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"On June 11 and June 12, 2019, the National Academies convened a workshop to explore the growing understanding of how the interplay between humans and microbes affects host physiology and causes noncommunicable diseases. Discussions included an overview of colliding epidemics, emerging research on associations between infectious and noncommunicable diseases, risks posed by chronic diseases to the development and severity of infectious diseases, and the influence of the microbiome. Workshop participants also examined the challenges and opportunities of convergence, the integration of health care delivery models and interventions, potential approaches for research, policy, and practice in the immediate-term, and potential directions for the long-term. This publication summarizes the presentations and discussions from the workshop"--Publisher's description

Medium- and heavy-duty trucks, motor coaches, and transit buses - collectively, "medium- and heavy-duty vehicles", or MHDVs - are used in every sector of the economy. The fuel consumption and greenhouse gas emissions of MHDVs have become a focus of legislative and regulatory action in the past few years. This study is a follow-on to the National Research Council's 2010 report, Technologies and Approaches to Reducing the Fuel Consumption of Medium-and Heavy-Duty Vehicles. That report provided a series of findings and recommendations on the development of regulations for reducing fuel consumption of MHDVs. On September 15, 2011, NHTSA and EPA finalized joint Phase I rules to establish a comprehensive Heavy-Duty National Program to reduce greenhouse gas emissions and fuel consumption for on-road medium- and heavy-duty vehicles. As NHTSA and EPA began working on a second round of standards, the National Academies issued another report, Reducing the Fuel Consumption and Greenhouse Gas Emissions of Medium- and Heavy-Duty Vehicles, Phase Two: First Report, providing recommendations for the Phase II standards. This third and final report focuses on a possible third phase of regulations to be promulgated by these agencies in the next decade.

"Patient-centered, high-quality health care relies on the well-being, health, and safety of health care clinicians. However, alarmingly high rates of clinician burnout in the United States are detrimental to the quality of care being provided, harmful to individuals in the workforce, and costly. It is important to take a systemic approach to address burnout that focuses on the structure, organization, and culture of health care. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being builds upon two groundbreaking reports from the past twenty years, To Err Is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century, which both called attention to the issues around patient safety and quality of care. This report explores the extent, consequences, and contributing factors of clinician burnout and provides a framework for a systems approach to clinician burnout and professional well-being, a research agenda to advance clinician well-being, and recommendations for the field"--

The U.S. Geological Survey (USGS) mission is to provide reliable and impartial scientific information to understand Earth, minimize loss of life and property from natural disasters, and manage water, biological, energy, and mineral resources. Data collection, analysis, interpretation, and dissemination are central to everything the USGS does. Among other activities, the USGS operates some 250 laboratories across the country to analyze physical and biological samples, including water, sediment, rock, plants, invertebrates, fish, and wildlife. The data generated in the laboratories help answer pressing scientific and societal questions or support regulation, resource management, or commercial applications. At the request of the USGS, this study reviews a representative sample of USGS laboratories to examine quality management systems and other approaches for assuring the quality of laboratory results and recommends best practices and procedures for USGS laboratories.

The increasing prevalence and burden of obesity transcends borders, straining populations worldwide. Data shows that 50 million girls, 74 million boys, 390 million women, and 281 million men were estimated to have obesity in 2016 (NCD-RisC, 2017). The National Academies of Sciences, Engineering, and Medicine convened a workshop on October 9, 2018 to address the status of the global obesity pandemic and discuss diverse approaches to manage this problem. Speakers examined the collective prevalence, costs, and drivers of obesity around the world using cross-cultural comparisons. Panels and group discussions emphasized the need to reduce disparities in prevention and treatment efforts and to generate new policy and system initiatives related to nutrition and physical activity worldwide. This publication summarizes the presentations and discussions from the workshop. --

"The Minerva Research Initiative is a Department of Defense (DoD) social science grant program that funds unclassified basic research relevant to national security. The goal of the program is to make use of the intellectual capital of university-based social scientists to inform understanding of issues important to DoD and the broader national security community. Evaluation of the Minerva Research Initiative discusses the program's successes and challenges over its first decade of operation, and highlights ways to strengthen the program's foundations and take advantage of opportunities for broadening its reach and usefulness."--

