Bøker utgitt av National Academies Press

"From the Institute of Medicine/ National Research Council Report"--T.P.

The United States Army faces a variety of challenges to maintain a ready and capable force into the future. Missions are increasingly diverse, ranging from combat and counterinsurgency to negotiation, reconstruction, and stability operations, and require a variety of personnel and skill sets to execute. Missions often demand rapid decision-making and coordination with others in novel ways, so that personnel are not simply following a specific set of tactical orders but rather need to understand broader strategic goals and choose among courses of action. Like any workforce, the Army is diverse in terms of demographic characteristics such as gender and race, with increasing pressure to ensure equal opportunities across all demographic parties. With these challenges comes the urgent need to better understand how contextual factors influence soldier and small unit behavior and mission performance. Recognizing the need to develop a portfolio of research to better understand the influence of social and organizational factors on the behavior of individuals and small units, the U.S. Army Research Institute (ARI) requested the National Research Council's Board on Behavioral, Cognitive, and Sensory Sciences to outline a productive and innovative collection of future basic science research projects to improve Amy mission performance for immediate implementation and lasting over the next 10-20 years. This report presents recommendations for a program of basic scientific research on the roles of social and organizational contextual factors, such as organizational institutions, culture, and norms, as determinants and moderators of the performance of individual soldiers and small units. The Context of Military Environments: Basic Research Opportunities on Social and Organizational Factors synthesizes and assesses basic research opportunities in the behavioral and social sciences related to social and organizational factors that comprise the context of individual and small unit behavior in military environments. This report focuses on tactical operations of small units and their leaders, to include the full spectrum of unique military environments including: major combat operations, stability/support operations, peacekeeping, and military observer missions, as well as headquarters support units. This report identifies key contextual factors that shape individual and small unit behavior and assesses the state of the science regarding these factors. The Context of Military Environments recommends an agenda for ARI's future research in order to maximize the effectiveness of U.S. Army personnel policies and practices of selection, recruitment, and assignment as well as career development in training and leadership. The report also specifies the basic research funding level needed to implement the recommended agenda for future ARI research.

"In the past decade, a number of state, local, and tribal jurisdictions have begun to take significant steps to overhaul their juvenile justice systems - for example, reducing the use of juvenile detention and out-of-home placement, bringing greater attention to racial and ethnic disparities, looking for ways to engage affected families in the process, and raising the age at which juvenile court jurisdiction ends. These changes are the result of heightening awareness of the ineffectiveness of punitive practices and accumulating knowledge about adolescent development. Momentum for reform is growing. However, many more state, local, and tribal jurisdictions need assistance, and practitioners in the juvenile justice field are looking for guidance from the federal government, particularly from the Office of Juvenile Justice and Delinquency Prevention (OJJDP) in the Department of Justice. Implementing Juvenile Justice Reform identifies and prioritizes strategies and policies to effectively facilitate reform of the juvenile justice system and develop an implementation plan for OJJDP. Based on the 2013 report Reforming Juvenile Justice, this report is designed to provide specific guidance to OJJDP regarding the steps that it should take, both internally and externally, to facilitate juvenile justice reform grounded in knowledge about adolescent development. The report identifies seven hallmarks of a developmental approach to juvenile justice to guide system reform: accountability without criminalization, alternatives to justice system involvement, individualized response based on needs and risks, confinement only when necessary for public safety, genuine commitment to fairness, sensitivity to disparate treatment, and family engagement. Implementing Juvenile Justice Reform outlines how these hallmarks should be incorporated into policies and practices within OJJDP, as well as in actions extended to state, local, and tribal jurisdictions to achieve the goals of the juvenile justice system through a developmentally informed approach. This report sets forth a detailed and prioritized strategic plan for the federal government to support and facilitate developmentally oriented juvenile justice reform. The pivotal component of the plan is to strengthen the role, capacity, and commitment of OJJDP, the lead federal agency in the field. By carrying out the recommendations of Implementing Juvenile Justice Reform, the federal government will both reaffirm and advance the promise of the Juvenile Justice and Delinquency Prevention Act."--Publisher's description.

