, unconscious bias, and sexual harassment. Promising Practices for Addressing the Underrepresentation of Women in Science, Engineering, and Medicine reviews and synthesizes existing research on policies, practices, programs, and other interventions for improving the recruitment, retention, and sustained advancement into leadership roles of women in these disciplines. This report makes actionable recommendations to leverage change and drive swift, coordinated improvements to the systems of education, research, and employment in order to improve both the representation and leadership of women.

The cloud model of data sharing has led to a vast increase in the quantity and complexity of data and expanded access to these data, which has attracted many more researchers, enabled multi-national neuroscience collaborations, and facilitated the development of many new tools. Yet, the cloud model has also produced new challenges related to data storage, organization, and protection. Merely switching the technical infrastructure from local repositories to cloud repositories is not enough to optimize data use. To explore the burgeoning use of cloud computing in neuroscience, the National Academies Forum on Neuroscience and Nervous System Disorders hosted a workshop on September 24, 2019. A broad range of stakeholders involved in cloud-based neuroscience initiatives and research explored the use of cloud technology to advance neuroscience research and shared approaches to address current barriers. This publication summarizes the presentation and discussion of the workshop.

Since 2004, the U.S. government has supported the global response to HIV/AIDS through the President's Emergency Plan for AIDS Relief (PEPFAR). The Republic of Rwanda, a PEPFAR partner country since the initiative began, has made gains in its HIV response, including increased access to and coverage of antiretroviral therapy and decreased HIV prevalence. However, a persistent shortage in human resources for health (HRH) affects the health of people living with HIV and the entire Rwandan population. Recognizing HRH capabilities as a foundational challenge for the health system and the response to HIV, the Government of Rwanda worked with PEPFAR and other partners to develop a program to strengthen institutional capacity in health professional education and thereby increase the production of high-quality health workers. The Program was fully managed by the Government of Rwanda and was designed to run from 2011 through 2019. PEPFAR initiated funding in 2012. In 2015, PEPFAR adopted a new strategy focused on high-burden geographic areas and key populations, resulting in a reconfiguration of its HIV portfolio in Rwanda and a decision to cease funding the Program, which was determined no longer core to its programming strategy. The last disbursement for the Program from PEPFAR was in 2017. Evaluation of PEPFAR's Contribution (2012-2017) to Rwanda's Human Resources for Health Program describes PEPFAR-supported HRH activities in Rwanda in relation to programmatic priorities, outputs, and outcomes and examines, to the extent feasible, the impact on HRH and HIV-related outcomes. The HRH Program more than tripled the country's physician specialist workforce and produced major increases in the numbers and qualifications of nurses and midwives. Partnerships between U.S. institutions and the University of Rwanda introduced new programs, upgraded curricula, and improved the quality of teaching and training for health professionals. Growing the number, skills, and competencies of health workers contributed to direct and indirect improvements in the quality of HIV care. Based on the successes and challenges of the HRH program, the report recommends that future investments in health professional education be designed within a more comprehensive approach to human resources for health and institutional capacity building, which would strengthen the health system to meet both HIV-specific and more general health needs. The recommendations offer an aspirational framework to reimagine how partnerships are formed, how investments are made, and how the effects of those investments are documented.

Teachers play a critical role in the success of their students, both academically and in regard to long term outcomes such as higher education participation and economic attainment. Expectations for teachers are increasing due to changing learning standards and a rapidly diversifying student population. At the same time, there are perceptions that the teaching workforce may be shifting toward a younger and less experienced demographic. These actual and perceived changes raise important questions about the ways teacher education may need to evolve in order to ensure that educators are able to meet the needs of students and provide them with classroom experiences that will put them on the path to future success. Changing Expectations for the K-12 Teacher Workforce: Policies, Preservice Education, Professional Development, and the Workplace explores the impact of the changing landscape of K-12 education and the potential for expansion of effective models, programs, and practices for teacher education. This report explores factors that contribute to understanding the current teacher workforce, changing expectations for teaching and learning, trends and developments in the teacher labor market, preservice teacher education, and opportunities for learning in the workplace and in-service professional development.

