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"Genomic medicine is defined as the routine use of genomic information about an individual as part of his or her clinical care as well as the health outcomes and policy implications of that clinical use. It is one approach that has the potential to improve the quality of health care by allowing practitioners to tailor prevention, diagnostic, and treatment strategies to individual patients. In recent years, research breakthroughs, technological advances, and the decreasing cost of DNA sequencing have led to the wider adoption of genomic medicine. However, as with the introduction of new technologies into health care, there are concerns that genetic and genomic testing and services will not reach all segments of the population both now and in the near future, and there remains a gap in knowledge regarding potential health care disparities in genomic medicine and precision health approaches. On June 27, 2018, the National Academies of Sciences, Engineering, and Medicine hosted a public workshop to examine the gaps in knowledge related to access to genomic medicine and to discuss health care disparities and possible approaches to overcoming the disparate use of genomic medicine among populations. Workshop participants discussed research on access to genetics and genomics services in medically underserved areas, model programs of care for diverse patient populations, and current challenges and possible best practices for alleviating health care disparities as they relate to genomics-based approaches. This publication summarizes the presentations and discussions from the workshop"--

"On June 13-14, 2018, the National Academies of Sciences, Engineering, and Medicine convened a multistakeholder workshop to examine the transitions affecting global health and innovative global health solutions. The goal of bringing these two topics together was to collectively explore models for innovative partnerships and private-sector engagement with the potential to support countries in transition. This publication summarizes the presentations and discussions from the workshop"--

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 (LAW) at the Hanford Nuclear Reservation intended for supplemental treatment. The second of four, this report reviews the results of the assessments, including the formulation and presentation of conclusions and the characterization and treatment of uncertainties.

"Emerging economies, social and political transitions, and new ways of doing business are changing the world dramatically. To be the leader in this competitive climate, a defense manufacturing enterprise will require up-to-date capabilities, which include improvements in materials processing, among other things. Also, national and international efforts to mitigate environmentally harmful effects of industrial processes and to improve decision making for handling and disposing of industrial contaminants adds additional requirements for any future efforts. The objective of retaining high-value materials-related manufacturing as a key national competitive capability implies a number of factors. The value of specific manufacturing capabilities could be defined not only in terms of criticality to defense systems but also in relation to technology and knowledge content, importance as a supplier to other industries, and importance to U.S. exports. Requested by Department of Defense (DoD) communities, the National Academies of Sciences, Engineering, and Medicine held a workshop in March 2015 to further explore materials and manufacturing processes. The participants explored changes in the global R&D landscape, technology awareness mechanisms--both DoD's mechanisms and other models--and collaboration models and issues in R&D. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

In the quest to mitigate the buildup of greenhouse gases in Earth's atmosphere, researchers and policymakers have increasingly turned their attention to techniques for capturing greenhouse gases such as carbon dioxide and methane, either from the locations where they are emitted or directly from the atmosphere. Once captured, these gases can be stored or put to use. While both carbon storage and carbon utilization have costs, utilization offers the opportunity to recover some of the cost and even generate economic value. While current carbon utilization projects operate at a relatively small scale, some estimates suggest the market for waste carbon-derived products could grow to hundreds of billions of dollars within a few decades, utilizing several thousand teragrams of waste carbon gases per year. Gaseous Carbon Waste Streams Utilization: Status and Research Needs assesses research and development needs relevant to understanding and improving the commercial viability of waste carbon utilization technologies and defines a research agenda to address key challenges. The report is intended to help inform decision making surrounding the development and deployment of waste carbon utilization technologies under a variety of circumstances, whether motivated by a goal to improve processes for making carbon-based products, to generate revenue, or to achieve environmental goals.

During the past century, the Everglades, one of the world's treasured ecosystems, has been dramatically altered by drainage and water management infrastructure that was intended to improve flood management, urban water supply, and agricultural production. The remnants of the original Everglades now compete for water with urban and agricultural interests and are impaired by contaminated runoff from these two sectors. The Comprehensive Everglades Restoration Plan (CERP), a joint effort launched by the state and the federal government in 2000, seeks to reverse the decline of the ecosystem. The multibillion-dollar project was originally envisioned as a 30- to 40-year effort to achieve ecological restoration by reestablishing the natural hydrologic characteristics of the Everglades, where feasible, and to create a water system that serves the needs of both the natural and the human systems of South Florida. Over the past two years, impressive progress has been made in planning new CERP projects, and the vision for CERP water storage is now becoming clear. Construction and completion of authorized CERP projects will likely take several decades, and at this pace of restoration, it is even more imperative that agencies anticipate and design for the Everglades of the future. This seventh biennial review assesses the progress made in meeting the goals of the CERP and provides an in-depth review of CERP monitoring, with particular emphasis on project-level monitoring and assessment. It reviews developments in research and assessment that inform restoration decision making, and identifies issues for in-depth evaluation considering new CERP program developments, policy initiatives, or improvements in scientific knowledge that have implications for restoration progress.

