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The Federal Aviation Administration (FAA) has overseen significant upgrades to the technology used to manage aviation operations to increase the safety and efficiency of the National Airspace System (NAS). Though necessary to regular operations, these modern computing and communications systems provide a greater attack surface for criminals, terrorists, or nation-states to exploit and thereby increase the potential for cybersecurity threats to the NAS and its constituents. The future safety and security of air travel will rely in part on the ability of the FAA to build a workforce capable of addressing the evolving cybersecurity threat landscape. Securing the computers, networks, and data that underpin modern aviation depends in part on the FAA having enough cybersecurity professionals (capacity) with the right knowledge, skills, and abilities (capability)). It also depends on the FAA's workforce having sufficient diversity of backgrounds and experience. Such diversity is critical in analyzing cybersecurity problems and widely understood to be a "functional imperative" for effective cybersecurity programs. At the request of Congress, the publication examines the FAA's cybersecurity workforce challenges, reviews the current strategy for meeting those challenges, and recommends ways to strengthen the FAA's cybersecurity workforce.

"Roundtable on Black Men and Black Women in Science, Engineering, and Medicine. Health and Medicine Division. Policy and Global Affairs, The National Academis of Sciences, Engineering, Medicine."

"The COVID-19 pandemic is transforming the global economy and significantly shifting workforce demand, requiring quick, adaptive responses. The pandemic has revealed the vulnerabilities of many organizations and regional economies, and it has accelerated trends that could lead to significant improvements in productivity, performance, and resilience, which will enable organizations and regions to thrive in the "next normal." To explore how communities around the United States are addressing workforce issues laid bare by the COVID-19 pandemic and how they are taking advantage of local opportunities to expand their science, technology, engineering, mathematics, and medicine (STEMM) workforces to position them for success going forward, the Board of Higher Education and Workforce of the National Academies of Sciences, Engineering, and Medicine convened a series of workshops to identify immediate and near-term regional STEMM workforce needs in the wake of the COVID-19 pandemic. The workshop planning committee identified five U.S. cities and their associated metropolitan areas - Birmingham, Alabama; Boston, Massachusetts; Richmond, Virginia; Riverside, California; and Wichita, Kansas - to host workshops highlighting promising practices that communities can use to respond urgently and appropriately to their STEMM workforce needs. A sixth workshop discussed how the lessons learned during the five region-focused workshops could be applied in other communities to meet STEMM workforce needs. This proceedings of a virtual workshop series summarizes the presentations and discussions from the six public workshops that made up the virtual workshop series and highlights the key points raised during the presentations, moderated panel discussions and deliberations, and open discussions among the workshop participants." --

Radioactive Sources: Applications and Alternative Technologies assesses the status of medical, research, sterilization, and other commercial applications of radioactive sources and alternative (nonradioisotopic) technologies in the United States and internationally. Focusing on Category 1, 2, and 3 sources, this report reviews the current state of these sources by application and reviews the current state of existing technologies on the market or under development that are or could be used to replace radioisotopic technologies in those applications. Radioactive Sources will support existing and future activities under the National Nuclear Security Administration Office of Radiological Security program to reduce the use of high-risk radiological materials in commercial applications.--

The effective use of data science - the science and technology of extracting value from data - improves, enhances, and strengthens acquisition decision-making and outcomes. Using data science to support decision making is not new to the defense acquisition community; its use by the acquisition workforce has enabled acquisition and thus defense successes for decades. Still, more consistent and expanded application of data science will continue improving acquisition outcomes, and doing so requires coordinated efforts across the defense acquisition system and its related communities and stakeholders. Central to that effort is the development, growth, and sustainment of data science capabilities across the acquisition workforce. At the request of the Under Secretary of Defense for Acquisition and Sustainment, Empowering the Defense Acquisition Workforce to Improve Mission Outcomes Using Data Science assesses how data science can improve acquisition processes and develops a framework for training and educating the defense acquisition workforce to better exploit the application of data science. This report identifies opportunities where data science can improve acquisition processes, the relevant data science skills and capabilities necessary for the acquisition workforce, and relevant models of data science training and education.

