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Carbon materials pervade many aspects of modern life, from fuels and building materials to consumer goods and commodity chemicals. Reaching net-zero emissions will require replacing existing fossil-carbon-based systems with circular-carbon economies that transform wastes like CO2 into useful materials. This report evaluates market opportunities and infrastructure needs to help decision makers better understand how carbon dioxide utilization can contribute to a net-zero emissions future.

The National Academies Roundtable on Quality Care for People with Serious Illness, National Cancer Policy Forum, and Forum on Aging, Disability and Independence hosted a workshop that examined opportunities to better support family caregiving for people with cancer or other serious illnesses. This workshop built upon previous work, including the 2016 consensus report Families Caring for an Aging America. This Proceedings of a Workshop summarizes the discussions held during the workshop, which focused on: strategies to better capture, understand, and act on family caregiver input and experience; research gaps and opportunities to guide caregiving for patients with serious illnesses; potential policy and practice opportunities to advance family-centered care for serious illness; and opportunities to embed a health equity focus across family caregiving research, policy, and practice.

The United States has deployed commercial nuclear power since the 1950s, and as of 2021, nuclear power accounts for approximately 20 percent of U.S. electricity generation. The current commercial nuclear fleet consists entirely of thermal-spectrum, light water reactors operating with low-enriched uranium dioxide fuel in a once-through fuel cycle. In recent years, the U.S. Congress, U.S. Department of Energy, and private sector have expressed considerable interest in developing and deploying advanced nuclear reactors to augment, and possibly replace, the U.S. operating fleet of reactors, nearly all of which will reach the end of their currently licensed operating lives by 2050. Much of this interest stems from the potential ability of advanced reactors and their associated fuel cycles - as claimed by their designers and developers - to provide a number of advantages, such as improvements in economic competitiveness, reductions in environmental impact via better natural resource utilization and/or lower waste generation, and enhancements in nuclear safety and proliferation resistance. At the request of Congress, this report explores merits and viability of different nuclear fuel cycles, including fuel cycles that may use reprocessing, for both existing and advanced reactor technologies; and waste management (including transportation, storage, and disposal options) for advanced reactors, and in particular, the potential impact of advanced reactors and their fuel cycles on waste generation and disposal.

Implementation science bridges the gap between research and medical practice, investigating aspects of practice and pedagogy that make the strategies successful for future use. By introducing and training leaders, faculty, and health workforce researchers in implementation science, health professions education institutions can build capacity for evidence-based practices. The National Academies Global Forum on Innovation in Health Professional Education held a workshop series to introduce the concept of implementation science to health professional educators to consider its potential use in the classroom. Speakers provided a foundation for discussion of the role of implementation science in health professions education and provided methods for educators interested in applying these recommendations to scale. This Proceedings of a Workshop highlights the presentations and discussions that occurred at the workshop.

The U.S. Department of State, through its Bureau of International Narcotics and Law Enforcement Affairs (INL), provides foreign assistance and supports capacity building for criminal justice systems and police organizations in approximately 90 countries around the world. It has a mandate to strengthen fragile states, support democratic transitions, and stabilize conflict-affected societies by helping partner countries develop effective and accountable criminal justice sector institutions and systems. At the request of INL, the National Academies of Sciences, Engineering, and Medicine assembled the Committee on Evidence to Advance Reform in the Global Security and Justice Sectors to review the available research evidence on police and policing practices, with emphasis on how police reform can promote the rule of law and protect the public. The 5 consensus studies that are part of this project provide evidence-driven policy and research recommendations for key stakeholders with the goal of informing capacity-building activities. This report is a compilation of those 5 studies.

The history of the U.S. criminal justice system is marked by racial inequality and sustained by present day policy. Large racial and ethnic disparities exist across the several stages of criminal legal processing, including in arrests, pre-trial detention, and sentencing and incarceration, among others, with Black, Latino, and Native Americans experiencing worse outcomes. The historical legacy of racial exclusion and structural inequalities form the social context for racial inequalities in crime and criminal justice. Racial inequality can drive disparities in crime, victimization, and system involvement.Reducing Racial Inequality in Crime and Justice: Science, Practice, and Policy synthesizes the evidence on community-based solutions, noncriminal policy interventions, and criminal justice reforms, charting a path toward the reduction of racial inequalities by minimizing harm in ways that also improve community safety. Reversing the effects of structural racism and severing the close connections between racial inequality, criminal harms such as violence, and criminal justice involvement will involve fostering local innovation and evaluation, and coordinating local initiatives with state and federal leadership.This report also highlights the challenge of creating an accurate, national picture of racial inequality in crime and justice: there is a lack of consistent, reliable data, as well as data transparency and accountability. While the available data points toward trends that Black, Latino, and Native American individuals are overrepresented in the criminal justice system and given more severe punishments compared to White individuals, opportunities for improving research should be explored to better inform decision-making.