In 2014, the National Agricultural Statistics Service (NASS) engaged the National Academies of Sciences, Engineering, and Medicine to convene a planning committee to organize a public workshop for an expert open discussion of their then-current livestock models. The models had worked well for some time. Unfortunately beginning in 2013, an epidemic that killed baby pigs broke out in the United States. The epidemic was not fully realized until 2014 and spread to many states. The result was a decline in hog inventories and pork production that was not predicted by the models. NASS delayed the workshop until 2019 while it worked to develop models that could help in times both of equilibrium and shock (disease or disaster), as well as alternative approaches to help detect the onset of a shock. The May 15, 2019, workshop was consistent with NASS' 2014 intention, but with a focus on a model that can help predict hog inventories over time, including during times of shock. This publication summarizes the presentations and discussions from the workshop.--Publishers website

Additive manufacturing (AM) is the process in which a three-dimensional object is built by adding subsequent layers of materials. AM enables novel material compositions and shapes, often without the need for specialized tooling. This technology has the potential to revolutionize how mechanical parts are created, tested, and certified. However, successful real-time AM design requires the integration of complex systems and often necessitates expertise across domains. Simulation-based design approaches, such as those applied in engineering product design and material design, have the potential to improve AM predictive modeling capabilities, particularly when combined with existing knowledge of the underlying mechanics. These predictive models have the potential to reduce the cost of and time for concept-to-final-product development and can be used to supplement experimental tests. The National Academies convened a workshop on October 24-26, 2018 to discuss the frontiers of mechanistic data-driven modeling for AM of metals. Topics of discussion included measuring and modeling process monitoring and control, developing models to represent microstructure evolution, alloy design, and part suitability, modeling phases of process and machine design, and accelerating product and process qualification and certification. These topics then led to the assessment of short-, immediate-, and long-term challenges in AM. This publication summarizes the presentations and discussions from the workshop.

For children and youth, summertime presents a unique break from the traditional structure, resources, and support systems that exist during the school year. For some students, this time involves opportunities to engage in fun and enriching activities and programs, while others face additional challenges as they lose a variety of supports, including healthy meals, medical care, supervision, and structured programs that enhance development. Children that are limited by their social, economic, or physical environments during the summer months are at higher risk for worse academic, health, social and emotional, and safety outcomes. In contrast, structured summertime activities and programs support basic developmental needs and positive outcomes for children and youth who can access and afford these programs. These discrepancies in summertime experiences exacerbate pre-existing academic inequities. While further research is needed regarding the impact of summertime on developmental domains outside of the academic setting, extensive literature exists regarding the impact of summertime on academic development trajectories. However, this knowledge is not sufficiently applied to policy and practice, and it is important to address these inequalities. Shaping Summertime Experiences examines the impact of summertime experiences on the developmental trajectories of school-age children and youth across four areas of well-being, including academic learning, social and emotional development, physical and mental health, and health-promoting and safety behaviors. It also reviews the state of science and available literature regarding the impact of summertime experiences. In addition, this report provides recommendations to improve the experiences of children over the summertime regarding planning, access and equity, and opportunities for further research and data collection.

"On April 23 and 24, 2019 the Forum on Neuroscience and Nervous System Disorders convened a workshop titled "Advancing Gene-Targeted Therapies for Central Nervous System Disorders" in Washington, DC. This public workshop brought together experts and key stakeholders from academia, government, industry, philanthropic foundations, and disease/patient-focused nonprofit organizations to explore approaches for advancing the development of gene-targeted therapies for central nervous system (CNS) disorders, and implications of developing these therapies. Participants explored lessons learned from both successful and unsuccessful clinical development programs; new knowledge about the genetic underpinnings of brain disorders; the current status and future potential of gene-targeted therapies for CNS disorders; challenges and potential solutions for translating preclinical findings to approved therapies; and patient and caregiver perspectives. They also discussed what will be needed to develop these therapies for common disorders such as Alzheimer's and Parkinson's disease, as well as neuropsychiatric and neurodevelopmental disorders such as schizophrenia and autism. The workshop included approaches that target both DNA and RNA, as well as gene products using viral vectors, antisense oligonucleotides, and RNA interference. This publication summarizes the presentations and discussion of the workshop"--Publisher's description

