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"A report of The National Academies of Sciences, Engineering, Medicine."

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) began 40 years ago as a pilot program and has since grown to serve over 8 million pregnant women, and mothers of and their infants and young children. Today the program serves more than a quarter of the pregnant women and half of the infants in the United States, at an annual cost of about $6.2 billion. Through its contribution to the nutritional needs of pregnant, breastfeeding, and post-partum women; infants; and children under 5 years of age; this federally supported nutrition assistance program is integral to meeting national nutrition policy goals for a significant portion of the U.S. population. To assure the continued success of the WIC, Congress mandated that the Food and Nutrition Service of the U.S. Department of Agriculture (USDA) reevaluate the program's food packages every 10 years. In 2014, the USDA asked the Institute of Medicine to undertake this reevaluation to ensure continued alignment with the goals of the Dietary Guidelines for Americans. In this third report, the committee provides its final analyses, recommendations, and the supporting rationale.

This is the fourth in a series of five letter reports that provide an independent review of the more than 30 evidence reports that NASA has compiled on human health risks for long-duration and exploration spaceflights.This letter report reviews eight evidence reports and examines the quality of the evidence, analysis, and overall construction of each report; identifies existing gaps in report content; and provides suggestions for additional sources of expert input.

Over the last decade, several large-scale United States and international programs have been initiated to incorporate advances in molecular and cellular biology, -omics technologies, analytical methods, bioinformatics, and computational tools and methods into the field of toxicology. Similar efforts are being pursued in the field of exposure science with the goals of obtaining more accurate and complete exposure data on individuals and populations for thousands of chemicals over the lifespan; predicting exposures from use data and chemical-property information; and translating exposures between test systems and humans. Using 21st Century Science to Improve Risk-Related Evaluations makes recommendations for integrating new scientific approaches into risk-based evaluations. This study considers the scientific advances that have occurred following the publication of the NRC reports Toxicity Testing in the 21st Century: A Vision and a Strategy and Exposure Science in the 21st Century: A Vision and a Strategy. Given the various ongoing lines of investigation and new data streams that have emerged, this publication proposes how best to integrate and use the emerging results in evaluating chemical risk. Using 21st Century Science to Improve Risk-Related Evaluations considers whether a new paradigm is needed for data validation, how to integrate the divergent data streams, how uncertainty might need to be characterized, and how best to communicate the new approaches so that they are understandable to various stakeholders.

Produced water--water from underground formations that is brought to the surface during oil and gas production--is the greatest volume byproduct associated with oil and gas production. It is managed by some combination of underground injection, treatment and subsequent use, treatment and discharge, or evaporation, subject to compliance with state and federal regulations. Management of these waters is challenging not only for industry and regulators, but also for landowners and the public because of differences in the quality and quantity of produced water, varying infrastructure needs, costs, and environmental considerations associated with produced water disposal, storage, and transport. Unconventional oil and gas development involves technologies that combine horizontal drilling with the practice of hydraulic fracturing. Hydraulic fracturing is a controlled, high-pressure injection of fluid and proppant into a well to generate fractures in the rock formation containing the oil or gas. After the hydraulic fracture procedure is completed, the injected fluid is allowed to flow back into the well, leaving the proppant in the newly created fractures. As a result, a portion of the injected water returns to the surface and this water is called "flowback water" which initially may mix with the naturally occurring produced water from the formation. The chemistry and volume of water returning to the surface from unconventional oil and gas operations thus changes during the lifetime of the well due to the amount of fluid used in the initial stage of well development, the amount of water naturally occurring in the geologic formation, the original water and rock chemistry, the type of hydrocarbon being produced, and the way in which production is conducted. The volume and composition of flowback and produced waters vary with geography, time, and site-specific factors. A workshop was conducted by the National Academies of Sciences, Engineering, and Medicine to highlight the challenges and opportunities associated in managing produced water from unconventional hydrocarbon development, and particularly in the area of potential beneficial uses for these waters. This publication summarizes the presentations and discussions from the workshop.