In response to a request from Congress, the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine conducted a study comparing the process to develop the Dietary Guidelines for Americans, 2020-2025 (DGA 2020-2025) to recommendations included in the previously published National Academies report, Redesigning the Process for Establishing the Dietary Guidelines for Americans. This report describes the findings of the committee and conclusions related to this assessment. Notably, this report does not evaluate the merits of the DGA 2020-2025 but evaluates the process by which they were created relative to the recommendations made in the previously published National Academies report.

Steel is a common component of U.S. infrastructure, but that steel can corrode when buried in soil, rock, or fill. Steel corrosion is estimated to cost the United States 3-4 percent of its gross domestic product every year, and it can lead to infrastructure failure, loss of lives, property, disruption of energy and transportation systems, and damage to the environment. Although the mechanisms of steel corrosion are well understood, limited data on subsurface corrosion and the inability to measure corrosivity directly make accurate corrosion prediction through modeling a challenge. When hazardous levels of corrosion does occur, it is difficult to determine whether the cause was related to site selection, engineering decisions, changes in subsurface conditions, or a combination of these factors. This report explores the state of knowledge and technical issues regarding the corrosion of steel used for earth applications (e.g., for ground stabilization, pipelines, and infrastructure foundations) in unconsolidated earth or rock in different geologic settings. The report summarizes mechanisms of steel corrosion, assesses the state of practice for characterizing factors in the subsurface environment that influence corrosion and corrosion rates, and assesses the efficacy and uncertainties associated with quantitative, field, and laboratory methods for predicting corrosion. The industries and experts most involved with managing buried steel should collaborate to improve multidisciplinary understanding of the processes that drive buried steel corrosion. Developing a common lexicon related to buried steel corrosion, generating new data on corrosion through collaborative long-term experiments, sharing and managing data, and developing new data analytical techniques to inform infrastructure design, construction, and management decisions are key. Industries, experts, and regulators should collaboratively develop decision support systems that guide site characterization and help manage risk. These systems and new data should undergird a common clearinghouse for data on corrosion of buried steel, which will ultimately inform better and more efficient management of buried steel infrastructure, and protect safety and the environment.

The Materials Genome Initiative (MGI) was launched in 2011 by the White House Office of Science and Technology Policy to help accelerate the design, discovery, development and deployment of advanced materials and to reduce costs through the integration of advanced computation and data management with experimental synthesis and characterization. A broad range of federal agencies - including the National Science Foundation (NSF), the Department of Energy, and the Department of Defense - are part of the MGI effort and have invested more than $1 billion in resources and infrastructure accumulative since the start. The efforts of NSF have been focused largely within the Designing Materials to Revolutionize and Engineer Our Future (DMREF) program, which supports the development of fundamental science, computational and experimental tools for generating and managing data, and workforce that enable industry and other government agencies to develop and deploy materials that meet societal needs and national priorities. At the request of NSF, this report evaluates the goals, progress, and scientific accomplishments of the DMREF program within the context of similar efforts both within the United States and abroad. The recommendations of this report will assist NSF as it continues to increase its engagement with industry and federal agencies to transition the results from fundamental science efforts to reach the MGI goal of deploying advanced materials at least twice as fast as possible today, at a fraction of the cost that meet national priorities.

Dietary assessment in older adults presents many unique problems due to the diversity of health states and capabilities that span the population group. Little is known about dietary intakes, body composition, and nutritional status among individuals 75 and older. The National Academies Food and Nutrition Board hosted a virtual workshop series in spring 2022 intended to provide guidance to researchers and clinicians. The workshops aimed to outline considerations relating to different methods of assessing intakes of food and dietary supplements in older adults. The covered topics included current status of dietary and nutrition assessment of older adults and advances and key issues in this topic; nutritional screening of older adults; and nutritional practices, challenges, and policies that affect older adults. This Proceedings highlights presentations and discussions from the workshops.