"Microbial threats, including endemic and emerging infectious diseases and antimicrobial resistance, can cause not only substantial health consequences but also enormous disruption to economic activity worldwide. While scientific advances have undoubtedly strengthened our ability to respond to and mitigate the mortality of infectious disease threats, events over the past two decades have illustrated our continued vulnerability to economic consequences from these threats. To assess the current understanding of the interaction of infectious disease threats with economic activity and suggest potential new areas of research, the National Academies of Sciences, Engineering, and Medicine planned a 1.5-day public workshop on understanding the economics of microbial threats. This workshop built on prior work of the Forum on Microbial Threats and aimed to help transform current knowledge into immediate action. This publication summarizes the presentations and discussions from the workshop"--

"Adults age 65 and older make up the fastest-growing segment of the U.S. population. At the same time, the complexity of health care delivery continues to grow, creating challenges that are magnified for older adults, given that age is one of the highest correlates of low health literacy. This creates a shared obligation between health care and the health care team to use the principles, tools, and practices of health literacy so that patients and families of older adults can more easily navigate discussions related to chronic disease, polypharmacy, long-term care, palliative care, insurance complexities, the social determinants of health, and other factors that create challenges for older adults, particularly among underserved populations nationwide. To gain a better understanding of the health communication challenges among older adults and their professional and family caregivers and how those challenges affect the care older adults receive, the National Academies of Sciences, Engineering, and Medicine's Roundtable on Health Literacy convened a 1-day public workshop featuring presentations and discussions that examined the effect of low health literacy on the health of older adults. This publication summarizes the presentations and discussions from the workshop" --

"A consensus study report of The National Academies of Sciences, Engineering, Medicine."

"Vehicle weight reduction is an effective strategy for reducing fuel consumption in civilian vehicles. For combat vehicles, it presents not only an important opportunity to reduce fuel use and associated logistics, but also important advantages in transport and mobility on the battlefield. Although there have been numerous efforts in the past to reduce the overall weight of combat vehicles, combat vehicle weight has continued to increase over time due to new threats and missions. On December 8 and 9, 2014, the National Academies of Sciences, Engineering, and Medicine held a workshop to explore opportunities in lightweight materials for armored vehicles. This was the ninth workshop in an ongoing series for the U.S. military on materials and manufacturing issues. The workshop discussed future advances in weight reduction by materials substitution for vehicles, including such topics as armor, structure, automotive parts, and armaments. This publication summarizes the presentations and discussions from the workshop"-- Provided by publisher.

The mental health and well-being of health professionals is a topic that is broad, exceptionally relevant, and urgent to address. It is both a local and a global issue, and affects professionals in all stages of their careers. To explore this topic, the Global Forum on Innovation in Health Professional Education held a 1.5 day workshop. This publication summarizes the presentations and discussions from the workshop.

Requested by NASA, this study offers a science strategy for astrobiology that outlines key scientific questions, identifies the most promising research in the field, and indicates the extent to which the mission priorities in existing decadal surveys address the search for life's origin, evolution, distribution, and future in the universe. This report makes recommendations for advancing the research, obtaining the measurements, and realizing NASA's goal to search for signs of life in the universe.--

