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The National Academy of Engineering convened a three-day workshop from May 24-26, 2021, which sought to define directions for future research on best practices, metrics, and policies that promote diversity in engineering and how they fit into the larger system of recruiting and retaining engineering students from all backgrounds. Workshop discussions examined the system of higher education admissions, transfer and 3+2 programs, research on admissions, and the advantages of and concerns with using artificial intelligence and data science tools in recruiting, admissions, and retention. This publication summarizes the presentations and discussions of the workshop.

Current assisted reproductive technologies such as in vitro fertilization (IVF) do not enable all prospective parents to have genetically related children. The National Academies Board on Health Sciences Policy hosted a workshop in April 2023 to explore the development of in vitro-derived human eggs and sperm from pluripotent stem cells through a process known as in vitro gametogenesis (IVG). Speakers emphasized the impacts of the potential biotechnology on research and reproductive medicine should clinical IVG ever be approved, along with the many social, ethical, legal, and technical considerations its development raises. This proceedings document summarizes workshop discussions.

The transition to renewable energy has spurred many efforts to scale up the U.S. portfolio of efficient clean energy resources, including the development of offshore wind farms. The Nantucket Shoals region off the coast of Massachusetts is the first large scale wind farm installation under development in U.S. waters. To ensure Nantucket Shoals region offshore wind energy installations are being planned, constructed, and developed in an environmentally responsible way, the Bureau of Ocean Energy Management (BOEM) asked the National Academies to evaluate the potential for offshore wind farms in the Nantucket Shoals region to affect oceanic physical processes, and, in turn, how those hydrodynamic alterations might affect local to regional ecosystems. Of particular interest to BOEM are the potential effects of hydrodynamic changes on zooplankton productivity and aggregations, which may affect foraging for the critically endangered North Atlantic right whale. This report found the impacts of offshore wind projects on the North Atlantic right whale and the availability of their prey in the Nantucket Shoals region will likely be difficult to distinguish from the significant impacts of climate change and other influences on the ecosystem. Further study and monitoring of the oceanography and ecology of the Nantucket Shoals region is needed to fully understand the impact of future wind farms. This report recommends the Bureau of Ocean Energy Management, the National Oceanic and Atmospheric Administration, and others should promote observational studies and modeling that will advance understanding of potential hydrodynamic effects and their consequent impacts on ecology in the Nantucket Shoals region during all phases of wind energy development.

The Survey of Income and Program Participation (SIPP) is one of the U.S. Census Bureau's major surveys with features making it a uniquely valuable resource for researchers and policy analysts. However, the Census Bureau faces the challenge of protecting the confidentiality of survey respondents which has become increasingly difficult because numerous databases exist with personal identifying information that collectively contain data on household finances, home values, purchasing behavior, and other SIPP-relevant characteristics. A Roadmap for Disclosure Avoidance in the Survey of Income and Program Participation addresses these issues and how to make data from SIPP available to researchers and policymakers while protecting the confidentiality of survey respondents. The report considers factors such as evolving privacy risks, development of new methods for protecting privacy, the nature of the data collected through SIPP, the practice of linking SIPP data with administrative data, the types of data products produced, and the desire to provide timely access to SIPP data. The report seeks to balance minimizing the risk of disclosure against allowing researchers and policymakers to have timely access to data that support valid inferences.

The National Academies Roundtable on Population Health Improvement hosted a workshop in February 2022, A Population Health Workforce to Meet 21st Century Challenges and Opportunities. The event, building upon the proceedings from their March 2019 workshop, Dialogue about the Workforce for Population Health Improvement, was further informed by the ongoing COVID-19 pandemic, the effects of climate change, and recent attention to and expenditure on the public health workforce. Workshop discussions explored the scope of work and work settings for public health and population health workers; the state of the workforce including attrition and gaps in specific roles and disciplines; and challenges to training, recruiting, and retaining workers. This Proceedings of a Workshop summarizes the presentations and discussions held during the workshop.

