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Every patient is unique, and the evolving field of precision medicine aims to ensure the delivery of the right treatment to the right patient at the right time. In an era of rapid advances in biomedicine and enhanced understanding of the genetic basis of disease, health care providers increasingly have access to advanced technologies that may identify molecular variations specific to an individual patient, which subsequently can be targeted for treatment. Known as biomarker tests for molecularly targeted therapies, these complex tests have the potential to enable the selection of the most beneficial treatment (and also to identify treatments that may be harmful or ineffective) for the molecular underpinnings of an individual patient's disease. Such tests are key to unlocking the promise of precision medicine. Biomarker tests for molecularly targeted therapies represent a crucial area of focus for developing methods that could later be applicable to other areas of precision medicine. The appropriate regulatory oversight of these tests is required to ensure that they are accurate, reliable, properly validated, and appropriately implemented in clinical practice. Moreover, common evidentiary standards for assessing the beneficial impact of biomarker-guided therapy selection on patient outcomes, as well as the effective collection and sharing of information related to those outcomes, are urgently needed to better inform clinical decision making. Biomarker Tests of Molecularly Targeted Therapies examines opportunities for and challenges to the use of biomarker tests to select optimal therapy and offers recommendations to accelerate progress in this field. This report explores regulatory issues, reimbursement issues, and clinical practice issues related to the clinical development and use of biomarker tests for targeting therapies to patients. Properly validated, appropriately implemented biomarker tests hold the potential to enhance patient care and improve outcomes, and therefore addressing the challenges facing such tests is critical.

"To examine the science, policy, and practice surrounding supporting family and community investments in young children globally and children in acute disruptions, the National Academies of Sciences, Engineering, and Medicine held a workshop in partnership with the Ethiopian Academy of Sciences in Addis Ababa, Ethiopia, from July 27-29, 2015. The workshop examined topics related to supporting family and community investments in young children globally. Examples of types of investments included financial and human capital. Participants also discussed how systems can better support children, families, and communities through acute disruptions such as the Ebola outbreak. Over the course of the 3-day workshop, researchers, policy makers, program practitioners, funders, young influencers, and other experts from 19 countries discussed how best to support family and community investments across areas of health, education, nutrition, social protection, and other service domains. This report summarizes the presentations and discussions from the workshop"--Publisher's description.

From 1962 to 1971, the US military sprayed herbicides over Vietnam to strip the thick jungle canopy that could conceal opposition forces, to destroy crops that those forces might depend on, and to clear tall grasses and bushes from the perimeters of US base camps and outlying fire-support bases. Mixtures of 2,4-dichlorophenoxyacetic acid (2,4-D), 2,4,5-trichlorophenoxyacetic acid (2,4,5-T), picloram, and cacodylic acid made up the bulk of the herbicides sprayed. The main chemical mixture sprayed was Agent Orange, a 50:50 mixture of 2,4-D and 2,4,5-T. At the time of the spraying, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), the most toxic form of dioxin, was an unintended contaminant generated during the production of 2,4,5-T and so was present in Agent Orange and some other formulations sprayed in Vietnam. Because of complaints from returning Vietnam veterans about their own health and that of their children combined with emerging toxicologic evidence of adverse effects of phenoxy herbicides and TCDD, the National Academy of Sciences was asked to perform a comprehensive evaluation of scientific and medical information regarding the health effects of exposure to Agent Orange, other herbicides used in Vietnam, and the various components of those herbicides, including TCDD. Updated evaluations were conducted every two years to review newly available literature and draw conclusions from the overall evidence. Veterans and Agent Orange: Update 2014 is a cumulative report of the series thus far.

The Update to the Strategic Plan (USP) is a supplement to the Ten-Year Strategic Plan of the U.S. Global Change Research Program (USGCRP) completed in 2012. The Strategic Plan sets out a research program guiding thirteen federal agencies in accord with the Global Change Research Act of 1990. This report reviews whether USGCRP's efforts to achieve its goals and objectives, as documented in the USP, are adequate and responsive to the Nation's needs, whether the priorities for continued or increased emphasis are appropriate, and if the written document communicates effectively, all within a context of the history and trajectory of the Program.