"The Edwards Aquifer in south-central Texas is the primary source of water for one of the fastest growing cities in the United States, San Antonio, and it also supplies irrigation water to thousands of farmers and livestock operators. It is also the source water for several springs and rivers, including the two largest freshwater springs in Texas that form the San Marcos and Comal Rivers. The unique habitat afforded by these spring-fed rivers has led to the development of species that are found in no other locations on Earth. Due to the potential for variations in spring flow caused by both human and natural causes, these species are continuously at risk and have been recognized as endangered under the federal Endangered Species Act (ESA). In an effort to manage the river systems and the aquifer that controls them, the Edwards Aquifer Authority (EAA) and stakeholders have developed a Habitat Conservation Plan (HCP). The HCP seeks to effectively manage the river-aquifer system to ensure the viability of the ESA-listed species in the face of drought, population growth, and other threats to the aquifer. This report is the third and final product of a three-phase study to provide advice to the EAA on various aspects of the HCP that will ultimately lead to improved management of the Edwards Aquifer. This final report focuses on the biological goals and objectives found in the HCP for each of the listed species."--

"Millions of Americans of all ages face the challenge of living with serious illnesses such as advanced cancer, heart, or lung disease. Many people with serious illness are increasingly cared for in community settings. While the number of community-based programs to provide care for those with serious illness has grown significantly, the quality of care provided is not consistent across geographic locations or care settings. Care for the serious illness population often features gaps in coordination across sites of care and poor patient and family perceptions as to the quality of care provided. In an effort to better understand and facilitate discussions about the challenges and opportunities related to identifying and implementing quality measures for accountability purposes in community-based serious illness care, the National Academies of Sciences, Engineering, and Medicine held a public workshop on April 17, 2018, in Washington, DC. Workshop participants explored the current state of quality measurement for people with serious illness, their families, and caregivers, with the aim of identifying next steps toward effectively implementing measures to drive improvement in the quality of community-based care for those facing serious illness. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

There are many reasons to be curious about the way people learn, and the past several decades have seen an explosion of research that has important implications for individual learning, schooling, workforce training, and policy. In 2000, How People Learn: Brain, Mind, Experience, and School: Expanded Edition was published and its influence has been wide and deep. The report summarized insights on the nature of learning in school-aged children; described principles for the design of effective learning environments; and provided examples of how that could be implemented in the classroom. Since then, researchers have continued to investigate the nature of learning and have generated new findings related to the neurological processes involved in learning, individual and cultural variability related to learning, and educational technologies. In addition to expanding scientific understanding of the mechanisms of learning and how the brain adapts throughout the lifespan, there have been important discoveries about influences on learning, particularly sociocultural factors and the structure of learning environments. How People Learn II: Learners, Contexts, and Cultures provides a much-needed update incorporating insights gained from this research over the past decade. The book expands on the foundation laid out in the 2000 report and takes an in-depth look at the constellation of influences that affect individual learning. How People Learn II will become an indispensable resource to understand learning throughout the lifespan for educators of students and adults.

"Rapid advances in cancer research, the development of new and more sophisticated approaches to diagnostic testing, and the growth in targeted cancer therapies are transforming the landscape of cancer diagnosis and care. These innovations have contributed to improved outcomes for patients with cancer, but they have also increased the complexity involved in diagnosis and subsequent care decisions. To examine opportunities to improve cancer diagnosis and care, the National Academies of Sciences, Engineering, and Medicine developed a two-workshop series. The first workshop, held on February 12-13, 2018, in Washington, DC, focused on potential strategies to ensure that patients have access to appropriate expertise and technologies in oncologic pathology and imaging to inform their cancer diagnosis and treatment planning, as well as assessment of treatment response and surveillance. This publication chronicles the presentations and discussions at the workshop."--

The past decade has delivered remarkable discoveries in the study of exoplanets. Hand-in-hand with these advances, a theoretical understanding of the myriad of processes that dictate the formation and evolution of planets has matured, spurred on by the avalanche of unexpected discoveries. Appreciation of the factors that make a planet hospitable to life has grown in sophistication, as has understanding of the context for biosignatures, the remotely detectable aspects of a planet's atmosphere or surface that reveal the presence of life. Exoplanet Science Strategy highlights strategic priorities for large, coordinated efforts that will support the scientific goals of the broad exoplanet science community. This report outlines a strategic plan that will answer lingering questions through a combination of large, ambitious community-supported efforts and support for diverse, creative, community-driven investigator research.