The past century has witnessed remarkable advances in life expectancy in the United States and throughout the world. In 2010, however, progress in life expectancy in the United States began to stall, despite continuing to increase in other high-income countries. Alarmingly, U.S. life expectancy fell between 2014 and 2015 and continued to decline through 2017, the longest sustained decline in life expectancy in a century (since the influenza pandemic of 1918-1919). The recent decline in U.S. life expectancy appears to have been the product of two trends: (1) an increase in mortality among middle-aged and younger adults, defined as those aged 25-64 years (i.e., "working age"), which began in the 1990s for several specific causes of death (e.g., drug- and alcohol-related causes and suicide); and (2) a slowing of declines in working-age mortality due to other causes of death (mainly cardiovascular diseases) after 2010. High and Rising Mortality Rates among Working Age Adults highlights the crisis of rising premature mortality that threatens the future of the nation's families, communities, and national wellbeing. This report identifies the key drivers of increasing death rates and disparities in working-age mortality over the period 1990 to 2017; elucidates modifiable risk factors that could alleviate poor health in the working-age population, as well as widening health inequalities; identifies key knowledge gaps and make recommendations for future research and data collection to fill those gaps; and explores potential policy implications. After a comprehensive analysis of the trends in working-age mortality by age, sex, race/ethnicity, and geography using the most up-to-date data, this report then looks upstream to the macrostructural factors (e.g., public policies, macroeconomic trends, social and economic inequality, technology) and social determinants (e.g., socioeconomic status, environment, social networks) that may affect the health of working-age Americans in multiple ways and through multiple pathways.

At the request of the U.S. Army, the Board on Army Research and Development of the National Academies of Sciences, Engineering, and Medicine conducted a 3-day workshop to explore how the Army can improve its strategic medical infrastructure planning with a view to 2035. The workshop, held July 14-16, 2020, brought together experts and key stakeholders from academia, industry, and government. The Army requires fidelity, consistency, and predictability in planning and managing research, development, test, and evaluation resources for medical infrastructure across all appropriation sources to effectively develop, deliver, and respond to military medical capability needs. In response to the Army's requirement, the workshop was designed to address the components of a sustainable, reinforcing enterprise framework (organizational and fiscal). Presentations and discussions examined roles, responsibilities, and coordinating mechanisms among major stakeholders of battlefield medicine; case studies of comparably complex non-government enterprise solutions; and opportunities to link ends, ways, and means for improvements. This publication summarizes the presentations and discussion of the workshop.

"This report, by a committee of experts, conducts an evaluation of the expected medium- and long-term evolution of the grid. This evaluation focuses on developments that include the emergence of new technologies, planning and operating techniques, grid architecture, and business models."

"The Roundtable on Obesity Solutions of The National Academies of Sciences, Engineering, and Medicine held a virtual workshop on September 16, 2020 titled Using Systems Applications to Inform Obesity Solutions. It explored various systems science approaches (i.e., methodologies and tools) and support structures that could guide future obesity research and action, and featured examples of how these approaches can inform decision making within policy and program areas. Workshop speakers discussed the support structures (e.g., data sources, modeling expertise, training, and partnerships and collaborations) that encourage and engage researchers and decision makers to use systems science approaches to better understand the causes of and solutions to the obesity epidemic. This publication summarizes the presentations and discussions from the workshop." --

The Food Forum of the National Academies of Sciences, Engineering, and Medicine hosted a virtual workshop on July 22-23, 2020 that explored integration of the health, societal, economic, and environmental effects and future needs of the food system. The main objective of the workshop was to understand how to achieve a more sustainable, resilient, equitable, and nourishing food system. The workshop covered a number of topics, including new expectations for the food system within three dimensions of the food system (vulnerabilities, resiliency, and transformation). Discussions also covered global change, access to nutritious food, resiliency in complex dynamic systems and resiliency for the future, and consumption- and production-oriented strategies for transforming the food system. This publication summarizes the presentations and discussions from the workshop.

"At the request of the Deputy Assistant Secretary of the Army for Research and Technology, Powering the U.S. Army of the Future examines the U.S. Army's future power requirements for sustaining a multi-domain operational conflict and considers to what extent emerging power generation and transmission technologies can achieve the Army's operational power requirements in 2035. The study was based on one operational usage case identified by the Army as part of its ongoing efforts in multi-domain operations. The recommendations contained in this report are meant to help inform the Army's investment priorities in technologies to help ensure that the power requirements of the Army's future capability needs are achieved." --

The Roundtable on Population Health Improvement of the National Academies of Sciences, Engineering, and Medicine hosted a public workshop on September 19, 2019 titled Models for Population Health Improvement by Health Care Systems and Partners: Tensions and Promise on the Path Upstream. The term upstream refers to the higher levels of action to improve health. Medical services act downstream (i.e., at the patient level) in improving population health, while such activities as screening and referring to social and human services (e.g., for housing, food assistance) are situated midstream, and the work of changing laws, policies, and regulations (e.g., toward affordable housing, expanding healthy food access) to improve the community conditions for health represents upstream action. The workshop explored the growing attention on population health, from health care delivery and health insurance organizations to the social determinants of health and their individual-level manifestation as health-related social needs, such as patients' needs. The workshop showcased collaborative population health improvement efforts, each of which included one or more health systems. This publication summarizes the presentations and discussions from the workshop.