Virginia was one of the first major gold-producing states in the U.S., but it has seen only limited and intermittent gold mining activity in the last 70 years. Recent increase in gold prices and other factors have brought renewed attention to mining gold at both new and historical sites in Virginia. This report provides an evaluation of the gold deposits in Virginia, the probable modern mining techniques that could be used at such deposits, and whether existing regulations in the Commonwealth are sufficient to protect air and water quality and human health from potential impacts of gold mining activities. The report concludes that the regulatory framework of Virginia appears to have been designed for operations like crushed stone quarrying and sand and gravel operations, not gold mining. Thus, the current regulatory framework is not adequate to address the potential impacts of commercial gold mining and lacks an adequate financial assurance system, which poses a fiscal and environmental risk to the Commonwealth. Additionally, Virginia lacks opportunities for the public to be engaged in permitting processes and a modern system for review of environmental impacts from potential gold mining projects.

While significant progress has been seen in fields such as cardiovascular medicine and cancer in improving patient stratification and developing targeted drugs based on genetic findings, progress continues to lag for neuropsychiatric disorders. To address this issue, the National Academies of Sciences, Engineering, and Medicine's Forum on Neuroscience and Nervous System Disorders convened a workshop in October 2021. The workshop brought together government, philanthropic foundations, and disease-focused non--profit organizations to discuss new genetic and neuroscience technologies and explore how they can be used to elucidate disease mechanisms and to advance the development of biomarkers and targeted therapies for people with neurological and psychiatric disorders. This Proceedings of a Workshop summarizes the presentations and discussions of the workshop.

Patient-centered outcomes research (PCOR) studies consider the questions and outcomes that are meaningful to patients to compare the effectiveness of different prevention, diagnostic, and treatment options. PCOR also increases patient involvement in their care by providing them an opportunity to evaluate the quality, outcomes, and effectiveness of health care treatments and intervention, especially in areas where there is poor existing clinical evidence. The National Academies of Sciences, Engineering, and Medicine Board on Healthcare Services hosted a series of public workshops to explore ways of accelerating the use of PCOR findings in clinical practice to improve health and health care. Workshop discussions touched on the role of community health workers in helping care providers see and understand the whole picture of patient lives, the need for community engagement to ensure research is conducted and applied to practice equitably, and ways of measuring the impact of efforts to disseminate and implement new practices based on PCOR. This report summarizes the discussions that took place at these workshops.

Beginning with the 1990-1991 Gulf War, more than 3.7 million U.S. service members have been deployed to Southwest Asia, where they have been exposed to a number of airborne hazards, including oil-well fire smoke, emissions from open burn pits, dust and sand, diesel exhaust, and poor-quality ambient air. Many service members, particularly those who served in Iraq and Afghanistan, have reported health problems they attribute to their exposure to emissions from open-air burn pits on military installations. In 2013, Congress directed the Department of Veterans Affairs (VA) to establish and maintain the Airborne Hazards and Open Burn Pit (AH&OBP) Registry to "ascertain and monitor" the health effects of such exposures. This report serves as a follow-up to an initial assessment of the AH&OBP Registry completed by an independent committee of the National Academies in 2017. This reassessment does not include any strength-of-the-evidence assessments of potential relationships between exposures to burn pits or airborne hazards and health effects. Rather, this report assesses the ability of the registry to fulfill the intended purposes that Congress and VA have specified for it.

In mid-2022, the United States has lost more than 1 million people to the COVID-19 pandemic. We have been real-time witnesses to scores of heroic responses to the disease, death, inequity, and economic strife unleashed by the virus, but have also experienced the consequences of poor pandemic preparedness and long-standing structural failures in our health system. For decades, the U.S. health system has fallen far short of its potential to support and improve individual and population health. The COVID-19 pandemic has presented death and devastation--but also an unprecedented opportunity to truly transform U.S. health, health care, and health delivery. To capitalize on this opportunity, the National Academy of Medicine gathered field leaders from across all of the major health system sectors to assess how each sector has responded to the pandemic and the opportunities that exist for health system transformation. The opportunity is now to capitalize on the hard-won lessons of COVID-19 and build a health care system that centers patients, families, and communities; cares for clinicians; supports care systems, public health, and biomedical research to perform at the best of their abilities; applies innovations from digital health and quality, safety, and standards organizations; and encourages health care payers and health product manufacturers and innovators to produce products that benefit all.