Since 1790, the U.S. census has been a recurring, essential civic ceremony in which everyone counts; it reaffirms a commitment to equality among all, as political representation is explicitly tied to population counts. Assessing the 2020 Census looks at the quality of the 2020 Census and its constituent operations, drawing appropriate comparisons with prior censuses. The report acknowledges the extraordinary challenges the Census Bureau faced in conducting the census and provides guidance as it plans for the 2030 Census. In addition, the report encourages research and development as the goals and designs for the 2030 Census are developed, urging the Census Bureau to establish a true partnership with census data users and government partners at the state, local, tribal, and federal levels.

From April 25-26, 2023 the Committee on National Statistics of the National Academies of Sciences, Engineering, and Medicine convened a workshop to identify challenges in and opportunities for measuring suicide in the law enforcement occupation. Experts in the field met to identify ways to improve the measurement of suicide by current and former police and corrections officers, dispatchers, and other sworn and civilian personnel, in public and private organizations. This proceedings provides a synthesis of key themes identified during the workshop.

Complementary feeding refers to the introduction of foods other than human milk or formula to an infants diet. In response to a request from the Centers for Disease Control and Prevention, the National Academies Health and Medicine Division convened the Committee on Complementary Feeding Interventions for Infants and Young Children under Age 2 to conduct a consensus study scoping review of peer-reviewed literature and other publicly available information on interventions addressing complementary feeding of infants and young children. The interventions studied took place in the U.S. and other high-income country health care systems; early care and education settings; university cooperative extension programs; the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); home visiting programs; and other settings. This consensus study report summarizes evidence and provides information on interventions that could be scaled up or implemented at a community or state level.

Artificial intelligence (AI) has the potential to aid new mathematical discoveries. Particularly as the amount of data available grows beyond what any person can study, AI can be useful in its power to identify patterns in data and refine relationships between properties. Sponsored by the National Science Foundation, the National Academies of Sciences, Engineering, and Medicine Board on Mathematical Sciences and Analytics convened a 3-day public virtual workshop on June 12-14, 2023, to bring together stakeholders to discuss the state of the art and current challenges and opportunities to advance research in using AI for mathematical reasoning. This publication summarizes the presentations and discussion of the workshop.

On March 20 and 21, 2023, the Board on Science Education at the National Academies of Sciences, Engineering, and Medicine hosted a workshop titled Effective Health Communication within the Current Information Environment and the Role of the Federal Government. Workshop speakers and participants, a majority of whom were working in government agencies in federal health communication or leadership positions, joined both in person in Washington, D.C. as well as virtually to explore the current health information environment as it pertains to public trust and behavior change, explore how federal health agencies can communicate effectively within the current information environment and what is needed to support effective health communication moving forward. This publication summarizes the presentations and discussion of the workshop.

"Research in biological and physical sciences in space provides the critical scientific and technological foundations that make space exploration possible. As humanity looks towards the Moon and Mars for future missions, this work is needed to help astronauts adapt and live in the harsh environments of space. Thriving in Space provides a roadmap for increasing national investment in biological and physical science research, from experiments to infrastructure to education. This report identifies key scientific questions, priorities, and ambitious research campaigns that will enable human space exploration and transform our understanding of how the universe works.Thriving in Space reviews the state of knowledge in the current and emerging areas of space-related biological and physical sciences research and generates recommendations for a comprehensive vision and strategy for a decade of transformative science at the frontiers of biological and physical sciences research in space. This report will help NASA define and align biological and physical sciences research to uniquely advance scientific knowledge, meet human and robotic exploration mission needs, and provide terrestrial benefits."--Publisher's website.