The twentieth century witnessed an era of unprecedented, large-scale, anthropogenic changes to the natural environment. Understanding how environmental factors directly and indirectly affect the emergence and spread of infectious disease has assumed global importance for life on this planet. While the causal links between environmental change and disease emergence are complex, progress in understanding these links, as well as how their impacts may vary across space and time, will require transdisciplinary, transnational, collaborative research. This research may draw upon the expertise, tools, and approaches from a variety of disciplines. Such research may inform improvements in global readiness and capacity for surveillance, detection, and response to emerging microbial threats to plant, animal, and human health. The Influence of Global Environmental Change on Infectious Disease Dynamics is the summary of a workshop hosted by the Institute of Medicine Forum on Microbial Threats in September 2013 to explore the scientific and policy implications of the impacts of global environmental change on infectious disease emergence, establishment, and spread. This report examines the observed and potential influence of environmental factors, acting both individually and in synergy, on infectious disease dynamics. The report considers a range of approaches to improve global readiness and capacity for surveillance, detection, and response to emerging microbial threats to plant, animal, and human health in the face of ongoing global environmental change.

"The Cost of Inaction for Young Children Globally is the summary of a workshop hosted by the Institute of Medicine Forum on Investing in Young Children Globally in April 2014 to focus on investments in young children and the cost of inaction. Participants explored existing, new, and innovative science and research from around the world to translate this evidence into sound and strategic investments in policies and practices that will make a difference in the lives of children and their caregivers. This report discusses intersections across health, education, nutrition, living conditions, and social protection and how investments of economic, natural, social, and other resources can sustain or promote early childhood development and well-being."--Publisher's description.

The Earth's population, currently 7.2 billion, is expected to rise at a rapid rate over the next 40 years. Current projections state that the Earth will need to support 9.6 billion people by the year 2050, a figure that climbs to nearly 11 billion by the year 2100. At the same time, most people envision a future Earth with a greater average standard of living than we currently have - and, as a result, greater consumption of our planetary resources. How do we prepare our planet for a future population of 10 billion? How can this population growth be achieved in a manner that is sustainable from an economic, social, and environmental perspective? Can Earth's and Society's Systems Meet the Needs of 10 Billion People? is the summary of a multi-disciplinary workshop convened by the National Academies in October 2013 to explore how to increase the world's population to 10 billion in a sustainable way while simultaneously increasing the well-being and standard of living for that population. This report examines key issues in the science of sustainability that are related to overall human population size, population growth, aging populations, migration toward cities, differential consumption, and land use change, by different subpopulations, as viewed through the lenses of both social and natural science.

Today's physician education system produces trained doctors with strong scientific underpinnings in biological and physical sciences as well as supervised practical experience in delivering care. Significant financial public support underlies the graduate-level training of the nation's physicians. Two federal programs--Medicare and Medicaid--distribute billions each year to support teaching hospitals and other training sites that provide graduate medical education.Graduate Medical Education That Meets the Nation's Health Needs is an independent review of the goals, governance, and financing of the graduate medical education system. This report focuses on the extent to which the current system supports or creates barriers to producing a physician workforce ready to provide high-quality, patient-centered, and affordable health care and identifies opportunities to maximize the leverage of federal funding toward these goals. Graduate Medical Education examines the residency pipeline, geographic distribution of generalist and specialist clinicians, types of training sites, and roles of teaching and academic health centers.The recommendations of Graduate Medical Education will contribute to the production of a better prepared physician workforce, innovative graduate medical education programs, transparency and accountability in programs, and stronger planning and oversight of the use of public funds to support training. Teaching hospitals, funders, policy makers, institutions, and health care organizations will use this report as a resource to assess and improve the graduate medical education system in the United States.

Additive manufacturing has the potential to positively affect human spaceflight operations by enabling the in-orbit manufacture of replacement parts and tools, which could reduce existing logistics requirements for the International Space Station and future long-duration human space missions. The benefits of in-space additive manufacturing for robotic spacecraft are far less clear, although this rapidly advancing technology can also potentially enable space-based construction of large structures and, perhaps someday, substantially in the future, entire spacecraft. Additive manufacturing can also help to reimagine a new space architecture that is not constrained by the design and manufacturing confines of gravity, current manufacturing processes, and launch-related structural stresses.The specific benefits and potential scope of additive manufacturing remain undetermined. The realities of what can be accomplished today, using this technology on the ground, demonstrate the substantial gaps between the vision for additive manufacturing in space and the limitations of the technology and the progress that has to be made to develop it for space use.3D Printing in Space evaluates the prospects of in-space additive manufacturing. This report examines the various technologies available and currently in development, and considers the possible impacts for crewed space operations and robotic spacecraft operations. Ground-based additive manufacturing is being rapidly developed by industry, and 3D Printing in Space discusses government-industry investments in technology development. According to this report, the International Space Station provides an excellent opportunity for both civilian and military research on additive manufacturing technology. Additive manufacturing presents potential opportunities, both as a tool in a broad toolkit of options for space-based activities and as a potential paradigm-changing approach to designing hardware for in-space activities. This report makes recommendations for future research, suggests objectives for an additive manufacturing roadmap, and envisions opportunities for cooperation and joint development.