As part of its responsibilities under the Clean Air Act, the U.S. Environmental Protection Agency sets National Ambient Air Quality Standards (NAAQS) for the air pollutants carbon monoxide, lead, oxides of nitrogen, particulate matter, ozone, and sulfur dioxide. EPA uses a "weight of evidence approach" to evaluate evidence from scientific studies and describe the causal relationships between these "criteria pollutants" and any adverse impacts on human health and on public welfare - including impacts on wildlife, water, forests, agriculture, and climate. The evaluation, called an Integrated Science Assessment, is used to inform standards setting associated with the criteria pollutants. This report, produced at the request of EPA, describes EPAs and several other frameworks for inferring causality of health or welfare effects and the characteristics of evidence useful for forming a causal determination. The report concludes that EPAs causal framework is effective, reliable, and scientifically defensible, provided that key scientific questions are identified and a range of necessary expertise is engaged. More transparency in how EPA integrates evidence could improve confidence in their determinations, and more guidance is needed in the framework on how evidence should be examined for vulnerable groups (e.g., human sub-populations) and sensitive ecosystems or species.

"Transportation is the largest source of greenhouse gas emissions in the United States, with petroleum accounting for 90 percent of transportation fuels. Policymakers encounter a range of questions as they consider low-carbon fuel standards to reduce emissions, including total emissions released from production to use of a fuel or the potential consequences of a policy. Life-cycle assessment is an essential tool for addressing these questions. This report provides researchers and practitioners with a toolkit for applying life-cycle assessment to estimate greenhouse gas emissions, including identification of the best approach to use for a stated policy goal, how to reduce uncertainty and variability through verification and certification, and the core assumptions that can be applied to various fuel types. Policymakers should still use a tailored approach for each fuel type, given that petroleum-based ground, air, and marine transportation fuels necessitate different considerations than alternative fuels including biofuels, hydrogen, and electricity. Ultimately, life-cycle assessments should clearly document what assumptions and methods are used to ensure transparency."--

"Climate change, driven by increases in human-produced greenhouse gases and particles (collectively referred to as GHGs), is the most serious environmental issue facing society. The need to reduce GHGs has become urgent as heat waves, heavy rain events, and other impacts of climate change have become more frequent and severe. Since the Paris Agreement was adopted in 2015, more than 136 countries, accounting for about 80% of total global GHG emissions, have committed to achieving net-zero emissions by 2050. A growing number of cities, regional governments, and industries have also made pledges to reduce emissions. Providing decision makers with useful, accurate, and trusted GHG emissions information is a crucial part of this effort. This report examines existing and emerging approaches used to generate and evaluate GHG emissions information at global to local scales. The report develops a framework for evaluating GHG emissions information to support and guide policy makers about its use in decision making. The framework identifies six criteria or pillars that can be used to evaluate and improve GHG emissions information: usability and timeliness, information transparency, evaluation and validation, completeness, inclusivity, and communication. The report recommends creating a coordinated repository or clearinghouse to operationalize the six pillars, for example, by providing timely, transparent, traceable information; standardized data formats; and governance mechanisms that are coordinated, trusted, and inclusive of the global community."--Publisher's website.

Oil and natural gas represent more than 50 percent of the worldwide energy supply, with high energy demand driven by population growth and improving standards of living. Despite significant progress in reducing the amount of oil in the sea from consumption, exploration, transportation, and production, risks remain. This report, the fourth in a series, documents the current state-of-knowledge on inputs, fates and effects of oil in the sea, reflecting almost 20 additional years of research, including long-term effects from spills such as the Exxon Valdez and a decade-long boom in oil spill science research following the Deepwater Horizon oil spill. The report finds that land-based sources of oil are the biggest input of oil to the sea, far outweighing other sources, and it also notes that the effects of chronic inputs on the marine environment, such as land-based runoff, are very different than that from an acute input, such as a spill. Steps to prevent chronic land-based oil inputs include reducing gasoline vehicle usage, improving fuel efficiency, increasing usage of electric vehicles, replacing older vehicles. The report identifies research gaps and provides specific recommendations aimed at preventing future accidental spills and ensuring oil spill responders are equipped with the best response tools and information to limit oil's impact on the marine environment.