The term "service-learning" generally refers to projects planned as components of academic coursework in which students use knowledge and skills taught in the course to address real needs in their communities. This kind of learning experience, which allows students to focus on critical, reflective thinking and civic responsibility, has become an increasingly popular component of undergraduate science education. In April 2016, the National Academies of Sciences, Engineering, and Medicine planned a workshop to explore the current and potential role of service-learning in undergraduate geosciences education. Participants explored how service learning is being used in geoscience education, its potential benefits, and the strength of the evidence base regarding the nature and benefits of these experiences. This publication summarizes the presentations and discussions from the workshop.

"Workshop on Improving Collection of Indicators of Criminal Justice System Involvement in Population Health Data Programs, March 29-30, 2016 ... Washington, DC"--Page 75.

"Cyber-physical systems (CPS) are 'engineered systems that are built from, and depend upon, the seamless integration of computational algorithms and physical components.' CPS can be small and closed, such as an artificial pancreas, or very large, complex, and interconnected, such as a regional energy grid. CPS engineering focuses on managing inter- dependencies and impact of physical aspects on cyber aspects, and vice versa. With the development of low-cost sensing, powerful embedded system hardware, and widely deployed communication networks, the reliance on CPS for system functionality has dramatically increased. These technical developments in combination with the creation of a workforce skilled in engineering CPS will allow the deployment of increasingly capable, adaptable, and trustworthy systems"--

Cardiac arrest often strikes seemingly healthy individuals without warning and without regard to age, gender, race, or health status. Representing the third leading cause of death in the United States, cardiac arrest is defined as "a severe malfunction or cessation of the electrical and mechanical activity of the heart ... [which] results in almost instantaneous loss of consciousness and collapse". Although the exact number of cardiac arrests is unknown, conservative estimates suggest that approximately 600,000 individuals experience a cardiac arrest in the United States each year. In June 2015, the Institute of Medicine (IOM) released its consensus report Strategies to Improve Cardiac Arrest Survival: A Time to Act, which evaluated the factors affecting resuscitation research and outcomes in the United States. Following the release of this report, the National Academies of Sciences, Engineering, and Medicine was asked to hold a workshop to explore the barriers and opportunities for advancing the IOM recommendations. This publication summarizes the presentations and discussions from the workshop.

"The penetration of solid-state lighting (SSL) has increased dramatically since the publication of the National Research Council (NRC) report Assessment of Advanced Solid-State Lighting in 2013. The Committee on Assessment of Solid-State Lighting, Phase 2 has been surprised by this rapid adoption and the accompanying diversity of applications of SSL, which has been driven largely by the dramatic decline in the retail price of lamps and luminaires, and recognition of the unique qualities of the light emitting diode (LED) light source. Improvements in lamp performance, the introduction of innovative applications, improved compatibility of lamps with controls, and the integration of LED lamps in systems have all contributed to this rapid acceptance. Examples of exploiting the special characteristics of SSL are the introduction to steerable headlamps in cars, the use of spectral control to prevent lighting-induced damage to artwork, and more efficient and controllable street lighting. Accompanying this growth in the SSL market has been the rapid decline of compact fluorescent lamps (CFLs) from retail shelves"--Preface, page vii.

"The Small Business Innovation Research (SBIR) program is one of the largest examples of U.S. public-private partnerships, and was established in 1982 to encourage small businesses to develop new processes and products and to provide quality research in support of the U.S. government's many missions. The Small Business Technology Transfer (STTR) Program was created in 1992 by the Small Business Research and Development Enhancement Act to expand joint venture opportunities for small businesses and nonprofit research institutions by requiring small business recipients to collaborate formally with a research institution. The U.S. Congress tasked the National Research Council with undertaking a comprehensive study of how the SBIR and STTR programs have stimulated technological innovation and used small businesses to meet federal research and development needs, and with recommending further improvements to the programs. In the first round of this study, an ad hoc committee prepared a series of reports from 2004 to 2009 on the SBIR and STTR programs at the five agencies responsible for 96 percent of the programs' operations -- including the Department of Energy (DoE). Building on the outcomes from the first round, this second round presents the committee's second review of the DoE SBIR program's operations. Public-private partnerships like SBIR and STTR are particularly important since today's knowledge economy is driven in large part by the nation's capacity to innovate. One of the defining features of the U.S. economy is a high level of entrepreneurial activity. Entrepreneurs in the United States see opportunities and are willing and able to assume risk to bring new welfare-enhancing, wealth-generating technologies to the market. Yet, although discoveries in areas such as genomics, bioinformatics, and nanotechnology present new opportunities, converting these discoveries into innovations for the market involves substantial challenges. The American capacity for innovation can be strengthened by addressing the challenges faced by entrepreneurs"--Publisher's description.