"Engineering education is emerging as an important component of US K-12 education. Across the country, students in classrooms and after- and out-of-school programs are participating in hands-on, problem-focused learning activities using the engineering design process. These experiences can be engaging; support learning in other areas, such as science and mathematics; and provide a window into the important role of engineering in society. As the landscape of K-12 engineering education continues to grow and evolve, educators, administrators, and policy makers should consider the capacity of the US education system to meet current and anticipated needs for K-12 teachers of engineering. Building Capacity for Teaching Engineering in K-12 Education reviews existing curricula and programs as well as related research to understand current and anticipated future needs for engineering-literate K-12 educators in the United States and determine how these needs might be addressed. Key topics in this report include the preparation of K-12 engineering educators, professional pathways for K-12 engineering educators, and the role of higher education in preparing engineering educators. This report proposes steps that stakeholders - including professional development providers, postsecondary preservice education programs, postsecondary engineering and engineering technology programs, formal and informal educator credentialing organizations, and the education and learning sciences research communities - might take to increase the number, skill level, and confidence of K-12 teachers of engineering in the United States."--

Health literacy is a critical skill for engaging in healthy behaviors to reduce disease risk and improve health outcomes across the continuum of cancer care. However, estimates suggest that more than one-third of the U.S. adult population has low health literacy, and nearly half of all patients with cancer have difficulty understanding information about their disease or treatment. Low health literacy among patients with cancer is associated with poor health and treatment outcomes, including lower adherence to treatment, higher rates of missed appointments, and an increased risk of hospitalization. Low health literacy can also impede informed decision making, especially as cancer care becomes increasingly complex and as patients and their families take more active roles in treatment decisions. To examine opportunities to improve communication across the cancer care continuum, the National Cancer Policy Forum collaborated with the Roundtable on Health Literacy to host a workshop, Health Literacy and Communication Strategies in Oncology, July 15-16, 2019, in Washington, DC. Patients, patient advocates, clinicians, and researchers, representatives of health care organizations, academic medical centers, insurers, and federal agencies explored the challenges of achieving effective communication in cancer care. This publication summarizes the presentations and discussions of the workshop.

The 2013 report Solar and Space Physics; A Science for a Technological Society outlined a program of basic and applied research for the period 2013-2022. This publication describes the most significant scientific discoveries, technical advances, and relevant programmatic changes in solar and space physics since the publication of that decadal survey. Progress Toward Implementation of the 2013 Decadal Survey for Solar and Space Physics assesses the degree to which the programs of the National Science Foundation and the National Aeronautics and Space Administration address the strategies, goals, and priorities outlined in the 2013 decadal survey, and the progress that has been made in meeting those goals. This report additionally considers steps to enhance career opportunities in solar and space physics and recommends actions that should be undertaken to prepare for the next decadal survey.

Biomedical research data sets are becoming larger and more complex, and computing capabilities are expanding to enable transformative scientific results. The National Institutes of Health's (NIH's) National Library of Medicine (NLM) has the unique role of ensuring that biomedical research data are findable, accessible, interoperable, and reusable in an ethical manner. Tools that forecast the costs of long-term data preservation could be useful as the cost to curate and manage these data in meaningful ways continues to increase, as could stewardship to assess and maintain data that have future value. The National Academies of Sciences, Engineering, and Medicine convened a workshop on July 11-12, 2019 to gather insight and information in order to develop and demonstrate a framework for forecasting long-term costs for preserving, archiving, and accessing biomedical data. Presenters and attendees discussed tools and practices that NLM could use to help researchers and funders better integrate risk management practices and considerations into data preservation, archiving, and accessing decisions; methods to encourage NIH-funded researchers to consider, update, and track lifetime data; and burdens on the academic researchers and industry staff to implement these tools, methods, and practices. This publication summarizes the presentations and discussion of the workshop.