In 2015, building on the advances of the Millennium Development Goals, the United Nations adopted Sustainable Development Goals that include an explicit commitment to achieve universal health coverage by 2030. However, enormous gaps remain between what is achievable in human health and where global health stands today, and progress has been both incomplete and unevenly distributed. In order to meet this goal, a deliberate and comprehensive effort is needed to improve the quality of health care services globally. Crossing the Global Quality Chasm: Improving Health Care Worldwide focuses on one particular shortfall in health care affecting global populations: defects in the quality of care. This study reviews the available evidence on the quality of care worldwide and makes recommendations to improve health care quality globally while expanding access to preventive and therapeutic services, with a focus in low-resource areas. Crossing the Global Quality Chasm emphasizes the organization and delivery of safe and effective care at the patient/provider interface. This study explores issues of access to services and commodities, effectiveness, safety, efficiency, and equity. Focusing on front line service delivery that can directly impact health outcomes for individuals and populations, this book will be an essential guide for key stakeholders, governments, donors, health systems, and others involved in health care.

"Since 1965 the foreign-born population of the United States has swelled from 9.6 million or 5 percent of the population to 45 million or 14 percent in 2015. Today, about one-quarter of the U.S. population consists of immigrants or the children of immigrants. Given the sizable representation of immigrants in the U.S. population, their health is a major influence on the health of the population as a whole. On average, immigrants are healthier than native-born Americans. Yet, immigrants also are subject to the systematic marginalization and discrimination that often lead to the creation of health disparities. To explore the link between immigration and health disparities, the Roundtable on the Promotion of Health Equity held a workshop in Oakland, California, on November 28, 2017. This summary of that workshop highlights the presentations and discussions of the workshop"--Publisher's description.

Updating two previous National Research Council publications, Nutrient Requirements of Sheep, Sixth Revised Edition, 1985, and Nutrient Requirements of Goats, First Edition, 1981, this new book provides an evaluation of the scientific literature on the nutrient requirements of small ruminants in all stages of life. In addition, effects of the environment, feed additives, and metabolism modifiers on nutrient requirements are addressed. Proper formulation of diets for small ruminants depends on adequate knowledge of their nutrient requirements. These requirements depend on the breed and age of the animal and whether he or she is exercising, pregnant, or lactating. Nutrient Requirements of Small Ruminants brings together a summary of this latest data with new and expanded information on the composition of feeds commonly consumed by small ruminants, both domestic and wild. For the first time this authoritative reference work includes information on cervids and camelids. Primarily intended for animal nutritionists, veterinarians, and other scientists, some sections will be useful to individual sheep and goat owners and managers and to those responsible for the care and management of wildlife species. As both a practical and a technical reference book, this material is written to ensure that diets of small ruminants contain adequate amounts of nutrients and that intakes of certain nutrients are not so excessive that they inhibit performance or impair health.

"Reliable, affordable, and technically recoverable energy is central to the nation's economic and social vitality. The United States is both a major consumer of geologically based energy resources from around the world and - increasingly of late - a developer of its own energy resources. Understanding the national and global availability of those resources as well as the environmental impacts of their development is essential for strategic decision making related to the nation's energy mix. The U.S. Geological Survey Energy Resources Program is charged with providing unbiased and publicly available national- and regional-scale assessments of the location, quantity, and quality of geologically based energy resources and with undertaking research related to their development. At the request of the Energy Resources Program (ERP), this publication considers the nation's geologically based energy resource challenges in the context of current national and international energy outlooks. Future Directions for the U.S. Geological Survey's Energy Resources Program examines how ERP activities and products address those challenges and align with the needs federal and nonfederal consumers of ERP products. This study contains recommendations to develop ERP products over the next 10-15 years that will most effectively inform both USGS energy research priorities and the energy needs and priorities of the U.S. government"--Publisher's description.

Significant advances in brain research have been made, but investigators who face the resulting explosion of data need new methods to integrate the pieces of the "brain puzzle." Based on the expertise of more than 100 neuroscientists and computer specialists, this new volume examines how computer technology can meet that need. Featuring outstanding color photography, the book presents an overview of the complexity of brain research, which covers the spectrum from human behavior to genetic mechanisms. Advances in vision, substance abuse, pain, and schizophrenia are highlighted. The committee explores the potential benefits of computer graphics, database systems, and communications networks in neuroscience and reviews the available technology. Recommendations center on a proposed Brain Mapping Initiative, with an agenda for implementation and a look at issues such as privacy and accessibility.

Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.

