Bøker utgitt av National Academies Press

"The opioid crisis in the United States has come about because of excessive use of these drugs for both legal and illicit purposes and unprecedented levels of consequent opioid use disorder (OUD). More than 2 million people in the United States are estimated to have OUD, which is caused by prolonged use of prescription opioids, heroin, or other illicit opioids. OUD is a life-threatening condition associated with a 20-fold greater risk of early death due to overdose, infectious diseases, trauma, and suicide. Mortality related to OUD continues to escalate as this public health crisis gathers momentum across the country, with opioid overdoses killing more than 47,000 people in 2017 in the United States. Efforts to date have made no real headway in stemming this crisis, in large part because tools that already exist--like evidence-based medications--are not being deployed to maximum impact"--

Since 1944, the National Research Council has published 10 editions of the Nutrient Requirements of Swine. This reference has guided nutritionists and other professionals in academia and the swine and feed industries in developing and implementing nutritional and feeding programs for swine. The swine industry has undergone considerable changes since the tenth edition was published in 1998 and some of the requirements and recommendations set forth at that time are no longer relevant or appropriate. The eleventh revised edition of the Nutrient Requirements of Swine builds on the previous editions published by the National Research Council. A great deal of new research has been published during the last 15 years and there is a large amount of new information for many nutrients. In addition to a thorough and current evaluation of the literature on the energy and nutrient requirements of swine in all stages of life, this volume includes information about feed ingredients from the biofuels industry and other new ingredients, requirements for digestible phosphorus and concentrations of it in feed ingredients, a review of the effects of feed additives and feed processing, and strategies to increase nutrient retention and thus reduce fecal and urinary excretions that could contribute to environmental pollution. The tables of feed ingredient composition are significantly updated. Nutrient Requirements of Swine represents a comprehensive review of the most recent information available on swine nutrition and ingredient composition that will allow efficient, profitable, and environmentally conscious swine production.

Industrial stormwater is derived from precipitation and/or runoff that comes in contact with industrial manufacturing, processing, storage, or material overburden and then runs offsite and enters drainage systems or receiving waters. In 1987, Congress significantly expanded the National Pollutant Discharge Elimination System (NPDES) program through amendments to the Clean Water Act to include industrial stormwater runoff conveyed through outfalls directly to receiving waters or indirectly through municipal separate storm sewer systems. The added regulation of stormwater in the NPDES program has been challenging. Stormwater is produced throughout a developed landscape, and its production and delivery are episodic. In 2009, the National Research Council released a comprehensive report on the Environmental Protection Agency's Stormwater Program that covered all sectors of the program. This study builds on that report, with a focus on industrial stormwater monitoring and management.

The committee was charged to review the available evidence and to update the current DRIs for sodium and potassium. In 2005, the evidence supported an Adequate Intake (AI) for both nutrients, and a Tolerable Upper Intake Level (UL) only for sodium. In addition, we were asked to consider adding, if relevant, sodium and potassium intake values to reduce the risk of chronic disease endpoints.

On July 30-31, 2018, the National Academies of Sciences, Engineering, and Medicine held a workshop titled Continuous Manufacturing for the Modernization of Pharmaceutical Production. This workshop discussed the business and regulatory concerns associated with adopting continuous manufacturing techniques to produce biologics such as enzymes, monoclonal antibodies, and vaccines. The participants also discussed specific challenges for integration across the manufacturing system, including upstream and downstream processes, analytical techniques, and drug product development. The workshop addressed these challenges broadly across the biologics domain but focused particularly on drug categories of greatest FDA and industrial interest such as monoclonal antibodies and vaccines. This publication summarizes the presentations and discussions from the workshop.