Ensuring the safety of food and the quality and safety of medicines in a country is an important role of government, made more complicated by global manufacturing and international trade. By recent estimates, unsafe food kills over 400,000 people a year, a third of them children under 5, mostly in low- and middle-income countries; every year poor quality medicines cause about 70,000 excess deaths from childhood pneumonia and roughly 8,500 to 20,000 malaria deaths in sub-Saharan Africa alone. The Federal Drug Administration (FDA) Office of Global Policy and Strategy is charged with improving capacity of the agency's foreign counterpart offices and increasing understanding of the importance of regulatory systems for public health, development, and trade. At the request of the FDA, this study sets out a strategy to support good quality, wholesome food and safe, effective medical products around the world. Its goal is to build on the momentum for strengthening regulatory systems and to set a course for sustainability and continued progress. The 2012 report Ensuring Safe Food and Medical Products Through Stronger Regulatory Systems Abroad outlined strategies to secure international supply chains, emphasized capacity building and support for surveillance in low- and middle-income countries, and explored ways to facilitate work sharing among food and medical product regulatory agencies. This new study assess progress made and the current regulatory landscape.

Resilient supply chains are crucial to maintaining the consistent delivery of goods and services to the American people. The modern economy has made supply chains more interconnected than ever, while also expanding both their range and fragility. In the third quarter of 2017, Hurricanes Harvey, Irma and Maria revealed some significant vulnerabilities in the national and regional supply chains of Texas, Florida, the U.S. Virgin Islands, and Puerto Rico. The broad impacts and quick succession of these three hurricanes also shed light on the effectiveness of the nation's disaster logistics efforts during response through recovery. Drawing on lessons learned during the 2017 hurricanes, this report explores future strategies to improve supply chain management in disaster situations. This report makes recommendations to strengthen the roles of continuity planning, partnerships between civic leaders with small businesses, and infrastructure investment to ensure that essential supply chains will remain operational in the next major disaster. Focusing on the supply chains food, fuel, water, pharmaceutical, and medical supplies, the recommendations of this report will assist the Federal Emergency Management Agency as well as state and local officials, private sector decision makers, civic leaders, and others who can help ensure that supply chains remain robust and resilient in the face of natural disasters.

Leadership in gas turbine technologies is of continuing importance as the value of gas turbine production is projected to grow substantially by 2030 and beyond. Power generation, aviation, and the oil and gas industries rely on advanced technologies for gas turbines. Market trends including world demographics, energy security and resilience, decarbonization, and customer profiles are rapidly changing and influencing the future of these industries and gas turbine technologies. Technology trends that define the technological environment in which gas turbine research and development will take place are also changing - including inexpensive, large scale computational capabilities, highly autonomous systems, additive manufacturing, and cybersecurity. It is important to evaluate how these changes influence the gas turbine industry and how to manage these changes moving forward. Advanced Technologies for Gas Turbines identifies high-priority opportunities for improving and creating advanced technologies that can be introduced into the design and manufacture of gas turbines to enhance their performance. The goals of this report are to assess the 2030 gas turbine global landscape via analysis of global leadership, market trends, and technology trends that impact gas turbine applications, develop a prioritization process, define high-priority research goals, identify high-priority research areas and topics to achieve the specified goals, and direct future research. Findings and recommendations from this report are important in guiding research within the gas turbine industry and advancing electrical power generation, commercial and military aviation, and oil and gas production.