Pediatric subspecialists are critical to ensuring quality care and pursuing research to improve prevention, diagnosis, and treatment for children. However, there are substantial disincentives to pursuing a career as a pediatric subspecialist, which are often heightened for individuals from groups underrepresented in medicine, and more effective collaboration with primary care clinicians is needed. Changing health care needs, increasing care complexity, and access barriers to pediatric subspecialty care have raised concerns about the current and future availability of pediatric subspecialty care and research. In response, the National Academies, with support from a coalition of sponsors, formed the Committee on the Pediatric Subspecialty Workforce and Its Impact on Child Health and Well-Being to recommend strategies and actions to ensure an adequate pediatric subspecialty physician workforce to support broad access to high quality subspecialty care and a robust research portfolio to advance the health and health care of infants, children, and adolescents. This report outlines recommendations that, if fully implemented, can improve the quality of pediatric medical subspecialty care through a well-supported, superbly trained, and appropriately used primary care, subspecialty, and physician-scientist workforce.

The Department of the Air Force (DAF) is in the early stages of incorporating modern artificial intelligence (AI) technologies into its systems and operations. The integration of AI-enabled capabilities across the DAF will accelerate over the next few years. At the request of DAF Air and Space Forces, this report examines the Air Force Test Center technical capabilities and capacity to conduct rigorous and objective tests, evaluations, and assessments of AI-enabled systems under operational conditions and against realistic threats. This report explores both the opportunities and challenges inherent in integrating AI at speed and at scale across the DAF.

A key step towards reducing the burden of central nervous system (CNS) disorders is the identification of disease-specific biomarkers that can help predict, monitor, and guide treatment development. Recent technological advances have led to an increased number of biomarkers for different CNS disorders, providing the opportunity to generate multimodal biomarkers. While multimodal biomarkers can serve as promising tools to better diagnose and make accurate disease assessments, there remain challenges in current data collection, standardization, and validation practices that impede in their development. Recognizing the need for increased CNS biomarker integration, the National Academies Forum on Neuroscience and Nervous System Disorders hosted a public workshop in March 2023 to explore steps toward this goal, including data collection for biomarker discovery, development, validation, and assessment of clinical utility. This Proceedings of a Workshop summarizes the discussions held during the workshop.

"Advances in biomedical science, data science, engineering, and technology are leading to high-pace innovation with potential to transform health and medicine. These innovations simultaneously raise important ethical and social issues, including how to fairly distribute their benefits and risks. The National Academies of Sciences, Engineering, and Medicine, in collaboration with the National Academy of Medicine, established the Committee on Creating a Framework for Emerging Science, Technology, and Innovation in Health and Medicine to provide leadership and engage broad communities in developing a framework for aligning the development and use of transformative technologies with ethical and equitable principles. The committees resulting report describes a governance framework for decisions throughout the innovation life cycle to advance equitable innovation and support an ecosystem that is more responsive to the needs of a broader range of individuals and is better able to recognize and address inequities as they arise."--

Today, with a changing climate putting pressure on communities and ecosystems worldwide, goals for a carbon-neutral economy mean that renewable and low-carbon energy sources are being presented as solutions. While these cleaner energy sources have the potential to reduce risk to the environment and bring energy security closer to a reality, questions remain about the stability of the energy supply chain, the ability to meet energy demand reliably, and the best ways to produce fair and equitable outcomes in an energy transition. To serve as a catalyst for developing new insights and coordination around the energy transition, the Gulf Research Program at the National Academies of Sciences, Engineering, and Medicine convened a 2-day workshop in Washington, DC, called Navigating the Energy Transition in the Gulf of Mexico. Based around two scenarios in the year 2050 - one in which a carbon neutral economy is achieved and another in which robust dependence on fossil fuels remains - this serious gaming event stimulated the sharing of ideas, concerns, and cascading impacts from participants across academia, industry, government, and Gulf communities. This publication summarizes the activities, presentations, and discussion of the workshop.

The National Academies of Sciences, Engineering, and Medicine was asked to articulate a 5-year strategic vision for international health security programs and provide findings and recommendations on how to optimize the impact of the Department of Defense (DOD) Biological Threat Reduction Program (BTRP) in fulfilling its biosafety and biosecurity mission. Because BTRP is just one of several U.S. government programs conducting international health security engagement, both the strategic vision and the success of the program rely on coordinating actions with the U.S. government as a whole and with its international partners. This report provides several recommendations for optimizing BTRP success in its current mission and the wider-looking strategic vision it proposes.