Sensors, satellite photography, and multispectral imaging are associated with futuristic space and communications science. Increasingly, however, they are considered part of the future of agriculture. The use of advanced technologies for crop production is known as precision agriculture, and its rapid emergence means the potential for revolutionary change throughout the agricultural sector. Precision Agriculture in the 21st Century provides an overview of the specific technologies and practices under the umbrella of precision agriculture, exploring the full implications of their adoption by farmers and agricultural managers. The volume discusses how precision agriculture could dramatically affect decisionmaking in irrigation, crop selection, pest management, environmental issues, and pricing and market conditions. It also examines the geographical dimensions--farm, regional, national--of precision agriculture and looks at how quickly and how widely the agricultural community can be expected to adopt the new information technologies. Precision Agriculture in the 21st Century highlights both the uncertainties and the exciting possibilities of this emerging approach to farming. This book will be important to anyone concerned about the future of agriculture: policymakers, regulators, scientists, farmers, educators, students, and suppliers to the agricultural industry.

More than 50 million Americans, one out of five, suffer from hay fever, asthma, and other allergic diseases. Many of these conditions are caused by exposure to allergens in indoor environments such as the house, work, and school--where we spend as much as 98 percent of our time. Developed by medical, public health, and engineering professionals working together, this unique volume summarizes what is known about indoor allergens, how they affect human health, the magnitude of their effect on various populations, and how they can be controlled. The book addresses controversies, recommends research directions, and suggests how to assist and educate allergy patients, as well as professionals. Indoor Allergens presents a wealth of information about common indoor allergens and their varying effects, from significant hay fever to life-threatening asthma. The volume discusses sources of allergens, from fungi and dust mites to allergenic chemicals, plants, and animals, and examines practical measures for their control. Indoor Allergens discusses how the human airway and immune system respond to inhaled allergens and assesses patient testing methods, covering the importance of the patient's medical history and outlining procedures and approaches to interpretation for skin tests, in vitro diagnostic tests, and tests of patients' pulmonary function. This comprehensive and practical volume will be important to allergists and other health care providers; public health professionals; specialists in building design, construction, and maintenance; faculty and students in public health; and interested allergy patients.

In the 1970s, the first wave of environmental regulation targeted specific sources of pollutants. In the 1990s, concern is focused not on the ends of pipes or the tops of smokestacks but on sweeping regional and global issues. This landmark volume explores the new industrial ecology, an emerging framework for making environmental factors an integral part of economic and business decision making. Experts on this new frontier explore concepts and applications, including: Bringing international law up to par with many national laws to encourage industrial ecology principles. Integrating environmental costs into accounting systems. Understanding design for environment, industrial "metabolism," and sustainable development and how these concepts will affect the behavior of industrial and service firms. The volume looks at negative and positive aspects of technology and addresses treatment of waste as a raw material. This volume will be important to domestic and international policymakers, leaders in business and industry, environmental specialists, and engineers and designers.

From a public health perspective, motor vehicle crashes are among the most serious problems facing teenagers. Even after more than six months of being licensed to drive alone, teens are two to three times more likely to be in a fatal crash than are the more experienced drivers. Crash rates are significantly higher for male drivers, and young people in the United States are at greater risk of dying or being injured in an automobile than their peers around the world. In fact, in 2003 motor vehicle crashes was the leading cause of death for youth ages 16-20 in the United States. Understanding how and why teen motor vehicle crashes happen is key to developing countermeasures to reduce their number. Applying this understanding to the development of prevention strategies holds significant promise for improving safety but many of these efforts are thwarted by a lack of evidence as to which prevention strategies are most effective. Preventing Teen Motor Crashes presents data from a multidisciplinary group that shared information on emerging technology for studying, monitoring, and controlling driving behavior. The book provides an overview of the factual information that was presented, as well as the insights that emerged about the role researchers can play in reducing and preventing teen motor crashes.

The report examines the Environmental Protection Agency's three-year plan for a comprehensive response to a chemical or biological attack on a civilian or public sector facility. The report states that EPA has correctly identified the essential major research areas (detection, containment, decontamination, and disposal) but calls for an initial focus on decontamination and disposal efforts and a longer term research program.

The report examines a draft plan, prepared by the Environmental Protection Agency, that identifies critical security issues for drinking water and wastewater and outlines related research and technical support needs. This report recommends increased attention to interagency coordination and encourages additional consideration of current restrictions on secure information dissemination. It further suggests that EPA incorporate the results of their research activities into an integrated water security guidance document to improve support for water and wastewater utilities.