Questions about the reproducibility of scientific research have been raised in numerous settings and have gained visibility through several high-profile journal and popular press articles. Quantitative issues contributing to reproducibility challenges have been considered (including improper data measurement and analysis, inadequate statistical expertise, and incomplete data, among others), but there is no clear consensus on how best to approach or to minimize these problems. A lack of reproducibility of scientific results has created some distrust in scientific findings among the general public, scientists, funding agencies, and industries. While studies fail for a variety of reasons, many factors contribute to the lack of perfect reproducibility, including insufficient training in experimental design, misaligned incentives for publication and the implications for university tenure, intentional manipulation, poor data management and analysis, and inadequate instances of statistical inference. The workshop summarized in this report was designed not to address the social and experimental challenges but instead to focus on the latter issues of improper data management and analysis, inadequate statistical expertise, incomplete data, and difficulties applying sound statistic inference to the available data. Many efforts have emerged over recent years to draw attention to and improve reproducibility of scientific work. This report uniquely focuses on the statistical perspective of three issues: the extent of reproducibility, the causes of reproducibility failures, and the potential remedies for these failures.

Workshop convened by the Computer Science and Telecommunications Board (CSTB) on July 21-22, 2015 in Washington, D.C.--page 1.

"Science and Technology for Sustainability Program"--Page 1 of cover.

"The workshop summarized in this report was organized as part of a study sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of the Assistant Secretary for Planning and Evaluation of the U.S. Department of Health and Human Services, with the goal of assisting SAMHSA in its responsibilities of expanding the collection of behavioral health data in several areas. The workshop brought together experts in mental health, psychiatric epidemiology and survey methods to facilitate discussion of the most suitable measures and mechanisms for producing estimates of specific mental illness diagnoses with functional impairment. The report discusses existing measures and data on mental disorders and functional impairment, challenges associated with collecting these data in large-scale population-based studies, as well as study design and estimation options"--

The 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 Board 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 2016. During the first year the Board examined the following elements within the ARL's science and technology campaigns: biological and bioinspired materials, energy and power materials, and engineered photonics materials; battlefield injury mechanisms, directed energy, and armor and adaptive protection; sensing and effecting, and system intelligence and intelligent systems; advanced computing architectures, computing sciences, data-intensive sciences, and predictive simulation sciences; human-machine interaction, intelligence and control, and perception; humans in multiagent systems, real-world behavior, and toward human variability; and mission capability of systems. A second, final report will subsume the findings of this interim report and add the findings from the second year of the review.

For the United States, the 1991 Persian Gulf War was a brief and successful military operation with few injuries and deaths. However, soon after returning from duty, a large number of veterans began reporting health problems they believed were associated with their service in the Gulf. At the request of Congress, the Institute of Medicine (IOM) has been conducting an ongoing review of the evidence to determine veterans' long-term health problems and potential causes. The fourth volume in the series, released in 2006, summarizes the long-term health problems seen in Gulf War veterans. In 2010, the IOM released an update that focuses on existing health problems and identifies possible new ones, considering evidence collected since the initial summary. Gulf War and Health: Volume 10 is an update of the scientific and medical literature on the health effects associated with deployment to the Gulf War that were identified in Volumes 4 and 8. This report reviews and evaluates the associations between illness and exposure to toxic agents, environmental or wartime hazards, or preventive measures and vaccines associated with Gulf War service, and provides recommendations for future research efforts on Gulf War veterans.

In 1982 the Census Bureau requested the Committee on National Statistics to establish a panel to suggest research and experiments, to recommend improved methods, and to guide the Census Bureau on technical problems in appraising contending methods with regard to the conduct of the decennial census. In response, the panel produced an interim report that focused on recommendations for improvements in census methodology that warranted early investigation and testing. This report updates and expands the ideas and conclusions about decennial census methodology.

"The national academies of sciences-engineering-medicine"--Cover.