Historically, the U.S. national data infrastructure has relied on the operations of the federal statistical system and the data assets that it holds. Throughout the 20th century, federal statistical agencies aggregated survey responses of households and businesses to produce information about the nation and diverse subpopulations. The statistics created from such surveys provide most of what people know about the well-being of society, including health, education, employment, safety, housing, and food security. The surveys also contribute to an infrastructure for empirical social- and economic-sciences research. Research using survey-response data, with strict privacy protections, led to important discoveries about the causes and consequences of important societal challenges and also informed policymakers. Like other infrastructure, people can easily take these essential statistics for granted. Only when they are threatened do people recognize the need to protect them. Toward a 21st Century National Data Infrastructure: Mobilizing Information for the Common Good develops a vision for a new data infrastructure for national statistics and social and economic research in the 21st century. This report describes how the country can improve the statistical information so critical to shaping the nation's future, by mobilizing data assets and blending them with existing survey data.

Encryption is a process for making information unreadable by an adversary who does not possess a specific key that is required to make the encrypted information readable. The inverse process, making information that has been encrypted readable, is referred to as decryption. Cryptography has become widespread and is used by private as well as governmental actors. It also enables authentication and underlies the safe use of the Internet and computer systems by individuals and organizations worldwide. Emerging cryptographic technologies offer capabilities such as the ability to process encrypted information without first decrypting it. At the request of the Office of the Director of National Intelligence, this report identifies potential scenarios that would describe the balance between encryption and decryption over the next 10 to 20 years and assesses the national security and intelligence implications of each scenario. For each of these scenarios, Cryptography and the Intelligence Community identifies risks, opportunities, and actions. Attention to the findings should enable the Intelligence Community to prepare for the future and to recognize emerging trends and developments and respond appropriately.

Wildfires in America are becoming larger, more frequent, and more destructive, driven by climate change and existing land management practices. Many of these fires occur at the wildland-urban interface (WUI), areas where development and wildland areas overlap and which are increasingly at risk of devastating fires as communities continue to expand into previously undeveloped areas. Unlike conventional wildfires, WUI fires are driven in part by burning of homes, cars, and other human-made structures, and in part by burning vegetation. The interaction of these two types of fires can lead to public health effects that are unique to WUI fires. This report evaluates existing and needed chemistry information that decision-makers can use to mitigate WUI fires and their potential health impacts. It describes key fuels of concern in WUI fires, especially household components like siding, insulation, and plastic, examines key pathways for exposure, including inhalation and ingestion, and identifies communities vulnerable to exposures. The report recommends a research agenda to inform response to and prevention of WUI fires, outlining needs in characterizing fuels, and predicting emissions and toxicants.

This report reviews Federal Communications Commission order FCC 20-48, which authorized Ligado Networks LLC to operate a low-power terrestrial radio network adjacent to the Global Positioning System (GPS) frequency band. It considers how best to evaluate harmful interference to civilian and defense users of GPS, the potential for harmful interference to GPS users and DOD activities, and the effectiveness and feasibility of the mitigation measures proposed in the FCC order.

The U.S. space science community includes thousands of scientists across multiple disciplines that influence and are influenced by the many engineers, technicians, and support personnel that are part of the space research enterprise. Over one-third of NASA's budget is devoted to space science, and the agency currently operates over 50 space missions in the fields of astrophysics, Earth science, solar and space physics, planetary science, and the biological and physical sciences. The strength of NASA science lies with its people, both those who work directly for the agency and the thousands of researchers and professionals who are funded by NASA grants and contracts. At the request of NASA, this report examines the foundation for healthy and vital research communities. Foundations of a Healthy and Vital Research Community for NASA Science identifies the characteristics of a healthy and vital research community, defines implementable measures for assessing the health and vitality of a research community, describes the types of data that NASA should be collecting to enable future assessments of the health and vitality of the scientific work force, and recommends best practices to improve the health and vitality of NASA's research communities.

In recent decades, production processes of intermediate and final products have been increasingly fragmented across countries in what are called global value chains (GVCs). GVCs may involve companies in one country outsourcing stages of production to unrelated entities in other countries, multinational enterprises (MNEs) offshoring stages of production to units of the MNE overseas, or both. GVCs can also involve completely independent companies merely sourcing their parts from whichever upstream company may be the most competitive, with no control arrangement necessarily involved. The changing global trade environment and the changes in firms' behavior have raised new and more complicated issues for policy makers and have made it difficult for them to understand the extent and operations of GVCs and their spillover effects on national and local economies. To improve the understanding, measurement, and valuation of GVCs, the Innovation Policy Forum at the National Academies of Sciences, Engineering, and Medicine convened a workshop, "Innovation, Global Value Chains, and Globalization Measurement" May 5-7, 2021. This proceedings has been prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop.