"The Veterans Health Administration (VHA) is America's largest integrated health care system, providing care at 1,243 health care facilities, including 172 medical centers and 1,063 outpatient sites of care of varying complexity, serving 9 million enrolled Veterans each year. In addition, VHA has opened outpatient clinics and established telemedicine and other services to accommodate a diverse veteran population and continues to cultivate ongoing medical research and innovation. Facilities specific to VHA fulfill clinical, operational, research laboratory, and administrative functions. Each site is designed to serve a geographical location with specific health care needs. VHA's building inventory has sites of different ages, and often there is a mix of building size and age at each site or campus. At the request of the VHA, this study presents a comprehensive resource planning and staffing methodology guidebook for VHA Facility Management Programs by reviewing the tasks of VHA building facilities staff and recommending actions for the VHA to meet the mission goals of delivering patient care, research, and effective operations."--

While progress has been made in the development of decarbonization technologies, much work remains in scale-up and deployment. For decarbonization technologies to reach meaningful scale, real-world constraints, societal, economic, and political, must be considered. To identify the primary challenges and opportunities to deploying decarbonization technologies at scale across major sectors of the U.S. economy, the Board on Energy and Environmental Systems of the National Academies of Sciences, Engineering, and Medicine convened a workshop on July 22-23, 2019. In addition to technology-specific and sector-specific studies, the workshop considered the types of societal transformations required, as well as potential policy drivers for carbon dioxide emissions reductions. This publication summarizes the presentations and discussion of the workshop.

Exposures at low doses of radiation, generally taken to mean doses below 100 millisieverts, are of primary interest for setting standards for protecting individuals against the adverse effects of ionizing radiation. However, there are considerable uncertainties associated with current best estimates of risks and gaps in knowledge on critical scientific issues that relate to low dose radiation. The Nuclear and Radiation Studies Board of the National Academies hosted the symposium on The Future of Low Dose Radiation Research in the United States on May 8 and 9, 2019. The goal of the symposium was to provide an open forum for a national discussion on the need for a long-term strategy to guide a low dose radiation research program in the United States. The symposium featured presentations on low dose radiation programs around the world, panel discussions with representatives from governmental and nongovernmental organizations about the need for a low dose radiation research program, reviews of low dose radiation research in epidemiology and radiation biology including new directions, and lessons to be learned from setting up large research programs in non-radiation research fields. This publication summarizes the presentation and discussion of the symposium.

Human trafficking has many names and can take many forms - pimp control, commercial sex, exploitation, forced labor, modern slavery, child labor, and several others - and the definitions vary greatly across countries and cultures, as well as among researchers. In the United States, the Trafficking Victims Protection Act (TVPA) is the cornerstone of counter-trafficking efforts. It provides guidance for identifying and defining human trafficking, and it authorizes legislation and appropriations for subsequent counter-trafficking measures both within and outside of the federal government. First enacted in 2000, the TVPA has since been reauthorized by three administrations, and it includes a directive for the President to establish an Interagency Task Force to Monitor and Combat Trafficking. The subsequent Frederick Douglass Trafficking Victims Prevention and Protection Reauthorization Act of 2018 also includes provisions for victim services and plans to enhance collaboration efforts to fight trafficking abroad. To explore current and innovative sampling methods, technological approaches, and analytical strategies for estimating the prevalence of sex and labor trafficking in vulnerable populations, a 2-day public workshop, Approaches to Estimating the Prevalence of Human Trafficking in the United States, was held in Washington, D.C. in April 2019. The workshop brought together statisticians, survey methodologists, researchers, public health practitioners, and other experts who work closely with human trafficking data or with the survivors of trafficking. Participants addressed the current state of research on human trafficking, advancements in data collection, and gaps in the data. They discussed international practices and global trends in human trafficking prevalence estimation and considered ways in which collaborations across agencies and among the U.S. government and private-sector organizations have advanced counter-trafficking efforts. This proceedings summarizes the presentations and discussions of the workshop.