"This report summarizes an 18-month study by the Committee on Improving Higher Education's Responsiveness to STEM Workforce Needs: Identifying Analytical Tools and Regional Best Practices, organized under the auspices of the Board on Higher Education and Workforce and the National Academy of Sciences, Engineering, and Medicine"--page vii.

Over the past several decades, the public and private sectors made significant investments in global health, leading to meaningful changes for many of the world's poor. These investments and the resulting progress are often concentrated in vertical health programs, such as child and maternal health, malaria, and HIV, where donors may have a strategic interest. Frequently, partnerships between donors and other stakeholders can coalesce on a specific topical area of expertise and interest. However, to sustain these successes and continue progress, there is a growing recognition of the need to strengthen health systems more broadly and build functional administrative and technical infrastructure that can support health services for all, improve the health of populations, increase the purchasing and earning power of consumers and workers, and advance global security. In June 2015, the National Academies of Sciences, Engineering, and Medicine held a workshop on the role of public-private partnerships (PPPs) in health systems strengthening. Participants examined a range of incentives, innovations, and opportunities for relevant sectors and stakeholders in strengthening health systems through partnerships; to explore lessons learned from pervious and ongoing efforts with the goal of illuminating how to improve performance and outcomes going forward; and to discuss measuring the value and outcomes of investments and documenting success in partnerships focused on health systems strengthening. This report summarizes the presentations and discussions from the workshop.

"The social cost of carbon (SCC) for a given year is an estimate, in dollars, of the present discounted value of the damage caused by a 1-metric ton increase in CO2 emissions into the atmosphere in that year; or equivalently, the benefits of reducing CO2 emissions by the same amount in that given year. The SCC is intended to provide a comprehensive measure of the monetized value of the net damages from global climate change from an additional unit of CO2, including, but not limited to, changes in net agricultural productivity, energy use, human health effects, and property damages from increased flood risk. Federal agencies use the SCC to value the CO2 emissions impacts of various policies including emission and fuel economy standards for vehicles, regulations of industrial air pollutants from industrial manufacturing, emission standards for power plants and solid waste incineration, and appliance energy efficiency standards. There are significant challenges to estimating a dollar value that reflects all the physical, human, ecological, and economic impacts of climate change. Recognizing that the models and scientific data underlying the SCC estimates evolve and improve over time, the federal government made a commitment to provide regular updates to the estimates. To assist with future revisions of the SCC, the Interagency Working Group on the Social Cost of Carbon (IWG) requested the National Academies of Sciences, Engineering, and Medicine complete a study that assessed the merits and challenges of a limited near-term update to the SCC and of a comprehensive update of the SCC to ensure that the estimates reflect the best available science. This interim report focuses on near-term updates to the SCC estimates"--

"Since the 2014 Ebola outbreak many public- and private-sector leaders have seen a need for improved management of global public health emergencies. The effects of the Ebola epidemic go well beyond the three hardest-hit countries and beyond the health sector. Education, child protection, commerce, transportation, and human rights have all suffered. The consequences and lethality of Ebola have increased interest in coordinated global response to infectious threats, many of which could disrupt global health and commerce far more than the recent outbreak. In order to explore the potential for improving international management and response to outbreaks the National Academy of Medicine agreed to manage an international, independent, evidence-based, authoritative, multistakeholder expert commission. As part of this effort, the Institute of Medicine convened four workshops in summer of 2015 to inform the commission report. The presentations and discussions from the Governance for Global Health Workshop are summarized in this report"--

"The Global Health Risk Framework Project Workshop on Pandemic Financing, National Academy of Sciences Building, 2101 Constitution Avenue NW, Washington, DC, Thursday, August 27, 2015"--Page 79.

"The Board on Health Sciences Policy within the Institute of Medicine of the National Academies of Science, Engineering, and Medicine convened Global Health Risk Framework: a Workshop on Resilient and Sustainable Health Systems to Respond to Global Infectious Disease Outbreaks, held August 5-7, 2015 in Accra, Ghana"--Page 6.

Summary of Meeting on "Updating and Optimizing a List of Civilian Research and Test Reactors that Operate Using HEU Fuel," held July 27-29, 2015 in Vienna Austria.