The strengths and abilities children develop from infancy through adolescence are crucial for their physical, emotional, and cognitive growth, which in turn help them to achieve success in school and to become responsible, economically self-sufficient, and healthy adults. Capable, responsible, and healthy adults are clearly the foundation of a well-functioning and prosperous society, yet America's future is not as secure as it could be because millions of American children live in families with incomes below the poverty line. A wealth of evidence suggests that a lack of adequate economic resources for families with children compromises these children's ability to grow and achieve adult success, hurting them and the broader society. A Roadmap to Reducing Child Poverty reviews the research on linkages between child poverty and child well-being, and analyzes the poverty-reducing effects of major assistance programs directed at children and families. This report also provides policy and program recommendations for reducing the number of children living in poverty in the United States by half within 10 years.

"The National Defense Authorization Act for fiscal year 2017 contained a request for a National Academies of Sciences, Engineering, and Medicine review and assessment of science and technology development efforts within the Department of Energy's Office of Environmental Management (DOE-EM). This technical report is the result of the review and presents findings and recommendations"--Publisher's description.

America's farms and farmers are integral to the U.S. economy and, more broadly, to the nation's social and cultural fabric. A healthy agricultural sector helps ensure a safe and reliable food supply, improves energy security, and contributes to employment and economic development, traditionally in small towns and rural areas where farming serves as a nexus for related sectors from farm machinery manufacturing to food processing. The agricultural sector also plays a role in the nation's overall economic growth by providing crucial raw inputs for the production of a wide range of goods and services, including many that generate substantial export value. If the agricultural sector is to be accurately understood and the policies that affect its functioning are to remain well informed, the statistical system's data collection programs must be periodically revisited to ensure they are keeping up with current realities. This report reviews current information and makes recommendations to the U.S. Department of Agriculture's (USDA's) National Agricultural Statistics Service (NASS) and Economic Research Service (ERS) to help identify effective methods for collecting data and reporting information about American agriculture, given increased complexity and other changes in farm business structure in recent decades.

New York City's water supply system is one of the oldest, largest, and most complex in the nation. It delivers more than 1.1 billion gallons of water each day from three upstate watersheds (Croton, Catskill, and Delaware) to meet the needs of more than eight million people in the City, one million people in Westchester, Putnam, Orange, and Ulster counties, and millions of commuters and tourists who visit the City throughout the year. The Catskill and Delaware portions, which make up about 90 percent of the supply, receive no filtration or treatment other than disinfection, except for rare instances of high turbidity when a coagulant is added to increase deposition of suspended solids. The remaining 10 percent of the supply comes from the Croton watershed and receives treatment via filtration. The drinking water supply is managed by the Bureau of Water Supply within the New York City Department of Environmental Protection (NYC DEP). To continue to avoid filtration of the Catskill/Delaware portion of the water supply, in 2007, NYC DEP reexamined its control of turbidity in the Catskill portion of the water supply, including both structural improvements to the system and operational changes. The Operations Support Tool (OST) was developed as part of these efforts. OST couples models of reservoir operations and water quality; it uses real-time data on streamflow, snow pack, water quality, reservoir levels, diversions, and releases; and it incorporates streamflow forecasts--all in order to predict future reservoir levels, water delivery to customers, and water quality within the system. These predictions inform the system operators, who then make decisions based on the most current data and forecasts. This report reviews the use of OST in current and future reservoir operations. It considers potential ways in which the City can more effectively use OST, makes recommendations for additional performance measures, and reviews the potential effects of climate change on the City's water supply to help identify and enhance understanding of areas of potential future concern with regard to the use of OST.

"The U.S. military has a stockpile of approximately 400,000 tons of excess, obsolete, or unserviceable munitions. About 60,000 tons are added to the stockpile each year. Munitions include projectiles, bombs, rockets, landmines, and missiles. Open burning/open detonation (OB/OD) of these munitions has been a common disposal practice for decades, although it has decreased significantly since 2011. OB/OD is relatively quick, procedurally straightforward, and inexpensive. However, the downside of OB and OD is that they release contaminants from the operation directly into the environment. Over time, a number of technology alternatives to OB/OD have become available and more are in research and development. Alternative technologies generally involve some type of contained destruction of the energetic materials, including contained burning or contained detonation as well as contained methods that forego combustion or detonation. Alternatives for the Demilitarization of Conventional Munitions reviews the current conventional munitions demilitarization stockpile and analyzes existing and emerging disposal, treatment, and reuse technologies. This report identifies and evaluates any barriers to full-scale deployment of alternatives to OB/OD or non-closed loop incineration/combustion, and provides recommendations to overcome such barriers"--