Water of appropriate quantity and quality is essential for drinking, sanitation, and food, energy, and industrial production for any society and is derived for most needs from surface- or groundwater sources. Studies suggest that groundwater use in irrigation globally is increasing in total volume as well as a percentage of all water used for irrigation, with the demand for groundwater resources increasing as available primary surface water supplies are depleted. Particularly in arid regions, groundwater may be the most accessible water supply for any purpose, leaving groundwater withdrawals concentrated in areas that are already experiencing water stress. Even in the presence of direct ground observations and measurements of the water table, quantitative evaluation of groundwater storage, flow, or recharge at different scales requires remotely sensed data and observations applied to groundwater models. Resolving the interaction of groundwater storage, flow, and recharge at a scale at which basins are managed requires remotely sensed data and proxy data. In June 2019, the Water Science and Technology Board of the National Academies of Sciences, Engineering, and Medicine convened a workshop to identify scientific and technological research frontiers in monitoring and modeling groundwater recharge and flow in various regions of the world. The goals of the workshop were to assess regional freshwater budgets under major use scenarios, including agriculture, industry, and municipal; examine state of the art research frontiers in characterizing groundwater aquifers, including residence time, quantity, flow, depletion, and recharge, using remotely sensed observations and proxy data; discuss groundwater model uncertainties and methods for mitigating them using sparse ground observations or data and other approaches; and consider our ability to detect which water management strategies that affect groundwater flow and recharge are being used and any changes in their use over time. This publication summarizes workshop presentations and plenary discussions.

"The field of atomic, molecular, and optical (AMO) science underpins many technologies and continues to progress at an exciting pace for both scientific discoveries and technological innovations. AMO physics studies the fundamental building blocks of functioning matter to help advance the understanding of the universe. It is a foundational discipline within the physical sciences, relating to atoms and their constituents, to molecules, and to light at the quantum level. AMO physics combines fundamental research with practical application, coupling fundamental scientific discovery to rapidly evolving technological advances, innovation and commercialization. Due to the wide-reaching intellectual, societal, and economical impact of AMO, it is important to review recent advances and future opportunities in AMO physics. Manipulating Quantum Systems: An Assessment of Atomic, Molecular, and Optical Physics in the United States assesses opportunities in AMO science and technology over the coming decade. Key topics in this report include tools made of light; emerging phenomena from few- to many-body systems; the foundations of quantum information science and technologies; quantum dynamics in the time and frequency domains; precision and the nature of the universe, and the broader impact of AMO science."--

"In 2018, the United Nations High Commissioner for Refugees estimated 70.8 million people could be considered forced migrants, which is nearly double their estimation just one decade ago. This includes internally displaced persons, refugees, asylum seekers, and stateless people. This drastic increase in forced migrants exacerbates the already urgent need for a systematic policy-related review of the available data and analyses on forced migration and refugee movements. To explore the causes and impacts of forced migration and population displacement, the National Academies convened a two-day workshop on May 21-22, 2019. The workshop discussed new approaches in social demographic theory, methodology, data collection and analysis, and practice as well as applications to the community of researchers and practitioners who are concerned with better understanding and assisting forced migrant populations. This workshop brought together stakeholders and experts in demography, public health, and policy analysis to review and address some of the domestic implications of international migration and refugee flows for the United States. This publication summarizes the presentations and discussions from the workshop" --Publisher's description.

To explore value proposition for different sectors that engage in global health - including industry, government, philanthropy, and civil society - and innovative models for multi-sectoral collaboration, the Forum on Public-Private Partnerships for Global Health and Safety of the National Academies of Sciences, Engineering, and Medicine convened a 2-day workshop on November 15 and 16, 2018. With a specific focus on industry engagement, the workshop examined how stakeholders within industry define and measure value relative to global health as well as how and why other sectors in the global health community engage with industry. This publication summarizes the presentation and discussion of the workshop.

"Adolescence is a critical growth period in which youth develop essential skills that prepare them for adulthood. Prevention and intervention programs are designed to meet the needs of adolescents who require additional support and promote healthy behaviors and outcomes. To ensure the success of these efforts, it is essential that they include reliably identifiable techniques, strategies, or practices that have been proven effective. Promoting Positive Adolescent Health Behaviors and Outcomes: Thriving in the 21st Century identifies key program factors that can improve health outcomes related to adolescent behavior and provides evidence-based recommendations toward effective implementation of federal programming initiatives. This study explores normative adolescent development, the current landscape of adolescent risk behavior, core components of effective programs focused on optimal health, and recommendations for research, programs, and policies."--