The Everglades ecosystem is vast, stretching more than 200 miles from Orlando to Florida Bay, and Everglades National Park is but a part located at the southern end. During the 19th and 20th centuries, the historical Everglades has been reduced to half of its original size, and what remains is not the pristine ecosystem many image it to be, but one that has been highly engineered and otherwise heavily influenced, and is intensely managed by humans. Rather than slowly flowing southward in a broad river of grass, water moves through a maze of canals, levees, pump stations, and hydraulic control structures, and a substantial fraction is diverted from the natural system to meet water supply and flood control needs. The water that remains is polluted by phosphorus and other contaminants originating from agriculture and other human activities. Many components of the natural system are highly degraded and continue to degrade. Progress Toward Restoring the Everglades is the sixth biennial review of progress made in meeting the goals of the Comprehensive Everglades Restoration Plan (CERP). This complex, multibillion-dollar project to protect and restore the remaining Everglades has a 30-40 year timeline. This report assesses progress made in the various separate project components and discusses specific scientific and engineering issues that may impact further progress. According to Progress Toward Restoring the Everglades, a dedicated source of funding could provide ongoing long-term system-wide monitoring and assessment that is critical to meeting restoration objectives. This report examines the implications of knowledge gained and changes in widely accepted scientific understanding regarding pre-drainage hydrology, climate change, and the feasibility of water storage since the CERP was developed.

"A report of the National Academies of Sciences, Engineering, Medicine."

Using science to improve science communication -- The complexities of communicating science -- The nature of science-related public controversies -- Communicating science in a complex, competitive communication environment -- Building the knowledge base for effective science communication -- References -- Appendix A: Agendas of public meetings -- Appendix B: Biographical sketches of Committee members and staff.

The Department of Homeland Security's (DHS's) BioWatch program aims to provide an early indication of an aerosolized biological weapon attack. The first generation of BioWatch air samplers were deployed in 2003. The current version of this technology, referred to as Generation 2 (Gen-2), uses daily manual collection and testing of air filters from each monitor, a process that can take 12 to 36 hours to detect the presence of biological pathogens. Until April 2014, DHS pursued a next-generation autonomous detection technology that aimed to shorten the time from sample collection to detection to less than 6 hours, reduce the cost of analysis, and increase the number of detectable biological pathogens. Because of concerns about the cost and effectiveness of the proposed Generation 3 system (Gen-3), DHS cancelled its acquisition plans for the next-generation surveillance system. In response to the cancellation announcement, Congress asked the Government Accountability Office (GAO) to conduct a review of the program and the proposed system enhancements that would have been incorporated in BioWatch Gen-3. However, Mike Walter, BioWatch Program manager, Office of Health Affairs, DHS, said that DHS did not agree with all of GAO's characterizations of the BioWatch program efforts described in this review. In response to this, DHS requested that the National Academies of Sciences, Engineering, and Medicine conduct a workshop to further explore the findings of the 2015 GAO report and discuss the impact these findings may have with regard to the future development of the technical capabilities of the BioWatch program. Workshop participants also discussed existing and possible collaborations between BioWatch, public health laboratories, and other stakeholders that could contribute to the enhancement of biosurveillance capabilities at the federal, state, and local levels. This publication summarizes the presentations and discussions from the workshop.

"With the amount of data in the world exploding, big data could generate significant value in the field of infectious disease. The increased use of social media provides an opportunity to improve public health surveillance systems and to develop predictive models. Advances in machine learning and crowdsourcing may also offer the possibility to gather information about disease dynamics, such as contact patterns and the impact of the social environment. New, rapid, point-of-care diagnostics may make it possible to capture not only diagnostic information but also other potentially epidemiologically relevant information in real time. With a wide range of data available for analysis, decision-making and policy-making processes could be improved. While there are many opportunities for big data to be used for infectious disease research, operations, and policy, many challenges remain before it is possible to capture the full potential of big data. In order to explore some of the opportunities and issues associated with the scientific, policy, and operational aspects of big data in relation to microbial threats and public health, the National Academies of Sciences, Engineering, and Medicine convened a workshop in May 2016. Participants discussed a range of topics including preventing, detecting, and responding to infectious disease threats using big data and related analytics; varieties of data (including demographic, geospatial, behavioral, syndromic, and laboratory) and their broader applications; means to improve their collection, processing, utility, and validation; and approaches that can be learned from other sectors to inform big data strategies for infectious disease research, operations, and policy. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