Modern materials science builds on knowledge from physics, chemistry, biology, mathematics, computer and data science, and engineering sciences to enable us to understand, control, and expand the material world. Although it is anchored in inquiry-based fundamental science, materials research is strongly focused on discovering and producing reliable and economically viable materials, from super alloys to polymer composites, that are used in a vast array of products essential to today's societies and economies. Frontiers of Materials Research: A Decadal Survey is aimed at documenting the status and promising future directions of materials research in the United States in the context of similar efforts worldwide. This third decadal survey in materials research reviews the progress and achievements in materials research and changes in the materials research landscape over the last decade; research opportunities for investment for the period 2020-2030; impacts that materials research has had and is expected to have on emerging technologies, national needs, and science; and challenges the enterprise may face over the next decade. --

"In November 2017, the The Forum on Promoting Children's Cognitive, Affective, and Behavioral Health, in collaboration with the Roundtable on the Promotion of Health Equity, convened a workshop on promoting children's behavioral health equity. The workshop used a socio-ecological developmental model to explore health equity of children and families, including those with complex needs and chronic conditions. Particular attention was paid to challenges experienced by children and families in both rural and urban contexts, to include but not limited to poverty, individual and institutional racism, low-resourced communities, and hindered access to educational and health care services. Workshop participants also engaged in solution-oriented discussions of initiatives, policies, and programs that aim to improve social determinants of health, opportunities for behavioral health promotion, and access to quality services that address the behavioral health of all children and families. This publication summarizes the presentations and discussion of the event"--

To examine the promise, concerns, and challenges related to neuroscience research using genetically modified nonhuman primates, the National Academies of Sciences, Engineering, and Medicine hosted a public workshop on October 4, 2018, bringing together an international group of experts and stakeholders representing academia, industry, laboratory animal management, disease-focused foundations, and federal agencies. The workshop was designed to explore the current state and future promise of research using genetically modified nonhuman primate models of disease to understand the complex functions of the brain that control behavior, movement, and cognition in both health and disease states. This publication summarizes the presentations and discussions from the workshop.

Randomized controlled trials (RCTs) have traditionally served as the gold standard for generating evidence about medical interventions. However, RCTs have inherent limitations and may not reflect the use of medical products in the real world. Additionally, RCTs are expensive, time consuming, and cannot answer all questions about a product or intervention. Evidence generated from real-world use, such as real-world evidence (RWE) may provide valuable information, alongside RCTs, to inform medical product decision making. To explore the potential for using RWE in medical product decision making, the National Academies of Sciences, Engineering, and Medicine planned a three-part workshop series. The series was designed to examine the current system of evidence generation and its limitations, to identify when and why RWE may be an appropriate type of evidence on which to base decisions, to learn from successful initiatives that have incorporated RWE, and to describe barriers that prevent RWE from being used to its full potential. This publication summarizes the discussions from the entire workshop series.

Climate assessment activities are increasingly driven by subnational organizations--city, county, and state governments; utilities and private companies; and stakeholder groups and engaged publics--trying to better serve their constituents, customers, and members by understanding and preparing for how climate change will impact them locally. Whether the threats are drought and wildfires, storm surge and sea level rise, or heat waves and urban heat islands, the warming climate is affecting people and communities across the country. To explore the growing role of subnational climate assessments and action, the National Academies of Sciences, Engineering, and Medicine hosted the 2-day workshop on August 14-15, 2018. This publication summarizes the presentations and discussions from the workshop.