Rapid advances in technology have lowered the cost of sequencing an individual's genome from the several billion dollars that it cost a decade ago to just a few thousand dollars today and have correspondingly greatly expanded the use of genomic information in medicine. Because of the lack of evidence available for assessing variants, evaluation bodies have made only a few recommendations for the use of genetic tests in health care. For example, organizations, such as the Evaluation of Genomic Applications in Practice and Prevention working group, have sought to set standards for the kinds of evaluations needed to make population-level health decisions. However, due to insufficient evidence, it has been challenging to recommend the use of a genetic test. An additional challenge to using large-scale sequencing in the clinic is that it may uncover "secondary," or "incidental," findings - genetic variants that have been associated with a disease but that are not necessarily related to the conditions that led to the decision to use genomic testing. Furthermore, as more genetic variants are associated with diseases, new information becomes available about genomic tests performed previously, which raises issues about how and whether to return this information to physicians and patients and also about who is responsible for the information. To help develop a better understanding of how genomic information is used for healthcare decision making, the Roundtable on Translating Genomic-Based Research for Health of the Institute of Medicine held a workshop in Washington, DC in February 2014. Stakeholders, including clinicians, researchers, patients, and government officials, discussed the issues related to the use of genomic information in medical practice. Assessing Genomic Sequencing Information for Health Care Decision Making is the summary of that workshop. This report compares and contrasts evidence evaluation processes for different clinical indications and discusses key challenges in the evidence evaluation process.

Over the last two decades, computers have become omnipresent in daily life. Their increased power and accessibility have enabled the accumulation, organization, and analysis of massive amounts of data. These data, in turn, have been transformed into practical knowledge that can be applied to simple and complex decision making alike. In many of today's activities, decision making is no longer an exclusively human endeavor. In both virtual and real ways, technology has vastly extended people's range of movement, speed and access to massive amounts of data. Consequently, the scope of complex decisions that human beings are capable of making has greatly expanded. At the same time, some of these technologies have also complicated the decision making process. The potential for changes to complex decision making is particularly significant now, as advances in software, memory storage and access to large amounts of multimodal data have dramatically increased. Increasingly, our decision making process integrates input from human judgment, computing results and assistance, and networks. Human beings do not have the ability to analyze the vast quantities of computer-generated or -mediated data that are now available. How might humans and computers team up to turn data into reliable (and when necessary, speedy) decisions? Complex Operational Decision Making in Networked Systems of Humans and Machines explores the possibilities for better decision making through collaboration between humans and computers. This study is situated around the essence of decision making; the vast amounts of data that have become available as the basis for complex decision making; and the nature of collaboration that is possible between humans and machines in the process of making complex decisions. This report discusses the research goals and relevant milestones in several enabling subfields as they relate to enhanced human-machine collaboration for complex decision making; the relevant impediments and systems-integration challenges that are preventing technological breakthroughs in these subfields; and a sense of the research that is occurring in university, government and industrial labs outside of the United States, and the implications of this research for U.S. policy. The development of human-machine collaboration for complex decision making is still in its infancy relative to where cross-disciplinary research could take it over the next generation. Complex Operational Decision Making explores challenges to progress, impediments to achieving technological breakthroughs, opportunities, and key research goals.

In the nearly 40 years since implementation of federal regulations governing the protection of human participants in research, the number of clinical studies has grown exponentially. These studies have become more complex, with multisite trials now common, and there is increasing use of archived biospecimens and related data, including genomics data. In addition, growing emphasis on targeted cancer therapies requires greater collaboration and sharing of research data to ensure that rare patient subsets are adequately represented. Electronic records enable more extensive data collection and mining, but also raise concerns about the potential for inappropriate or unauthorized use of data, bringing patient protections into a new landscape. There are also long-standing concerns about the processes and forms used to obtain informed consent from patients participating in clinical studies. These changes and challenges raise new ethical and practical questions for the oversight of clinical studies, and for protecting patients and their health information in an efficient manner that does not compromise the progress of biomedical research. Contemporary Issues for Protecting Patients in Cancer Research is the summary of a workshop convened by the National Cancer Policy Forum of the Institute of Medicine in February 2014 to explore contemporary issues in human subjects protections as they pertain to cancer research, with the goal of identifying potential relevant policy actions. Clinical researchers, government officials, members of Institutional Review Boards, and patient advocates met to discuss clinical cancer research and oversight. This report examines current regulatory provisions that may not adequately protect patients or may be hindering research, and discusses potential strategies and actions to address those challenges.