"The oncology careforce faces challenges as population growth in the U.S. contributes to increases in the number of patients diagnosed with cancer. Significant advances in cancer research, screening and diagnostic practices, and treatment have led to the age-adjusted declining mortality rate from cancer. However, as the field continues to develop and advance, cancer care has become more complex than ever before. There is a growing concern regarding the U.S. health care system's capacity to deliver high-quality cancer care to the increasing number of patients. The National Academies convened a workshop on February 11-12, 2019 to explore trends in cancer care and identify opportunities for improvement in the rapidly developing oncology careforce. Discussions at the workshop primarily focused on trends in demographics, the careforce, and oncology practice, as well as implications for the future of cancer care and strategies to improve the organization and delivery of cancer care. Opportunities to change policy and leverage technologies in oncology were also identified. This publication summarizes the presentations and discussions from the workshop"--

"On January 30-31, 2019 the Board on Mathematical Sciences and Analytics, in collaboration with the Board on Energy and Environmental Systems and the Computer Science and Telecommunications Board, convened a workshop in Washington, D.C. to explore the frontiers of mathematics and data science needs for sustainable urban communities. The workshop strengthened the emerging interdisciplinary network of practitioners, business leaders, government officials, nonprofit stakeholders, academics, and policy makers using data, modeling, and simulation for urban and community sustainability, and addressed common challenges that the community faces. Presentations highlighted urban sustainability research efforts and programs under way, including research into air quality, water management, waste disposal, and social equity and discussed promising urban sustainability research questions that improved use of big data, modeling, and simulation can help address. This publication summarizes the presentation and discussion of the workshop"--Publisher's description.

This is the 22nd Volume in the series Memorial Tributes compiled by the National Academy of Engineering as a personal remembrance of the lives and outstanding achievements of its members and foreign associates. 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 had personal knowledge of the interests and the engineering accomplishments of the deceased. Through its members and foreign associates, the Academy carries out the responsibilities for which it was established in 1964. Under the charter of the National Academy of Sciences, the National Academy of Engineering was formed as a parallel organization of outstanding engineers. Members are elected on the basis of significant contributions to engineering theory and practice and to the literature of engineering or on the basis of demonstrated unusual accomplishments in the pioneering of new and developing fields of technology. The National Academies share a responsibility to advise the federal government on matters of science and technology. The expertise and credibility that the National Academy of Engineering brings to that task stem directly from the abilities, interests, and achievements of our members and foreign associates, our colleagues and friends, whose special gifts we remember in this book.

The high rate of incarceration in the United States contributes significantly to the nation's health inequities, extending beyond those who are imprisoned to families, communities, and the entire society. Since the 1970s, there has been a seven-fold increase in incarceration. This increase and the effects of the post-incarceration reentry disproportionately affect low-income families and communities of color. It is critical to examine the criminal justice system through a new lens and explore opportunities for meaningful improvements that will promote health equity in the United States. The National Academies convened a workshop on June 6, 2018 to investigate the connection between incarceration and health inequities to better understand the distributive impact of incarceration on low-income families and communities of color. Topics of discussion focused on the experience of incarceration and reentry, mass incarceration as a public health issue, women's health in jails and prisons, the effects of reentry on the individual and the community, and promising practices and models for reentry. The programs and models that are described in this publication are all Philadelphia-based because Philadelphia has one of the highest rates of incarceration of any major American city. This publication summarizes the presentations and discussions of the workshop.

"The Board on Science Education and the Board on Mathematical Sciences and Analytics of the National Academies of Sciences, Engineering, and Medicine convened the Workshop on Increasing Student Success in Developmental Mathematics on March 18-19, 2019. The Workshop explored how to best support all students in postsecondary mathematics, with particular attention to students who are unsuccessful in developmental mathematics and with an eye toward issues of access to promising reforms and equitable learning environments. The two-day workshop was designed to bring together a variety of stakeholders, including experts who have developed and/or implemented new initiatives to improve the mathematics education experience for students. The overarching goal of the workshop was to take stock of the mathematics education community's progress in this domain. Participants examined the data on students who are well-served by new reform structures in developmental mathematics and discussed various cohorts of students who are not currently well served - those who even with access to reforms do not succeed and those who do not have access to a reform due to differential access constraints. Throughout the workshop, participants also explored promising approaches to bolstering student outcomes in mathematics, focusing especially on research and data that demonstrate the success of these approaches; deliberated and discussed barriers and opportunities for effectively serving all students; and outlined some key directions of inquiry intended to address the prevailing research and data needs in the field. This publication summarizes the presentations and discussion of the workshop"--