"As the demographics of the United States shift toward a population that is made up of an increasing percentage of older adults and people with disabilities, the workforce that supports and enables these individuals is also shifting to meet the demands of this population. For many older adults and people with disabilities, their priorities include maximizing their independence, living in their own homes, and participating in their communities. In order to meet this population's demands, the workforce is adapting by modifying its training, by determining how to coordinate among the range of different professionals who might play a role in supporting any one older adult or individual with disabilities, and by identifying the ways in which technology might be helpful. To better understand how the increasing demand for supports and services will affect the nation's workforce, the National Academies of Sciences, Engineering, and Medicine convened a public workshop in June 2016, in Washington, DC. Participants aimed to identify how the health care workforce can be strengthened to support both community living and community participation for adults with disabilities and older adults. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

Over the past 20 years, public concerns have grown in response to the apparent rising prevalence of food allergy and related atopic conditions, such as eczema. Although evidence on the true prevalence of food allergy is complicated by insufficient or inconsistent data and studies with variable methodologies, many health care experts who care for patients agree that a real increase in food allergy has occurred and that it is unlikely to be due simply to an increase in awareness and better tools for diagnosis. Many stakeholders are concerned about these increases, including the general public, policy makers, regulatory agencies, the food industry, scientists, clinicians, and especially families of children and young people suffering from food allergy. At the present time, however, despite a mounting body of data on the prevalence, health consequences, and associated costs of food allergy, this chronic disease has not garnered the level of societal attention that it warrants. Moreover, for patients and families at risk, recommendations and guidelines have not been clear about preventing exposure or the onset of reactions or for managing this disease. Finding a Path to Safety in Food Allergy examines critical issues related to food allergy, including the prevalence and severity of food allergy and its impact on affected individuals, families, and communities; and current understanding of food allergy as a disease, and in diagnostics, treatments, prevention, and public policy. This report seeks to: clarify the nature of the disease, its causes, and its current management; highlight gaps in knowledge; encourage the implementation of management tools at many levels and among many stakeholders; and delineate a roadmap to safety for those who have, or are at risk of developing, food allergy, as well as for others in society who are responsible for public health.

"The most recent Ebola epidemic that began in late 2013 alerted the entire world to the gaps in infectious disease emergency preparedness and response. The regional outbreak that progressed to a significant public health emergency of international concern (PHEIC) in a matter of months killed 11,310 and infected more than 28,616. While this outbreak bears some unique distinctions to past outbreaks, many characteristics remain the same and contributed to tragic loss of human life and unnecessary expenditure of capital: insufficient knowledge of the disease, its reservoirs, and its transmission; delayed prevention efforts and treatment; poor control of the disease in hospital settings; and inadequate community and international responses. Recognizing the opportunity to learn from the countless lessons of this epidemic, the National Academies of Sciences, Engineering, and Medicine convened a workshop in March 2015 to discuss the challenges to successful outbreak responses at the scientific, clinical, and global health levels. Workshop participants explored the epidemic from multiple perspectives, identified important questions about Ebola that remained unanswered, and sought to apply this understanding to the broad challenges posed by Ebola and other emerging pathogens, to prevent the international community from being taken by surprise once again in the face of these threats. This publication summarizes the presentations and discussions from the workshop"--

"Multimodal therapy approaches that combine interventions aimed at different aspects of disease are emerging as potential--and perhaps essential--ways to enhance clinical outcomes for patients with psychiatric and neurological disorders. In order to examine the general principles underlying multimodal therapies and to explore challenges, potential barriers, and opportunities for their development, the National Academies of Sciences, Engineering, and Medicine convened a workshop in June 2016. Participants explored scientific, clinical, regulatory, and reimbursement issues related to multimodal approaches and potential opportunities to enhance clinical outcomes for individuals with nervous system disorders. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