This volume presents papers on the topics covered at the National Academy of Engineering's 2018 US Frontiers of Engineering Symposium. Every year the symposium brings together 100 outstanding young leaders in engineering to share their cutting-edge research and innovations in selected areas. The 2018 symposium was held September 5-7 and hosted by MIT Lincoln Laboratory in Lexington, Massachusetts. The intent of this book is to convey the excitement of this unique meeting and to highlight innovative developments in engineering research and technical work.

Engineering skills and knowledge are foundational to technological innovation and development that drive long-term economic growth and help solve societal challenges. Therefore, to ensure national competitiveness and quality of life it is important to understand and to continuously adapt and improve the educational and career pathways of engineers in the United States. To gather this understanding it is necessary to study the people with the engineering skills and knowledge as well as the evolving system of institutions, policies, markets, people, and other resources that together prepare, deploy, and replenish the nations engineering workforce.This report explores the characteristics and career choices of engineering graduates, particularly those with a BS or MS degree, who constitute the vast majority of degreed engineers, as well as the characteristics of those with non-engineering degrees who are employed as engineers in the United States. It provides insight into their educational and career pathways and related decision making, the forces that influence their decisions, and the implications for major elements of engineering education-to-workforce pathways.

This workshop was preceded by two other workshops, "Examining Core Elements of International Research Collaboration", held on July 26-27, 2010, and "Culture Matters: An Approach to International Research Agreements", held on July 29-31, 2013.

"Nearly one-third of the United States is covered by forests, accounting for more than one million square miles, an area exceeded only in Canada, Brazil, and Russia. These forest ecosystems play vital roles in carbon storage, nutrient cycling, and air and water purification, as well as in supplying habitat for wildlife. Forests hold historical, cultural, and social significance for Americans and are sources of both food and fiber. Today, these valued resources are endangered as never before. Global commerce has hastened the introduction of nonnative, invasive tree pests and diseases, and those native to the country are becoming more virulent due to external drivers such as climate change. The loss of a tree species can have cascading adverse effects on the forest ecosystem and on the range of services it provides and the values it represents to human populations"--

The Future of Nursing explores how nurses' roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by health care reform and to advance improvements in America's increasingly complex health system. At more than 3 million in number, nurses make up the single largest segment of the health care work force. They also spend the greatest amount of time in delivering patient care as a profession. Nurses therefore have valuable insights and unique abilities to contribute as partners with other health care professionals in improving the quality and safety of care as envisioned in the Affordable Care Act (ACA) enacted this year. Nurses should be fully engaged with other health professionals and assume leadership roles in redesigning care in the United States. To ensure its members are well-prepared, the profession should institute residency training for nurses, increase the percentage of nurses who attain a bachelor's degree to 80 percent by 2020, and double the number who pursue doctorates. Furthermore, regulatory and institutional obstacles--including limits on nurses' scope of practice--should be removed so that the health system can reap the full benefit of nurses' training, skills, and knowledge in patient care. In this book, the Institute of Medicine makes recommendations for an action-oriented blueprint for the future of nursing.

Obesity and overweight pose significant challenges to the armed forces in the United States, affecting service members (including active duty, guard, and reserve components), veterans, retirees, and their families and communities. The consequences of obesity and overweight in the armed forces influence various aspects of its operations that are critical to national security. On May 7, 2018, the National Academies of Sciences, Engineering, and Medicine, held a workshop titled "Understanding and Overcoming the Challenge of Obesity and Overweight in the Armed Forces." Speakers examined how obesity and overweight are measured in the armed forces and how they affect recruitment, retention, resilience, and readiness; discussed service-specific issues related to these problems and highlighted innovative strategies to address them through improved nutrition, physical activity, and stress management; and offered perspectives from outside of the armed forces on approaches to prevent and treat obesity. They also discussed the challenges and opportunities related to overcoming the concerns posed by obesity and overweight in the armed forces, military families, and their communities, including potential cross-sector opportunities. This publication summarizes the presentations and discussions from the workshop.