The National Academies Global Forum on Innovation in Health Professional Education hosted a multi-day workshop series in March and April 2023 to explore the potential of artificial intelligence (AI) in health professions education. Speakers at the workshops provided background on AI; discussed the social, cultural, policy, legal, and regulatory considerations to integrating AI into health care and training; considered the skills health professionals will need as educators and providers to effectively use AI in practice; and explored needs for educating the next generation of health workers. Speakers took consideration of the bias, burden, health equity concerns that introducing AI into clinical education would bring. This Proceedings of a Workshop summarizes the discussions held during the workshop.

Responding to climate change will entail massive socio-emotional and behavioral changes. Translating policies, investments, or built infrastructure-reshaping mandates into real and sustained local impact that incorporates accountability and culture change will require hands-on work. Adaptive societal responses to climate change will succeed or fail based on the attitudes, behaviors, social cohesion and capital, organizational and emotional strengths, and collective impact and input of all stakeholders. To consider how to integrate, align, and converge the broad mix of social, behavioral, and cognitive sciences to produce new insights and inform efforts for enhanced human responses to environmental change, Board on Environmental Change and Society of the National Academies of Sciences, Engineering and Medicine convened this 2023 workshop, entitled Committee on Integrating the Human Sciences to Scale Societal Responses to Environmental Change: A Workshop. The workshop was intended to investigate ways to accelerate and deepen conversations within the social sciences and to focus on synthesis, especially for the purpose of increasing community capacity to understand and effectively respond to climate change-induced environmental changes - at scales ranging from the individual to the household to the community, and all the way up to the level of state and international governance. This publication summarizes the presentations and discussion of the workshop.

Where people live can affect their health because of location-specific exposure to chemicals and toxicants, lifestyle, diet, immune function development, and social and historical determinants of health. A better understanding of the connections between environmental exposures and genetics that are associated with cancer can help inform efforts to identify risks and prevent potentially harmful outcomes. Recent scientific advancements have brought new insights into genomic and epigenomic biomarkers of cancer, which encompasses the toxicogenomic effects of environmental hazards, genetic susceptibility to environmental exposures, and the role of genetic and epigenetic changes in the development of cancer. Public communication around the potential risks of environmental hazards has also been evolving. The National Academies of Sciences, Engineering, and Medicine National Cancer Policy Forum convened a virtual public workshop in collaboration with the Roundtable on Genomics and Precision Health on April 13, 2023 to explore the state of the science in identifying potential genomic and epigenomic biomarkers of environmental exposures associated with cancers, with an emphasis on pediatric cancers. This proceedings document summarizes workshop discussions.

The mental and behavioral health care needs of Americans, including veterans, have substantially grown over the past few decades. As the nations largest provider of mental health care, the U.S. Department of Veterans Affairs (VA) faces some of the greatest challenges in meeting the mental health care needs of its population. These challenges are exacerbated by a shrinking mental health care workforce and provider shortages in low-income and rural communities. To address these challenges, and at the request of VA, the National Academies of Sciences, Engineering, and Medicine Forum on Mental Health and Substance Use Disorders held a public workshop on Improving Access to High-Quality Mental Health Care for Veterans to explore the U.S. landscape for mental health care services, including telehealth services. The workshop considered ways to improve veterans timely access to high-quality care for mental health conditions. In particular, it explored internal and external best practices for three critical needs for mental health access (known as tripartite access in VA): urgent/crisis, engagement, and sustained access. This proceedings document summarizes discussions at the workshop.