In 2002, the U.S. Food and Drug Administration (FDA) launched the Pharmaceutical Quality for the 21st Century Initiative to encourage adoption of innovative technologies that would lead to an agile, flexible pharmaceutical manufacturing sector. The goal was to encourage a transition to manufacturing processes and approaches that could produce high-quality drugs reliably without extensive regulatory oversight. Much progress has been made toward that goal as the industry has developed and advanced new technologies, but more progress is required as recent natural disasters and the coronavirus pandemic have revealed vulnerabilities in supply chains and highlighted the need to modernize pharmaceutical manufacturing further. At the request of the FDA Center for Drug Evaluation and Research (CDER), Innovations in Pharmaceutical Manufacturing on the Horizon identifies emerging technologies - such as product technologies, manufacturing processes, control and testing strategies, and platform technologies - that have the potential to advance pharmaceutical quality and modernize pharmaceutical manufacturing for products regulated by CDER. This report describes many innovations to modernize the manufacture of drug substances and drug products, to advance new control approaches, and to develop integrated, flexible, and distributed manufacturing networks within 5-10 years.

"High-quality primary care is the foundation of the health care system. It provides continuous, person-centered, relationship-based care that considers the needs and preferences of individuals, families, and communities. Without access to high-quality primary care, minor health problems can spiral into chronic disease, chronic disease management becomes difficult and uncoordinated, visits to emergency departments increase, preventive care lags, and health care spending soars to unsustainable levels. Unequal access to primary care remains a concern, and the COVID-19 pandemic amplified pervasive economic, mental health, and social health disparities that ubiquitous, high-quality primary care might have reduced. Primary care is the only health care component where an increased supply is associated with better population health and more equitable outcomes. For this reason, primary care is a common good, which makes the strength and quality of the country's primary care services a public concern. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care puts forth an evidence-based plan with actionable objectives and recommendations for implementing high-quality primary care in the United States. The implementation plan of this report balances national needs for scalable solutions while allowing for adaptations to meet local needs." --

Immunization against disease is among the most successful global health efforts of the modern era, and substantial gains in vaccination coverage rates have been achieved worldwide. However, that progress has stagnated in recent years, leaving an estimated 20 million children worldwide either undervaccinated or completely unvaccinated. The determinants of vaccination uptake are complex, mutable, and context specific. A primary driver is vaccine hesitancy - defined as a "delay in acceptance or refusal of vaccines despite availability of vaccination services". The majority of vaccine-hesitant people fall somewhere on a spectrum from vaccine acceptance to vaccine denial. Vaccine uptake is also hampered by socioeconomic or structural barriers to access. On August 17-20, 2020, the Forum on Microbial Threats at the National Academies of Sciences, Engineering, and Medicine held a 4-day virtual workshop titled The Critical Public Health Value of Vaccines: Tackling Issues of Access and Hesitancy. The workshop focused on two main areas (vaccine access and vaccine confidence) and gave particular consideration to health systems, research opportunities, communication strategies, and policies that could be considered to address access, perception, attitudes, and behaviors toward vaccination. This publication summarizes the presentations and discussion of the workshop.