"The Workshop on Research and Development of Medical Products is one of the four workstream activities of the Global Health Risk Framework Initiative ... The workshop was co-hosted by the Institute of Medicine (IOM) and the University of Hong Kong, in Hong Kong, on August 19-21, 2015"--Page 2-3.

An assessment of the scientific and technical work performed by three divisions of the National Institute of Standards and Technology (NIST) Information Technology Laboratory for the fiscal year 2015, to include the Information Access Division (IAD), the Software and Systems Division (SSD), and the Statistical Engineering Division (SED).

Recent health care payment reforms aim to improve the alignment of Medicare payment strategies with goals to improve the quality of care provided, patient experiences with health care, and health outcomes, while also controlling costs. These efforts move Medicare away from the volume-based payment of traditional fee-for-service models and toward value-based purchasing, in which cost control is an explicit goal in addition to clinical and quality goals. Specific payment strategies include pay-for-performance and other quality incentive programs that tie financial rewards and sanctions to the quality and efficiency of care provided and accountable care organizations in which health care providers are held accountable for both the quality and cost of the care they deliver. Accounting for Social Risk Factors in Medicare Payment: Identifying Social Risk Factors is the first in a series of five reports commissioned to provide input into whether socioeconomic status (SES) and other social risk factors could be accounted for in Medicare payment and quality programs. This report focuses on defining SES and other social factors for the purposes of application to Medicare quality measurement and payment programs.

Speech and language are central to the human experience; they are the vital means by which people convey and receive knowledge, thoughts, feelings, and other internal experiences. Acquisition of communication skills begins early in childhood and is foundational to the ability to gain access to culturally transmitted knowledge, organize and share thoughts and feelings, and participate in social interactions and relationships. Thus, speech disorders and language disorders--disruptions in communication development--can have wide-ranging and adverse impacts on the ability to communicate and also to acquire new knowledge and fully participate in society. Severe disruptions in speech or language acquisition have both direct and indirect consequences for child and adolescent development, not only in communication, but also in associated abilities such as reading and academic achievement that depend on speech and language skills. The Supplemental Security Income (SSI) program for children provides financial assistance to children from low-income, resource-limited families who are determined to have conditions that meet the disability standard required under law. Between 2000 and 2010, there was an unprecedented rise in the number of applications and the number of children found to meet the disability criteria. The factors that contribute to these changes are a primary focus of this report. Speech and Language Disorders in Children provides an overview of the current status of the diagnosis and treatment of speech and language disorders and levels of impairment in the U.S. population under age 18. This study identifies past and current trends in the prevalence and persistence of speech disorders and language disorders for the general U.S. population under age 18 and compares those trends to trends in the SSI childhood disability population.

When Congress authorized the National Flood Insurance Program (NFIP) in 1968, it intended for the program to encourage community initiatives in flood risk management, charge insurance premiums consistent with actuarial pricing principles, and encourage the purchase of flood insurance by owners of flood prone properties, in part, by offering affordable premiums. The NFIP has been reauthorized many times since 1968, most recently with the Biggert-Waters Flood Insurance Reform Act of 2012 (BW 2012). In this most recent reauthorization, Congress placed a particular emphasis on setting flood insurance premiums following actuarial pricing principles, which was motivated by a desire to ensure future revenues were adequate to pay claims and administrative expenses. BW 2012 was designed to move the NFIP towards risk-based premiums for all flood insurance policies. The result was to be increased premiums for some policyholders that had been paying less than NFIP risk-based premiums and to possibly increase premiums for all policyholders. Recognition of this possibility and concern for the affordability of flood insurance is reflected in sections of the Homeowner Flood Insurance Affordability Act of 2014 (HFIAA 2014). These sections called on FEMA to propose a draft affordability framework for the NFIP after completing an analysis of the efforts of possible programs for offering "means-tested assistance" to policyholders for whom higher rates may not be affordable. BW 2012 and HFIAA 2014 mandated that FEMA conduct a study, in cooperation with the National Academies of Sciences, Engineering, and Medicine, which would compare the costs of a program of risk-based rates and means-tested assistance to the current system of subsidized flood insurance rates and federally funded disaster relief for people without coverage. Production of two reports was agreed upon to fulfill this mandate. This second report proposes alternative approaches for a national evaluation of affordability program policy options and includes lessons for the design of a national study from a proof-of-concept pilot study.

