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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.

Regular use of sunscreens has been shown to reduce the risk of sunburn and skin cancer, and slow photoaging of skin. Sunscreens can rinse off into water where people are swimming or wading, and can also enter bodies of water through wastewater such as from bathing or showering. As a result, the ultraviolet (UV) filters - the active ingredients in sunscreens that reduce the amount of UV radiation on skin - have been detected in the water, sediment, and animal tissues in aquatic environments. Because the impact of these filters on aquatic ecosystems is not fully understood, assessment is needed to better understand their environmental impacts. This report calls on the U.S. Environmental Protection Agency to conduct an ecological risk assessment of UV filters to characterize the possible risks to aquatic ecosystems and the species that live in them. EPA should focus on environments more likely to be exposed such as those with heavy recreational use, or where wastewater and urban runoff enter the water. The risk assessment should cover a broad range of species and biological effects and could consider potential interacting effects among UV filters and with other environmental stresses such as climate change. In addition, the report describes the role of sunscreens in preventing skin cancer and what is known about how human health could be affected by potential changes in usage. While the need for a risk assessment is urgent, research is needed to advance understanding of both risks to the environment from UV filters and impacts to human health from changing sunscreen availability and usage.

On May 18-19, 2021, the Condensed Matter and Materials Research Committee of the National Academies of Sciences, Engineering, and Medicine convened a public workshop to examine the frontiers of research on moiré quantum matter. Participants at the workshop discussed the challenges and possibilities that this new material presents. This publication summarizes the presentations and discussion of the workshop.

Methadone is a Food and Drug Administration- (FDA-) approved medication for treating opioid use disorder (OUD), a chronic brain disease that affects more than 2.7 million people in the United States aged 12 and older. Despite its effectiveness in saving lives, many barriers impede access to, initiation of, and retention in methadone treatment for OUD. To address these barriers, on March 3 and 4, 2022, the National Academies of Sciences, Engineering, and Medicine hosted a workshop on "Methadone Treatment for Opioid Use Disorder: Examining Federal Regulations and Laws," at the request of the Office of National Drug Control Policy in the Executive Office of the President. This publication summarizes the presentation and discussion of the workshop.

The United States has a complex system of laws and policies that attempt to regulate the distribution, manufacture, and use of a variety of non-legal drug substances as part of its overall criminal justice system. Laws regarding drug use have disproportionately impacted individuals and communities of color at every step of the journey through the criminal justice system, including arrest, conviction, sentencing, and incarceration. These disparities have clear outcomes for both individual and community health. To examine the effects of drug control policies on the health of individuals and communities of color, the Roundtable on the Promotion of Health Equity held a workshop on October 8, 2018, in Washington, DC. This publication summarizes the presentations and discussions of the workshop.

"Chemistry plays a pivotal role in the strength of the U.S. economy and the advancement of humankind. Chemists' achievements include life-saving pharmaceuticals, advanced energy solutions, improved agricultural productivity, and novel materials used in products from clothing to electronic devices. The many sectors reliant on the U.S. chemical economy account for about 25% of the U.S. GDP and support 4.1 million U.S. jobs. However, a new and evolving chemistry landscape requires changes with regard to funding, training, and a focus on integrating sustainability into manufacturing, product usage, and product disposal. This report identifies strategies and options for research investments that will support U.S. leadership while considering environmental sustainability and developing a diverse chemical economy workforce with equitable opportunities for all chemistry talent. The report recommends that funding agencies and philanthropic organizations who support the chemical sciences fund as large a breadth of fundamental research projects as possible. Chemical industry and their partners at universities, scientific research institutions, and national laboratories should align the objectives of fundamental research to directly assist with new practices toward environmental stewardship, sustainability, and clean energy. Additionally, the report recommends that funding agencies make substantial investment toward education research to enable innovative ways of teaching about emerging concepts, tools and technologies"--

"Heritable disorders of connective tissue (HDCTs) are a diverse group of inherited genetic disorders and subtypes. Because connective tissue is found throughout the body, the impairments associated with HDCTs manifest in multiple body systems and may change or vary in severity throughout an affected individual's lifetime. In some cases, these impairments may be severe enough to qualify an eligible child or adult for monetary benefits through the U.S. Social Security Administration's (SSA's) Social Security Disability Insurance or Supplemental Security Income program. SSA asked the National Academies of Sciences, Engineering, and Medicine to convene an expert committee that would provide current information regarding the diagnosis, treatment, and prognosis of selected HDCTs, including Marfan syndrome and the Ehlers-Danlos syndromes, and the effect of the disorders and their treatment on functioning. The resulting report, Selected Heritable Disorders of Connective Tissue and Disability, presents the committee's findings and conclusions"--

'Long COVID' refers to the wide range of long-lasting symptoms experienced by some patients after a SARS-CoV-2 infection. The most common symptoms include fatigue, headache, brain fog, shortness of breath, hair loss, and pain. At this time, there are many knowledge gaps related to Long COVID, including the prevalence of the condition, the impact of the symptoms on survivors' ability to function, and the long-term course of the condition. While many individuals with Long COVID recover within one year, others experience little or no decrease in symptom severity over time. Long COVID symptoms can affect a person's ability to work and otherwise function in daily life, so people with the condition may need to utilize programs such as Social Security Disability Insurance (SSDI) and the Supplemental Security Income Program (SSI). The Social Security Administration (SSA), which administers both of these programs, requested that the National Academies of Sciences, Engineering, and Medicine host a public workshop to discuss research into the long-term health effects of COVID-19, their impacts on individuals and populations, and how the SSDI and SSI programs can support individuals who suffer disability as a result of Long COVID. This publication summarizes the presentation and discussion of the workshop.

The Forum on Regenerative Medicine of the National Academies of Sciences, Engineering, and Medicine convened a two-day virtual public workshop to address knowledge gaps in the understanding of promising approaches to manipulate the immune system and/or the regenerative medicine product to improve outcomes of tissue repair and regeneration in patients. The workshop, titled Understanding the Role of the Immune System in Improving Tissue Regeneration, explored the role of the immune system in the success or failure of regenerative medicine therapies. Participants considered potential strategies to effectively prepare patients' immune systems to accept regenerative therapies and increase the likelihood of successful clinical outcomes and also discussed risks associated with modulating the immune system. This Proceedings of a Workshop highlights the presentations and discussions that occurred during the workshop.

To examine the potential role of companion animals as sentinels of relevant, shared environmental exposures that may affect human aging and cancer, the National Cancer Policy Forum held a workshop in collaboration with the Forum on Aging, Disability, and Independence and the Standing Committee on the Use of Emerging Science for Environmental Health Decisions to explore this promising and underutilized pathway for research. Presentations and panel discussions covered the current state of the science and pathways for accelerating research, along with opportunities and challenges for using this novel translational approach to exposure science to advance human health. This Proceedings of a Workshop outlines the presentations and discussions that occurred during the workshop.