Modern geoscience research informs many important decisions and projects, such as geological disaster preparation, natural resource extraction, and global development. This critical research relies on technology and collaboration at state-of-the-art seismological and geodetic facilities. Currently, these facilities provide a wide variety of observation systems that support scientists' understanding of Earth and its changing environmental systems. As emerging technologies develop rapidly, seismological and geodetic facilities have new capabilities and more complex management and research communication systems. This requires a reevaluation of management structures and best practices within these facilities. The National Academies convened a 1.5-day workshop to discuss management models of theoretical seismological and geodetic facilities of the future. Initial discussions built upon a 2015 Incorporated Research Institutions for Seismology community workshop report, which identified current and future capabilities of these research facilities. Management models from other types of scientific facilities were used as a springboard for further discussions about management and decision-making models that could be applied to seismological and geodetic facilities. Workshop participants also emphasized the importance of distributing capabilities among multiple facilities. Lastly, this workshop explored complex management topics in these facilities including instrumentation, user support services, data management, education and outreach, and workforce development capabilities. This publication summarizes the presentations and discussions from the workshop.

"The Centers for Disease Control and Prevention estimates that approximately 40 million people in the United States suffer from a serious illness that limits their daily activities. These illnesses include heart and lung disease, cancer, diabetes, and Alzheimer's disease and other forms of dementia. However, significant disparities exist across different communities in the quality and access to care for these illnesses. Factors such as race, ethnicity, gender, geography, socioeconomic status, or insurance status exacerbate these complex disparities. It is critical to reevaluate the current models of care delivery across diverse communities and vulnerable populations. On April 4, 2019, The National Academies of Sciences, Engineering, and Medicine convened a workshop to investigate barriers, policy initiatives, and opportunities for improving access to and equity of care for people living with a serious illness. Discussions explored the current climate of health care and opportunities to improve access to care using organizational, community, patient and family, and clinician perspectives. This publication summarizes the discussions and presentations from the workshop"--

"Opioid prescriptions for acute and chronic pain increased dramatically from the late 1990s into the current decade in both the civilian and the Department of Veterans Affairs and Department of Defense treatment environments. Similarly, prescriptions for benzodiazepines also increased significantly for anxiety and insomnia. Combinations of opioid and benzodiazepines have proben fatal when taken concurrently, with research demonstrating this phenomenon for nearly 40 years. This issue is exacerbated within the veteran population because of higher rates of pain, anxiety and other related health issues due to military life. An evaluation of the relationship between opioid and benzodiazepine medication practices at the VA is necessary to improve treatment for mental health and combat-related trauma for veterans. An Approach to Evaluate the Effects of Concomitant Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides investigates the effects of opioid initiation and tapering strategies in the presence of benzodiazepines in veterans. This report explores neurobiology and the principles of addiction and tolerance, in addition to the current use of opioids and benzodiazepines for treating pain and anxiety in both the veteran and general population. It also provides a protocol to evaluate the relationship between opioid and benzodiazepine medication practices. This framework is a critical foundation for further research to improve concomitant opioid and benzodiazepine medication practices for veterans and the general population"--

"Healthy mental, emotional, and behavioral (MEB) development is a critical foundation for a productive adulthood. Much is known about strategies to support families and communities in strengthening the MEB development of children and youth, by promoting healthy development and also by preventing and mitigating disorder, so that young people reach adulthood ready to thrive and contribute to society. Over the last decade, a growing body of research has significantly strengthened understanding of healthy MEB development and the factors that influence it, as well as how it can be fostered. Yet, the United States has not taken full advantage of this growing knowledge base. Ten years later, the nation still is not effectively mitigating risks for poor MEB health outcomes; these risks remain prevalent, and available data show no significant reductions in their prevalence. Fostering Healthy Mental, Emotional, and Behavioral Development in Children and Youth: A National Agenda examines the gap between current research and achievable national goals for the next ten years. This report identifies the complexities of childhood influences and highlights the need for a tailored approach when implementing new policies and practices. This report provides a framework for a cohesive, multidisciplinary national approach to improving MEB health"--Publisher's description