Fusion offers the prospect of virtually unlimited energy. The United States and many nations around the world have made enormous progress toward achieving fusion energy. With ITER scheduled to go online within a decade and demonstrate controlled fusion ten years later, now is the right time for the United States to develop plans to benefit from its investment in burning plasma research and take steps to develop fusion electricity for the nation's future energy needs. At the request of the Department of Energy, the National Academies of Sciences, Engineering, and Medicine organized a committee to develop a strategic plan for U.S. fusion research. The final report's two main recommendations are: (1) The United States should remain an ITER partner as the most cost-effective way to gain experience with a burning plasma at the scale of a power plant. (2) The United States should start a national program of accompanying research and technology leading to the construction of a compact pilot plant that produces electricity from fusion at the lowest possible capital cost.

There are over 20 million young people of color in the United States whose representation in STEM education pathways and in the STEM workforce is still far below their numbers in the general population. Their participation could help re-establish the United States' preeminence in STEM innovation and productivity, while also increasing the number of well-educated STEM workers. There are nearly 700 minority-serving institutions (MSIs) that provide pathways to STEM educational success and workforce readiness for millions of students of color--and do so in a mission-driven and intentional manner. They vary substantially in their origins, missions, student demographics, and levels of institutional selectivity. But in general, their service to the nation provides a gateway to higher education and the workforce, particularly for underrepresented students of color and those from low-income and first-generation to college backgrounds. The challenge for the nation is how to capitalize on the unique strengths and attributes of these institutions and to equip them with the resources, exceptional faculty talent, and vital infrastructure needed to educate and train an increasingly critical portion of current and future generations of scientists, engineers, and health professionals. Minority Serving Institutions examines the nation's MSIs and identifies promising programs and effective strategies that have the highest potential return on investment for the nation by increasing the quantity and quality MSI STEM graduates. This study also provides critical information and perspective about the importance of MSIs to other stakeholders in the nation's system of higher education and the organizations that support them.

"In 2014 the National Science Foundation (NSF) provided support to the National Academies of Sciences, Engineering, and Medicine for a series of Forums on Open Science in response to a government-wide directive to support increased public access to the results of research funded by the federal government. However, the breadth of the work resulting from the series precluded a focus on any specific topic or discussion about how to improve public access. Thus, the main goal of the Workshop on Transparency and Reproducibility in Federal Statistics was to develop some understanding of what principles and practices are, or would be, supportive of making federal statistics more understandable and reviewable, both by agency staff and the public. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

"The United States possesses a treasure-trove of extraterrestrial samples that were returned to Earth via space missions over the past four decades. Analyses of these previously returned samples have led to major breakthroughs in the understanding of the age, composition, and origin of the solar system. Having the instrumentation, facilities and qualified personnel to undertake analyses of returned samples, especially from missions that take up to a decade or longer from launch to return, is thus of paramount importance if the National Aeronautics and Space Administration (NASA) is to capitalize fully on the investment made in these missions, and to achieve the full scientific impact afforded by these extraordinary samples. Planetary science may be entering a new golden era of extraterrestrial sample return; now is the time to assess how prepared the scientific community is to take advantage of these opportunities. Strategic Investments in Instrumentation and Facilities for Extraterrestrial Sample Curation and Analysis assesses the current capabilities within the planetary science community for sample return analyses and curation, and what capabilities are currently missing that will be needed for future sample return missions. This report evaluates whether current laboratory support infrastructure and NASA's investment strategy is adequate to meet these analytical challenges and advises how the community can keep abreast of evolving and new techniques in order to stay at the forefront of extraterrestrial sample analysis"--Publisher's description.