The Department of Veterans Affairs (VA) provides health care and other benefits to eligible veterans with physical and mental injuries or illnesses (conditions) related to their military service. When the scientific information needed to connect a veterans service or a particular military exposure with their diagnosed condition is nonexistent, impossible to obtain, or incomplete, VA may make a presumption of service connection using a formalized decision process. In 2022, VA instituted a series of changes intended to ensure the presumption decision process was more scientifically based, fair, consistent, transparent, timely, and veteran-centric. The PACT Act of 2022 called for a National Academies committee to review the VA revised process document used to identify medical conditions to evaluate for presumption status, the factors that such an evaluation entails, and the governance process for the review and approval of a presumption recommendation. This resulting report, Review of the Department of Veterans Affairs Presumption Decision Process, contains the committee findings, conclusions, and recommendations.

Formaldehyde is widely present in the environment and is one of the highest production chemicals by volume, used in manufactured goods including wood products, permanent press fabrics, and household products. It is also formed by combustion sources and is present in smoke from cigarettes and other tobacco products, and in emissions from gas stoves and open fireplaces. In carrying out its mission to protect human health, the U.S. Environmental Protection Agency (EPA) identifies and characterizes the health hazards of chemicals found in the environment through its Integrated Risk Information System (IRIS) Program, which has reviewed the human health hazards resulting from formaldehyde exposure in several assessments. This report is a continuation of guidance from the National Academies on draft IRIS assessments of formaldehyde and other aspects of the IRIS program. This report reviews the 2022 Draft Assessment with regard to its adequacy and transparency in evaluating the scientific literature, use of appropriate methods to synthesize the current state-of-the science, and presentations of conclusions that are supported by the scientific evidence. The report concludes that the 2022 Draft Assessment follows the advice of prior National Academies reports and that its findings on hazard and quantitative risk are supported by the evidence identified. However, revisions are needed to ensure that users can find and follow the methods used in each step of the assessment for each health outcome.

What can be more vital to each of us than our health? Yet, despite unprecedented health care spending, the U.S. health system is substantially underperforming, especially with respect to what should be possible, given current knowledge. Although the United States is currently devoting 18% of its Gross Domestic Product to delivering medical care--more than $3 trillion annually and nearly double the expenditure of other advanced industrialized countries--the U.S. health system ranked only 37 in performance in a World Health Organization assessment of member nations. In Vital Directions for Health & Health Care: An Initiative of the National Academy of Medicine, the National Academy of Medicine (NAM), which has long stood as the nation's most trusted independent source of guidance in health, health care, and biomedical science, has marshaled the wisdom of more than 150 of the nation's best researchers and health policy experts to assess opportunities for substantially improving the health and well-being of Americans, the quality of care delivered, and the contributions of science and technology. This publication identifies practical and affordable steps that can and must be taken across eight action and infrastructure priorities, ranging from paying for value and connecting care, to measuring what matters most and accelerating the capture of real-world evidence. Without obscuring the difficulty of the changes needed, in Vital Directions, the NAM offers an important blueprint and resource for health, policy, and leaders at all levels to achieve much better health outcomes at much lower cost.

In 2016, the National Academy of Medicine (NAM) hosted a series of meetings, which was sponsored by the Patient-Centered Outcomes Research Institute, with support from NAM's Executive Leadership Network. The series underscored the importance of partnerships between researchers and health system leadership and considered opportunities to build institutional capacity, cross-institutional synergy, and system-wide learning. During these meetings, health system executives, researchers, and others discussed building infrastructure that simultaneously facilitates care delivery, care improvement and evidence development. The vision is a digital system-wide progress toward continuous and seamless learning and improvement throughout health and health care. This publication aims to answer the following questions: How can evidence development be accelerated, given current knowledge and resources? What might that mean for better outcomes for patients and greater efficiency in health care? What system and culture changes are required to generate evidence from the care experience? How much progress has been made in preparing the field for the paradigm shift? What are the hallmarks of successful partnerships among care executives and research leaders? What are the priorities in advancing executive leadership to the next level for continuously learning health and health care?