Every ten years, the Department of Health and Human Service's Healthy People Initiative develops a new set of science-based, national objectives with the goal of improving the health of all Americans. Defining balanced and comprehensive criteria for healthy people enables the public, programs, and policymakers to gauge our progress and reevaluate efforts towards a healthier society. Criteria for Selecting the Leading Health Indicators for Healthy People 2030 makes recommendations for the development of Leading Health Indicators for the initiative's Healthy People 2030 framework. The authoring committee's assessments inform their recommendations for the Healthy People Federal Interagency Workgroup in their endeavor to develop the latest Leading Health Indicators. The finalized Leading Health Indicators will establish the criteria for healthy Americans and help update policies that will guide decision-marking throughout the next decade. This report also reviews and reflects upon current and past Healthy People materials to identify gaps and new objectives.

"Near Earth objects (NEOs) have the potential to cause significant damage on Earth. In December 2018, an asteroid exploded in the upper atmosphere over the Bering Sea (western Pacific Ocean) with the explosive force of nearly 10 times that of the Hiroshima bomb. While the frequency of NEO impacts rises in inverse proportion to their sizes, it is still critical to monitor NEO activity in order to prepare defenses for these rare but dangerous threats. Currently, NASA funds a network of ground-based telescopes and a single, soon-to-expire space-based asset to detect and track large asteroids that could cause major damage if they struck Earth. This asset is crucial to NEO tracking as thermal-infrared detection and tracking of asteroids can only be accomplished on a space-based platform. Finding Hazardous Asteroids Using Infrared and Visible Wavelength Telescopes explores the advantages and disadvantages of infrared (IR) technology and visible wavelength observations of NEOs. This report reviews the techniques that could be used to obtain NEO sizes from an infrared spectrum and delineate the associated errors in determining the size. It also evaluates the strengths and weaknesses of these techniques and recommends the most valid techniques that give reproducible results with quantifiable errors"--Publisher's description

Accidents and terrorist attacks that lead to the release of radioactive materials can cause deaths, injuries, and a range of psychosocial effects in the surrounding community and team of emergency responders. In the United States, federal, state, and local agencies respond with the necessary resources to address the consequences of nuclear and radiological incidents and monitor the affected population. Following the 2011 Fukushima Daiichi Nuclear Power Plant accident and the 2017 Gotham Shield National Level Exercise, the CDC recognized an opportunity to improve their practices by establishing a more efficient and timely health effect surveillance system before another incident occurs. On March 12-13th, 2019, the National Academies convened a workshop to discuss the process for preparing a radiation registry for monitoring long-term health effects of populations affected by a nuclear or radiological incident. Participants assessed existing information, useful practices, and tools for planning a radiation registry that will enhance incident monitoring and response methods. This publication summarizes the discussions and presentations from the workshop.

"Oral health care and medical health care both seek to maintain and enhance human health and well-being. Yet, dentistry and primary care in the United States are largely separated and isolated from each other. Each has its own siloed systems for education, service delivery, financing, and policy oversight. The result has been duplication of effort, a cultural gap between the two professions, and lost opportunities for productive collaboration and better health. On December 6, 2018, in Washington, DC, the National Academies of Sciences, Engineering, and Medicine held a workshop titled Integrating Oral and General Health Through Health Literacy Practices. This publication summarizes the presentations and discussions from the workshop"--

The Army Research Laboratory (ARL) is the corporate laboratory for the U.S. army, which bridges scientific and military communities. The ARL is critical in maintaining the United States' dominant military power through its advanced research and analysis capabilities. The National Academies of Sciences, Engineering, and Medicine's Army Research Laboratory Technical Assessment Board (ARLTAB) conducts biennial assessments of the scientific and technical quality of the facilities. These assessments are necessary to ensure that the ARL's resources and quality of programs are maximized. 2017-2018 Assessment of the Army Research Laboratory includes findings and recommendations regarding the quality of the ARL's research, development, and analysis programs. The report of the assessment is subdivided by the ARL's Science and Technology campaigns, including Materials Research, Sciences for Lethality and Protection, Information Sciences, Computational Sciences, Sciences for Maneuver, Human Sciences, and Analysis and Assessment. This biennial report summarizes the findings for the 2017-2018 period.

