Bøker utgitt av National Academies Press

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.

"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.