The drylands region shared by the United States and Mexico currently faces multiple sustainability challenges at the intersection of the human and natural systems. Warming and drying conditions threaten surface water and groundwater availability, disrupt land- and marine-based livelihood systems, and challenge the sustainability of human settlements. These biophysical challenges are exacerbated by a highly mobile and dynamic population, volatile economic and policy conditions, increased exposure to extreme events, and urbanization on marginal, vulnerable lands. The U.S. National Academies of Sciences, Engineering, and Medicine collaborated with the Mexican Academy of Sciences, Academy of Engineering, and the National Academy of Medicine to plan a 2-day binational workshop, Advancing Sustainability of U.S.-Mexico Transboundary Drylands. The workshop goals were to highlight the challenges facing the region, assess the scientific and technical capacity that each nation can bring to bear in addressing these challenges, and identify new opportunities for binational research collaboration and coordinated management approaches in the advancement of sustainability science and development. This publication summarizes the presentations and discussions from the workshop.

"The critical importance of using mobile technology is clear to anyone in the health professions, particularly those who treat people with central nervous system (CNS) disorders. To explore current developments and opportunities for using mobile technology to advance research and treatment of CNS disorders, the National Academies' Forum on Neuroscience and Nervous System Disorders hosted a workshop in June 5-6, 2018. This publication summarizes the presentations and discussions at the workshop"--

"Coral reef declines have been recorded for all major tropical ocean basins since the 1980s, averaging approximately 30-50% reductions in reef cover globally. These losses are a result of numerous problems, including habitat destruction, pollution, overfishing, disease, and climate change. Greenhouse gas emissions and the associated increases in ocean temperature and carbon dioxide (CO2) concentrations have been implicated in increased reports of coral bleaching, disease outbreaks, and ocean acidification (OA). For the hundreds of millions of people who depend on reefs for food or livelihoods, the thousands of communities that depend on reefs for wave protection, the people whose cultural practices are tied to reef resources, and the many economies that depend on reefs for fisheries or tourism, the health and maintenance of this major global ecosystem is crucial. A growing body of research on coral physiology, ecology, molecular biology, and responses to stress has revealed potential tools to increase coral resilience. Some of this knowledge is poised to provide practical interventions in the short-term, whereas other discoveries are poised to facilitate research that may later open the doors to additional interventions. A Research Review of Interventions to Increase the Persistence and Resilience of Coral Reefs reviews the state of science on genetic, ecological, and environmental interventions meant to enhance the persistence and resilience of coral reefs. The complex nature of corals and their associated microbiome lends itself to a wide range of possible approaches. This first report provides a summary of currently available information on the range of interventions present in the scientific literature and provides a basis for the forthcoming final report"--Publisher's description.

For the United States, the 1991 Persian Gulf War was a brief and successful military operation with few injuries and deaths. However, soon after returning from duty, a large number of veterans began reporting health problems they believed were associated with their service in the Gulf. At the request of Congress, the National Academies of Sciences, Engineering, and Medicine has been conducting an ongoing review of the evidence to determine veterans' long-term health problems and potential causes. Some of the health effects identified by past reports include post-traumatic stress disorders, other mental health disorders, Gulf War illness, respiratory effects, and self-reported sexual dysfunction. Veterans' concerns regarding the impacts of deployment-related exposures on their health have grown to include potential adverse effects on the health of their children and grandchildren. These concerns now increasingly involve female veterans, as more women join the military and are deployed to war zones and areas that pose potential hazards. Gulf War and Health: Volume 11 evaluates the scientific and medical literature on reproductive and developmental effects and health outcomes associated with Gulf War and Post-9/11 exposures, and designates research areas requiring further scientific study on potential health effects in the descendants of veterans of any era.

Poor health literacy has many negative consequences for achieving the quadruple aim of better care, improving the health of the community and the population, providing affordable care, and improving the work life of health care providers, and those consequences disproportionately affect those individuals with disabilities and those who experience health disparities. To better understand how health literacy, health equity, and health disparities intersect for individuals living with disabilities, the Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities and the Roundtable on Health Literacy jointly sponsored a workshop that was held on June 14, 2016, in Washington, DC. This publication summarizes the presentations and discussions from the workshop.