This is the twenty-fourth volume in the Memorial Tributes series compiled by the National Academy of Engineering as a personal remembrance of the lives and outstanding achievements of its members and international members. These volumes are intended to stand as an enduring record of the many contributions of engineers and engineering to the benefit of humankind. In most cases, the authors of the tributes are contemporaries or colleagues who have personal knowledge of the interests and engineering accomplishments of the deceased.

The National Academies of Sciences, Engineering, and Medicine's Roundtable on Obesity Solutions convened a three-part workshop series that explored how structural racism, weight bias and stigma, and health communication intersect with obesity, gaps in the evidence base, and challenges and opportunities for long-term, systems-wide strategies needed to reduce the incidence and prevalence of obesity. Through diverse examples across different levels and sectors of society, the workshops explored how to leverage the connections between these three drivers and innovative data-driven and policy approaches to inform actionable priorities for individuals, organizations, and policymakers to make lasting systems change.

The U.S. Equal Employment Opportunity Commission (EEOC) expanded EEO-1 data collection for reporting years 2017 to 2018 in an effort to improve its ability to investigate and address pay disparities between women and men and between different racial and ethnic groups. These pay disparities are well documented in national statistics. For example, the U.S. Census Bureau (2021) found that Black and Hispanic women earned only 63 percent and 55 percent as much, respectively, of what non-Hispanic White men earned. Evaluation of Compensation Data Collected Through the EEO-1 Form examines the quality of pay data collected using the EEO-1 form and provides recommendations for future data collection efforts. The report finds that there is value in the expanded EEO-1 data, which are unique among federal surveys by providing employee pay, occupation, and demographic data at the employer level. Nonetheless, both short-term and longer-term improvements are recommended to address significant concerns in employer coverage, conceptual definitions, data measurement, and collection protocols. If implemented, these recommendations could improve the breadth and strength of EEOC data for addressing pay equity, potentially reduce employer burden, and better support employer self-assessment.

Involvement with the juvenile justice system can impact young people's physical and mental health and well-being throughout their lives, as well as the health and well-being of their families and communities. Youth of color are more likely to become involved with the juvenile justice system, and suffer worse outcomes in sentencing, during incarceration, and after release. The National Academies of Sciences, Engineering, and Medicine's Roundtable on the Promotion of Health Equity convened a workshop to discuss the impact that juvenile justice system involvement has on the health and well-being of adolescents, families, and communities of color; examine policies that are successful in improving outcomes; and explore what needs to be done to improve all aspects of encounters with the juvenile justice system. The workshop suggested pursuing alternatives to traditional juvenile justice systems that would allow adolescents to stay in their communities rather than in detention, responding to behavioral problems in youth with interventions that promote health and positive development rather than punishment, and tailoring interventions and programming to participants' cultural background and gender identity. This report summarizes the proceedings of the workshop.

In thousands of communities across the United States, drinking water is contaminated with chemicals known as perfluoroalkyl and polyfluoroalkyl substances (PFAS). PFAS are used in a wide range of products, such as non-stick cookware, water and stain repellent fabrics, and fire-fighting foam, because they have properties that repel oil and water, reduce friction, and resist temperature changes. PFAS can leak into the environment where they are made, used, disposed of, or spilled. PFAS exposure has been linked to a number of adverse health effects including certain cancers, thyroid dysfunction, changes in cholesterol, and small reductions in birth weight. This report recommends that the Centers for Disease Control and Prevention (CDC) update its clinical guidance to advise clinicians to offer PFAS blood testing to patients who are likely to have a history of elevated exposure, such as those with occupational exposures or those who live in areas known to be contaminated. If testing reveals PFAS levels associated with an increased risk of adverse effects, patients should receive regular screenings and monitoring for these and other health impacts. Guidance on PFAS Exposure, Testing, and Clinical Follow-Up recommends that the CDC, Agency for Toxic Substances and Disease Registry (ATSDR), and public health departments support clinicians by creating educational materials on PFAS exposure, potential health effects, the limitations of testing, and the benefits and harms of testing.