High-entropy materials, ultra-strong molecules, and nanoelectronics have become a focus of active research because of their unique potential and applications. Global research is rapidly accelerating and unlocking major recent breakthroughs. It is important to highlight these recent developments and explore possibilities for future research and applications. The National Academies convened a workshop on February 10-11, 2016 to discuss issues in defense materials, manufacturing, and infrastructure. Key topics of discussion included emerging capabilities and research objectives for ultra-strong molecules, high-entropy materials, and nanoelectronics. This publication summarizes the presentations and discussions from the workshop.

The obesity crisis in the United States disproportionately affects some demographic groups more than others. Contextual influences on obesity are complex and include an individual's weight-related behaviors and outcomes, the intermediate variables that influence these behaviors and outcomes, and broader, upstream historical, social, economic, physical, and policy contexts. The National Academies convened a workshop on April 1, 2019 to explore the history of health equity issues in demographic groups that have above-average obesity risk and to consider principles and approaches to address these issues as part of obesity prevention and treatment efforts. This publication summarizes the presentations and discussions from the workshop.

"Legionnaires' disease, a pneumonia caused by the Legionella bacterium, is the leading cause of reported waterborne disease outbreaks in the United States. Legionella occur naturally in water from many different environmental sources, but grow rapidly in the warm, stagnant conditions that can be found in engineered water systems such as cooling towers, building plumbing, and hot tubs. Humans are primarily exposed to Legionella through inhalation of contaminated aerosols into the respiratory system. Legionnaires' disease can be fatal, with between 3 and 33 percent of Legionella infections leading to death, and studies show the incidence of Legionnaires' disease in the United States increased five-fold from 2000 to 2017. Management of Legionella in Water Systems reviews the state of science on Legionella contamination of water systems, specifically the ecology and diagnosis. This report explores the process of transmission via water systems, quantification, prevention and control, and policy and training issues that affect the incidence of Legionnaires' disease. It also analyzes existing knowledge gaps and recommends research priorities moving forward"--Publisher's description

Globalization is rapidly changing lives and industries around the world. Drug development, authorization, and regulatory supervision have become international endeavors, with most medicines becoming global commodities. Drug companies utilize global supply chains that often include facilities in countries with inconsistent regulations from those of the United States, perform pivotal trials in multiple countries to support registration submissions in various jurisdictions, and subsequently market their medicines throughout most of the world. These companies operate across borders and require individual national regulators to ensure that drugs authorized for use in their countries are safe and effective, and appropriate for their health care system and their population. This process involves significant resources and often duplicative work. It is important to consider how this process can be improved in order to better allocate resources, time, and efforts to improve public health. Regulating Medicines in a Globalized World: The Need for Increased Reliance Among Regulators considers the role of mutual recognition and other reliance activities among regulators in contributing to enhancing public health. This report identifies opportunities for leveraging reliance activities more broadly in order to potentially impact public health globally. Key topics in this report include the job of medicines regulators in today's world, what policy makers need to know about today's regulatory environment, stakeholder views of recognition and reliance, as well as removing impediments and facilitating action for greater recognition and reliance among regulatory authorities.

"Recent advancements in quantum-enabled systems present a variety of new opportunities and challenges. These technologies are important developments for a variety of computing, communications, and sensing applications. However, many materials and components relevant to quantum-enabled systems exist outside of the United States, and it is important to promote the development of assured domestic sources of materials, manufacturing capabilities, and expertise. The National Academies of Sciences, Engineering, and Medicine convened a 2-day workshop to explore implications and concerns related to the application of quantum-enabled systems in the United States. This workshop focused on quantum-enabled computing systems, quantum communications and networks, and quantum sensing opportunities. Participants explored the path to quantum computing, communications, and networks, opportunities for collaboration, as well as key gaps, supply chain concerns, and security issues. This publication summarizes the presentations and discussions from the workshop"--