As a result of a collaboration between the National Academy of Medicine (NAM) and the Office of the National Coordinator for Health Information Technology, this NAM Special Publication summarizes and builds on a meeting series in which a multi-stakeholder group of experts discussed the potential of clinical decision support (CDS) to transform care delivery by ameliorating the burden that expanding clinical knowledge and care and choice complexity place on the finite time and attention of clinicians, patients, and members of the care team. This summary also includes highlights from discussions to address the barriers to realizing the full benefits of CDS-facilitated value improvement. Optimizing Strategies for Clinical Decision Support identifies the need for a continuously learning health system driven by the seamless and rapid generation, processing, and practical application of the best available evidence for clinical decision making and lays out a series of actionable collaborative next steps to optimize strategies for adoption and use of CDS.

There is no question that opioid use disorder has become the fastest growing, serious, and far-reaching public health crisis facing our nation today. The growing and unprecedented opioid epidemic is a critical issue for public health and medical care throughout the country. Provisional estimates suggest that nearly 65,000 Americans died from a drug overdose in 2016, a 21% increase from the previous year and at a level higher than occurred during the peak years for deaths from HIV infection and automobile fatalities. Nearly half of opioid overdose deaths are related to medications obtained legally by prescription, sparking deep concern among leaders in the health care sector. The need is clear for clinicians, as the "gatekeepers" of opioid prescriptions, and as the front line in facilitating access to treatment for addiction, to work together with state and community leaders to reduce the impact of opioid misuse on American communities. At the request of the National Governors Association, the National Academy of Medicine convened a group of experts and field leaders to explore clinicians' roles in addressing opioid misuse and addiction. The resulting Special Publication is informed by, and builds on, initiatives and guidelines that have been stewarded by various stakeholder organizations providing leadership in addressing these issues. In the midst of evolving understanding of and experience in pain management and substance abuse, the authors offer to clinicians a set of axioms applicable both to responsible, appropriate opioid prescribing practices, and to recognition and treatment of substance use disorder. Also underscored are actions that clinicians can take to improve their skills and effectiveness in the face of the growing need, including leadership engagement to ensure that communities have the resources and tools that clinicians require to fulfill their responsibilities.

Social factors, signals, and biases shape the health of our nation. Racism and poverty manifest in unequal social, environmental, and economic conditions, resulting in deep-rooted health disparities that carry over from generation to generation. In Perspectives on Health Equity and Social Determinants of Health, authors call for collective action across sectors to reverse the debilitating and often lethal consequences of health inequity. This edited volume of discussion papers provides recommendations to advance the agenda to promote health equity for all. Organized by research approaches and policy implications, systems that perpetuate or ameliorate health disparities, and specific examples of ways in which health disparities manifest in communities of color, this Special Publication provides a stark look at how health and well-being are nurtured, protected, and preserved where people live, learn, work, and play. All of our nation's institutions have important roles to play even if they do not think of their purpose as fundamentally linked to health and well-being. The rich discussions found throughout Perspectives on Health Equity and Social Determinants of Health make way for the translation of policies and actions to improve health and health equity for all citizens of our society. The major health problems of our time cannot be solved by health care alone. They cannot be solved by public health alone. Collective action is needed, and it is needed now.

To advance insights and perspectives on how to better manage the care of the high-need patient population, the National Academy of Medicine, with guidance from an expert planning committee, was tasked with convening three workshops held between July 2015 and October 2016. The resulting special publication, Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health, summarizes the presentations, discussions, and relevant literature.

The National Academies National Cancer Policy Forum hosted a Summer 2022 workshop to explore the current state of knowledge regarding risk factors for cancer and best practices for cancer prevention and risk reduction interventions. Speakers reviewed the current evidence base, examined best practices and innovative approaches for clinic- and population-based cancer prevention, and discussed strategies to promote effective communication about cancer prevention. This Proceedings of a Workshop summarizes the discussions held during the workshop. This workshop is the second in a series examining policy issues in cancer prevention and cancer screening. The first workshop, which took place in 2020, focused on advancing the development and implementation of effective, high-quality cancer screening.