"At the request of Congress, this report presents findings and recommendations related to governance of the U.S. government's monitoring, detection, and verification (MDV) enterprise and offers findings and recommendations related to technical MDV capabilities and research, development, test, and evaluation efforts, focused in particular on the nuclear fuel cycle, nuclear test explosions, and arms control." --

"Advance Care Planning(ACP)has long been a staple of caring for people with serious illness. Over its history, it has been defined in different ways. Clinicians, researchers, patients, and the public have developed a variety of perspectives about the many aspects of ACP, ranging from the definition to the timing, goals, outcomes, and value of ACP. To better understand the challenges and opportunities for ACP, acknowledge and highlight divergent viewpoints, and examine what is empirically known and not known about ACP and its outcomes, the National Academies of Sciences, Engineering, and Medicine's Roundtable on Quality Care for People with Serious Illness hosted a virtual public workshop, Advance Care Planning: Challenges and Opportunities, on October 26 and November 2, 2020. The workshop explored the paradox of ACP, its evidence base, ways to think differently about ACP, and various approaches to making it more effective.This Proceedings of a Workshop summarizes the presentations and discussions from that workshop." --

"A virtual workshop titled Integrating Systems and Sectors Toward Obesity Solutions, held April 6, 2020 (Part I), and June 30, 2020 (Part II), was convened by the Roundtable on Obesity Solutions, Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine. The workshop introduced the concept of complex systems and the field of systems science, and explored systems science approaches to obesity solutions. Speakers provided an overview of systems science theories, approaches, and applications, highlighting examples from within and outside the obesity field. Presentations and discussions examined complex systems in society that have the potential to shape public health and well-being, and considered opportunities for systems change as they relate to obesity solutions. Specifically, the workshop explored factors that can influence obesity - such as (in)equity, relationships, connections, networks, capacity, power dynamics, social determinants, and political will - and how these factors can impact communications and cross-sector collaboration to address obesity. This publication summarizes the presentations and discussion of the workshop." --

"One in five people in the United States had a sexually transmitted infection (STI) on any given day in 2018, totaling nearly 68 million estimated infections. STIs are often asymptomatic (especially in women) and are therefore often undiagnosed and unreported. Untreated STIs can have severe health consequences, including chronic pelvic pain, infertility, miscarriage or newborn death, and increased risk of HIV infection, genital and oral cancers, neurological and rheumatological effects. In light of this, the Centers for Disease Control and Prevention, through the National Association of County and City Health Officials, commissioned the National Academies of Sciences, Engineering, and Medicine to convene a committee to examine the prevention and control of sexually transmitted infections in the United States and provide recommendations for action. In 1997, the Institute of Medicine released a report, The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Although significant scientific advances have been made since that time, many of the problems and barriers described in that report persist today; STIs remain an underfunded and comparatively neglected field of public health practice and research. The committee reviewed the current state of STIs in the United States, and the resulting report, Sexually Transmitted Infections: Advancing a Sexual Health Paradigm, provides advice on future public health programs, policy, and research." --

"Government statistics are widely used to inform decisions by policymakers, program administrators, businesses and other organizations as well as households and the general public. Principles and Practices for a Federal Statistical Agency, Seventh Edition will assist statistical agencies and units, as well as other agencies engaged in statistical activities, to carry out their responsibilities to provide accurate, timely, relevant, and objective information for public and policy use. This report will also inform legislative and executive branch decision makers, data users, and others about the characteristics of statistical agencies that enable them to serve the public good." --

Regenerative medicine products, which are intended to repair or replace damaged cells or tissues in the body, include a range of therapeutic approaches such as cell- and gene-based therapies, engineered tissues, and non-biologic constructs. The current approach to characterizing the quality of a regenerative medicine product and the manufacturing process often involves measuring as many endpoints as possible, but this approach has proved to be inadequate and unsustainable. The Forum on Regenerative Medicine of the National Academies of Sciences, Engineering, and Medicine convened experts across disciplines for a 2-day virtual public workshop to explore systems thinking approaches and how they may be applied to support the identification of relevant quality attributes that can help in the optimization of manufacturing and streamline regulatory processes for regenerative medicine. A broad array of stakeholders, including data scientists, physical scientists, industry researchers, regulatory officials, clinicians, and patient representatives, discussed new advances in data acquisition, data analysis and theoretical frameworks, and how systems approaches can be applied to the development of regenerative medicine products that can address the unmet needs of patients. This publication summarizes the presentation and discussion of the workshop.

Climate change is creating impacts that are widespread and severe for individuals, communities, economies, and ecosystems around the world. While efforts to reduce emissions and adapt to climate impacts are the first line of defense, researchers are exploring other options to reduce warming. Solar geoengineering strategies are designed to cool Earth either by adding small reflective particles to the upper atmosphere, by increasing reflective cloud cover in the lower atmosphere, or by thinning high-altitude clouds that can absorb heat. While such strategies have the potential to reduce global temperatures, they could also introduce an array of unknown or negative consequences. This report concludes that a strategic investment in research is needed to enhance policymakers' understanding of climate response options. The United States should develop a transdisciplinary research program, in collaboration with other nations, to advance understanding of solar geoengineering's technical feasibility and effectiveness, possible impacts on society and the environment, and social dimensions such as public perceptions, political and economic dynamics, and ethical and equity considerations. The program should operate under robust research governance that includes such elements as a research code of conduct, a public registry for research, permitting systems for outdoor experiments, guidance on intellectual property, and inclusive public and stakeholder engagement processes.