"The public health burden from lung cancer is substantial: it is the second most commonly diagnosed cancer and the leading cause of cancer-related deaths in the United States. Given the individual and population health burden of lung cancer, especially when it is diagnosed at later stages, there has been a push to develop and implement screening strategies for early detection. However, many factors need to be considered for broad implementation of lung cancer screening in clinical practice. Effective implementation will entail understanding the balance of potential benefits and harms of lung cancer screening, defining and reaching eligible populations, addressing health disparities, and many more considerations. In recognition of the substantial challenges to developing effective lung cancer screening programs in clinical practice, the National Academies of Sciences, Engineering, and Medicine held a workshop in June 2016. At the workshop, experts described the current evidence base for lung cancer screening, the current challenges of implementation, and opportunities to overcome them. Workshop participants also explored capacity and access issues; best practices for screening programs; assessment of patient outcomes, quality, and value in lung cancer screening; and research needs that could improve implementation efforts. This publication summarizes the presentations and discussions from the workshop"--

The medical research landscape in the United States is supported by a variety of organizations that spend billions of dollars in government and private funds each year to seek answers to complex medical and public health problems. The largest government funder is the National Institutes of Health (NIH), followed by the Department of Defense (DoD). Almost half of DoD's medical research funding is administered by the Congressionally Directed Medical Research Programs (CDMRP). The mission of CDMRP is to foster innovative approaches to medical research in response to the needs of its stakeholders--the U.S. military, their families, the American public, and Congress. CDMRP funds medical research to be performed by other government and nongovernmental organizations, but it does not conduct research itself. The major focus of CDMRP funded research is the improved prevention, diagnosis, and treatment of diseases, injuries, or conditions that affect service members and their families, and the general public. The hallmarks of CDMRP include reviewing applications for research funding using a two-tiered review process, and involving consumers throughout the process. Evaluation of the Congressionally Directed Medical Research Programs Review Process evaluates the CDMRP two-tiered peer review process, its coordination of research priorities with NIH and the Department of Veterans Affairs, and provides recommendations on how the process for reviewing and selecting studies can be improved.

On January 20, 2015, President Obama announced the Precision Medicine Initiative (PMI) in his State of the Union address. The PMI, by developing new approaches for detecting, measuring, and analyzing a wide range of biomedical information including molecular, genomic, cellular, clinical, behavioral, physiological, and environmental parameters, is intended to enable a new era of medicine in which researchers, providers, and patients work together to develop individualized care. Part of this effort included the creation of a national, large-scale research participant group, or cohort. The PMI Cohort Program is aimed at extending precision medicine to many diseases, including both rare and common diseases such as diabetes, heart disease, Alzheimer's disease, obesity, and mental illnesses such as depression, bipolar disorder, and schizophrenia, by building a national research cohort of 1 million or more U.S. participants. An important challenge to assembling the PMI Cohort will be to reach individuals who are socioeconomically disadvantaged. Individuals who are socioeconomically disadvantaged have lower health literacy; often belong to racial, ethnic, and minority communities; and are often less likely to participate in research studies and biorepositories. To explore possible strategies and messaging designs, the Roundtable on Health Literacy formed an ad hoc committee charged with planning and conducting a 1-day public workshop on the intersection of health literacy and precision medicine. The workshop participants discussed a variety of topics including an overview of precision medicine and its potential, the relevance of health literacy to the success of precision medicine efforts, and perspectives and understanding of different groups, such as health care providers, consumers, and insurers. This publication summarizes the presentations and discussions from the workshop.

"The Air Force (USAF) has continuously sought to improve the speed with which it develops new capabilities to accomplish its various missions in air, space, and cyberspace. Historically, innovation has been a key part of USAF strategy, and operating within an adversary's OODA loop (observe, orient, decide, act) is part of Air Force DNA. This includes the ability to deploy technological innovations faster than do our adversaries. The Air Force faces adversaries with the potential to operate within the USAF's OODA loop, and some of these adversaries are already deploying innovations faster than the USAF. The Role of Experimentation Campaigns in the Air Force Innovation Life Cycle examines the current state of innovation and experimentation in the Air Force and best practices in innovation and experimentation in industry and other government agencies. This report also explores organizational changes needed to eliminate the barriers that deter innovation and experimentation and makes recommendations for the successful implementation of robust innovation and experimentation by the Air Force"--Publisher's description.