Review of NASA's Evidence Reports on Human Health Risks 2015 Letter Report is the third in a series of five reports from the Institute of Medicine that will independently review more than 30 evidence reports that the National Aeronautics and Space Administration has compiled on human health risks for long-duration and exploration space flights. This report builds on the 2008 IOM report Review of NASA's Human Research Program Evidence Books: A Letter Report, which provided an initial and brief review of the evidence reports. This letter report reviews seven 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. The report analyzes each evidence report's overall quality, which included readability; internal consistency; the source and breadth of cited evidence; identification of existing knowledge and research gaps; authorship expertise; and, if applicable, response to recommendations from the 2008 IOM letter report.--

Between 1963 and 1969, the U.S. military carried out a series of tests, termed Project SHAD (Shipboard Hazard and Defense), to evaluate the vulnerabilities of U.S. Navy ships to chemical and biological warfare agents. These tests involved use of active chemical and biological agents, stimulants, tracers, and decontaminants. Approximately 5,900 military personnel, primarily from the Navy and Marine Corps, are reported to have been included in Project SHAD testing. In the 1990s some veterans who participated in the SHAD tests expressed concerns to the Department of Veterans Affairs (VA) that they were experiencing health problems that might be the result of exposures in the testing. These concerns led to a 2002 request from VA to the Institute of Medicine (IOM) to carry out an epidemiological study of the health of SHAD veterans and a comparison population of veterans who had served on similar ships or in similar units during the same time period. In response to continuing concerns, Congress in 2010 requested an additional IOM study. This second study expands on the previous IOM work by making use of additional years of follow up and some analysis of diagnostic data from Medicare and the VA health care system.

The market for high-skilled workers is becoming increasingly global, as are the markets for knowledge and ideas. While high-skilled immigrants in the United States represent a much smaller proportion of the workforce than they do in countries such as Australia, Canada, and the United Kingdom, these immigrants have an important role in spurring innovation and economic growth in all countries and filling shortages in the domestic labor supply. This report summarizes the proceedings of a Fall 2014 workshop that focused on how immigration policy can be used to attract and retain foreign talent. Participants compared policies on encouraging migration and retention of skilled workers, attracting qualified foreign students and retaining them post-graduation, and input by states or provinces in immigration policies to add flexibility in countries with regional employment differences, among other topics. They also discussed how immigration policies have changed over time in response to undesired labor market outcomes and whether there was sufficient data to measure those outcomes.

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. Public-private partnerships are one means to help entrepreneurs bring new ideas to market. The Small Business Technology Transfer (STTR) and the Small Business Innovation Research (SBIR) program form one of the largest examples of U.S. public-private partnerships. In the SBIR Reauthorization Act of 2000, Congress tasked the National Research Council with undertaking a comprehensive study of how the SBIR program has stimulated technological innovation and used small businesses to meet federal research and development needs and with recommending further improvements to the program. When reauthorizing the SBIR and STTR programs in 2011, Congress expanded the study mandate to include a review of the STTR program. This report builds on the methodology and outcomes from the previous review of SBIR and assesses the STTR program.

Since its creation by the Institute of Medicine (IOM) in 2007, the Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities has been fostering dialogue on racial and ethnic disparities in health and health care, examining the development of programs and strategies to reduce disparities, and encouraging the emergence of new leadership focused on health equity. For the past several years, a prominent topic of discussion within the roundtable has been the Patient Protection and Affordable Care Act (ACA). The ACA has multiple provisions specific to race, ethnicity, and language and other provisions with significant implications for racially and ethnically diverse populations. In April 2013, the roundtable held a workshop to address many issues surrounding the ACA, including expansion of coverage, delivery systems, and access points, service delivery and payment reform, public-private partnerships, and challenges to the safety net. This report summarizes the presentations and discussions from the workshop.