These are proceedings of the second of a two-workshop series. This workshop took place in October 2018. The first workshop took place in February 2018 and was entitled: Improving Cancer Diagnosis and Care: Patient Access to Oncologic Imaging and Pathology Expertise and Technologies.

Education and health care significantly influence well-being and health outcomes, especially throughout adolescence. In fact, doctors note that performance in school is highly reflective of a child's current and future health. Despite knowledge of this connection, pediatricians are rarely aware of their patients' school performance and have a limited understanding of the education system. Fostering collaboration and aligning efforts within the health and education sectors is a critical step towards building stronger and healthier communities. On June 14, 2018, the National Academies convened a workshop to discuss how efforts within the health sector can support children's education from pre-kindergarten through 12th grade and to explore the barriers between these sectors. The committee also examined case examples of health-education collaboration and opportunities in policy. This publication summarizes the presentations and discussions from the workshop.

The National Institutes of Health (NIH) is the primary agency of the United States government responsible for biomedical and public health research. Founded in the late 1870s, NIH has produced extraordinary advances in the treatment of common and rare diseases and leads the world in biomedical research. It is a critical national resource that plays an important role in supporting national security. The 310-acre Bethesda campus supports some 20,000 employees and contractors, and it contains more than 12 million square feet of facilities divided amongst nearly 100 buildings, including the largest dedicated research hospital in the world. The Bethesda campus supports some of the most sophisticated and groundbreaking biomedical research in the world. However, while some new state-of-the-art buildings have been constructed in recent years, essential maintenance for many facilities and the campus overall has been consistently deferred for many years. The deteriorating condition of NIH's built environment is now putting its ability to fulfill its mission at substantial risk. Managing the NIH Bethesda Campus' Capital Assets for Success in a Highly Competitive Global Biomedical Research Environment identifies the facilities in greatest need of repair on the Bethesda campus and evaluates cost estimates to determine what investment is needed for the NIH to successfully accomplish its mission going forward.--

In 1943, as part of the Manhattan Project, the Hanford Nuclear Reservation was established with the mission to produce plutonium for nuclear weapons. During 45 years of operations, the Hanford Site produced about 67 metric tonnes of plutonium--approximately two-thirds of the nation's stockpile. Production processes generated radioactive and other hazardous wastes and resulted in airborne, surface, subsurface, and groundwater contamination. Presently, 177 underground tanks contain collectively about 210 million liters (about 56 million gallons) of waste. The chemically complex and diverse waste is difficult to manage and dispose of safely. Section 3134 of the National Defense Authorization Act for Fiscal Year 2017 calls for a Federally Funded Research and Development Center (FFRDC) to conduct an analysis of approaches for treating the portion of low-activity waste at the Hanford Nuclear Reservation intended for supplemental treatment. The third of four, this report provides an overall assessment of the FFRDC team's final draft report, dated April 5, 2019.

On November 29-30, 2018, in Washington, D.C., the National Academies of Sciences, Engineering, and Medicine held the Workshop on the Continuous Improvement of NASA's Innovation Ecosystem. The workshop was requested by the National Aeronautics and Space Administration (NASA) Office of the Chief Technologist with the goal of identifying actionable and implementable initiatives that could build on NASA's current innovation culture to reach a future state that will ensure the agency's continued success in the evolving aerospace environment. This publication summarizes the presentations and discussions from the workshop.

In January 2019, the National Academies of Sciences, Engineering, and Medicine convened the 2-day Workshop on Resourcing, Workforce Modeling, and Staffing. This workshop is one of several data-gathering sessions to support the committee's iterative study. The overarching goal of the study is to help the Veterans Health Administration (VHA) assess the overall resource needs of its Facilities Management Program and to develop budget and staffing methodologies. Such methodologies can provide better justification for ensuring that local VHA programs are adequately and consistently staffed to accomplish the mission and meet all requirements. This publication summarizes the presentations and discussions from the workshop.