Accumulating evidence gathered over the past three decades has demonstrated a biological basis for differences between men and women with respect to clinical features and treatment responses to several neuropsychiatric, neurodevelopmental, and neurodegenerative disorders. Dramatic sex differences have also been identified in the brain transcriptomes of individuals with multiple brain disorders, including depression, posttraumatic stress disorder, and autism. The brain transcriptome includes all of the messenger RNA as well as the non-protein-coding RNA molecules expressed in brain tissue and thus represents gene activity. To explore these sex-based transcriptomic differences further, the National Academies of Sciences, Engineering, and Medicine's Forum on Neuroscience and Nervous System Disorders hosted a workshop on September 23, 2020, titled Sex Differences in Brain Disorders: Emerging Transcriptomic Evidence and Implications for Therapeutic Development. The workshop brought together a broad spectrum of stakeholders to share cutting-edge emerging evidence, discuss challenges, and identify future opportunities and potential directions. This publication summarizes the presentation and discussion of the workshop.

Space Nuclear Propulsion for Human Mars Exploration identifies primary technical and programmatic challenges, merits, and risks for developing and demonstrating space nuclear propulsion technologies of interest to future exploration missions. This report presents key milestones and a top-level development and demonstration roadmap for performance nuclear thermal propulsion and nuclear electric propulsion systems and identifies missions that could be enabled by successful development of each technology.

"Millions of people are living with dementia in the United States and globally. To live well with dementia, people need care, services, and supports that reflect their values and preferences, build on their strengths and abilities, promote well-being, and address needs that evolve as cognitive impairment deepens. Persons living with dementia co-manage their care with or rely on the support of a wide range of care partners and caregivers, including spouses, other family members and friends, and direct care workers in homes or residential care settings. While dementia care has improved since the 1970s, many individuals still lack access to high-quality care and are not living as well as they might. Disadvantaged groups, especially racial and ethnic minorities, still face challenges in access to care, services, and supports, due to deep and persistent inequities. Meeting the Challenge of Caring for Persons Living with Dementia and Their Care Partners and Caregivers: A Way Forward examines the complex body of evidence on dementia care and informs decision making about which interventions are ready to be broadly disseminated and implemented. It also offers a blueprint to guide future research using rigorous, cutting-edge methods that are inclusive, equitable, and yield critical information for real-world implementation, toward the ultimate goal of better supporting persons living with dementia and their care partners and caregivers in living as well as possible." --

To explore various aspects of faculty development, the Global Forum on Innovation in Health Professional Education of the National Academies of Sciences, Engineering, and Medicine held a virtual workshop in August 2020 titled Health Professions Faculty for the Future. At the workshop, presenters provided examples of how educators are using effective teaching strategies and of practices in health professional education. This publication summarizes the presentation and discussion of the workshop.

The U.S. Department of Energy (DOE) and its predecessor agencies have conducted activities to develop atomic energy for civilian and defense purposes since the initiation of the World War II Manhattan Project in 1942. These activities took place at large federal land reservations of hundreds of square miles involving industrial-scale operations, but also at many smaller federal and non-federal sites such as uranium mines, materials processing and manufacturing facilities. The nuclear weapons and energy production activities at these facilities produced large quantities of radioactive and hazardous wastes and resulted in widespread groundwater and soil contamination at these sites. DOE initiated a concerted effort to clean up these sites beginning in the 1980s. Many of these sites have been remediated and are in long-term caretaker status, closed or repurposed for other uses. Review of the Effectiveness and Efficiency of Defense Environmental Cleanup Activities of the Department of Energy's Office of Environmental Management: First Report provides background information on the sites currently assigned to the DOE's Office of Environmental Management that are undergoing cleanup; discusses current practices for management and oversight of the cleanups; offers findings and recommendations on such practices and how progress is measured against them; and considers the contracts under which the cleanups proceed and how these have been and can be structured to include incentives for improved cost and schedule performance.