In July 2016 The National Academies of Sciences, Engineering, and Medicine convened a workshop with the goal of bringing together industrial and organizational (I-O) psychologists, experts on personnel selection and testing, forensic scientists, and other researchers whose work has a nexus with workforce needs in the forensic science field with a focus on pattern evidence. Participants reviewed the current status of selection and training of forensic scientists who specialize in pattern evidence and discussed how tools used in I-O psychology to understand elements of a task and measure aptitude and performance could address challenges in the pattern evidence domain of the forensic sciences. This publication summarizes the presentations and discussions from the workshop.

With the worst human refugee crisis since World War II as the backdrop, from March 16 through March 18, 2016, the National Academies of Sciences, Engineering, and Medicine, in partnership with UNICEF and the King Abdullah Bin Abdulaziz International Center for Inter-religious and Intercultural Dialogue (KAICIID), held a workshop in Amman, Jordan, to explore topics related to investing in young children for peaceful societies. Over the course of the workshop, researchers, policy makers, program practitioners, funders, youth, and other experts came together to understand the effects of conflict and violence on children, women, and youth across areas of health, education, nutrition, social protection, and other domains. The goal of the workshop was to continue to fill in gaps in knowledge and explore opportunities for discourse through a process of highlighting the science and practice. This publication summarizes the presentations and discussions from the workshop.

The Office of the Under Secretary of Defense (Personnel & Readiness), referred to throughout this report as P&R, is responsible for the total force management of all Department of Defense (DoD) components including the recruitment, readiness, and retention of personnel. Its work and policies are supported by a number of organizations both within DoD, including the Defense Manpower Data Center (DMDC), and externally, including the federally funded research and development centers (FFRDCs) that work for DoD. P&R must be able to answer questions for the Secretary of Defense such as how to recruit people with an aptitude for and interest in various specialties and along particular career tracks and how to assess on an ongoing basis service members' career satisfaction and their ability to meet new challenges. P&R must also address larger-scale questions, such as how the current realignment of forces to the Asia-Pacific area and other regions will affect recruitment, readiness, and retention. While DoD makes use of large-scale data and mathematical analysis in intelligence, surveillance, reconnaissance, and elsewhere--exploiting techniques such as complex network analysis, machine learning, streaming social media analysis, and anomaly detection--these skills and capabilities have not been applied as well to the personnel and readiness enterprise. Strengthening Data Science Methods for Department of Defense Personnel and Readiness Missions offers and roadmap and implementation plan for the integration of data analysis in support of decisions within the purview of P&R.

Description based on online resource (NAP website, viewed Dec. 13, 2016).

Extremely hazardous substances can be released accidentally as a result of chemical spills, industrial explosions, fires, or accidents involving railroad cars and trucks transporting EHSs. Workers and residents in communities surrounding industrial facilities where these substances are manufactured, used, or stored and in communities along the nation's railways and highways are potentially at risk of being exposed to airborne EHSs during accidental releases or intentional releases by terrorists. Pursuant to the Superfund Amendments and Reauthorization Act of 1986, the U.S. Environmental Protection Agency (EPA) has identified approximately 400 EHSs on the basis of acute lethality data in rodents. Acute Exposure Guideline Levels for Selected Airborne Chemicals, Volume 20 reviews and updates the technical support document on acute exposure guideline levels (AEGLs) for selected chloroformates. This update focuses on establishing AEGL-3 values for n-propyl chloroformate and isopropyl chloroformate, but will also consider whether any new data are available that would affect the proposed values for the other 10 chloroformates. AEGLs represent threshold exposure limits (exposure levels below which adverse health effects are not likely to occur) for the general public and are applicable to emergency exposures ranging from 10 minutes (min) to 8 h. Three levels - AEGL-1, AEGL-2, and AEGL-3 - are developed for each of five exposure periods (10 min, 30 min, 1 h, 4 h, and 8 h) and are distinguished by varying degrees of severity of toxic effects. This report will inform planning, response, and prevention in the community, the workplace, transportation, the military, and the remediation of Superfund sites.