People's bonds, associations and networks - as well as the civil, political, and institutional characteristics of the society in which they live - can be powerful drivers affecting the quality of life among a community's, a city's, or a nation's inhabitants and their ability to achieve both individual and societal goals. Civic engagement, social cohesion, and other dimensions of social capital affect social, economic and health outcomes for individuals and communities. Can these be measured, and can federal surveys contribute toward this end? Can this information be collected elsewhere, and if so, how should it be collected? Civic Engagement and Social Cohesion identifies measurement approaches that can lead to improved understanding of civic engagement, social cohesion, and social capital - and their potential role in explaining the functioning of society. With the needs of data users in mind, this report examines conceptual frameworks developed in the literature to determine promising measures and measurement methods for informing public policy discourse. The report identifies working definitions of key terms; advises on the feasibility and specifications of indicators relevant to analyses of social, economic, and health domains; and assesses the strength of the evidence regarding the relationship between these indicators and observed trends in crime, employment, and resilience to shocks such as natural disasters. Civic Engagement and Social Cohesion weighs the relative merits of surveys, administrative records, and non-government data sources, and considers the appropriate role of the federal statistical system. This report makes recommendations to improve the measurement of civic health through population surveys conducted by the government and identifies priority areas for research, development, and implementation.

The recent movement in K-12 education toward common standards in key subjects represents an unprecedented opportunity for improving learning outcomes for all students. These standards initiatives - the Common Core State Standards for English Language Arts and Mathematics (CCSS) and the Next Generation Science Standards (NGSS) - are informed by research on learning and teaching and a decade of standards-based education reform. While the standards have been developed separately in English/Language Arts and Science, there are areas where the standards intersect directly. One such area of intersection occurs between the "Literacy in Science" portions of the Common Core State Standards for English/Language Arts and the practices in the NGSS (originally outlined in the NRC's A Framework for K-12 Science Education), particularly the practice of "Obtaining, evaluating and communicating information". Because the CCSS literacy in science standards predated the NGSS, developers of the NGSS worked directly with the CCSS team to identify the connections between the two sets of standards. However, questions about how the two sets of standards can complement each other and can be used in concert to improve students' reading and writing, as well as listening and speaking, in science to learn science continue to exist. Literacy for Science is the summary of a workshop convened by the National Research Council Board on Science Education in December 2013 to address the need to coordinate the literacy for science aspect of CCSS and the practices in NGSS. The workshop featured presentations about the complementary roles of English/language arts teachers and science teachers as well as the unique challenges and approaches for different grade levels. Literacy for Science articulates the knowledge and skills teachers need to support students in developing competence in reading and communicating in science. This report considers design options for curricula and courses that provide aligned support for students to develop competencies in reading and communicating, and addresses the role of district and school administrators in guiding implementation of science and ELA to help ensure alignment. Literacy for Science will be a useful point of reference for anyone interested in the opportunities and challenges of overlapping science and literacy standards to improve the learning experience.

The Everglades ecosystem is vast, stretching more than 200 miles from Orlando to Florida Bay, and Everglades National Park is but a part located at the southern end. During the 19th and 20th centuries, the historical Everglades has been reduced to half of its original size, and what remains is not the pristine ecosystem many image it to be, but one that has been highly engineered and otherwise heavily influenced, and is intensely managed by humans. Rather than slowly flowing southward in a broad river of grass, water moves through a maze of canals, levees, pump stations, and hydraulic control structures, and a substantial fraction is diverted from the natural system to meet water supply and flood control needs. The water that remains is polluted by phosphorus and other contaminants originating from agriculture and other human activities. Many components of the natural system are highly degraded and continue to degrade. Progress Toward Restoring the Everglades is the fifth biennial review of progress made in meeting the goals of the Comprehensive Everglades Restoration Plan (CERP). This complex, multibillion-dollar project to protect and restore the remaining Everglades has a 30-40 year timeline. This report assesses progress made in the various separate project components and discusses specific scientific and engineering issues that may impact further progress. According to Progress Toward Restoring the Everglades, a dedicated source of funding could provide ongoing long-term system-wide monitoring and assessment that is critical to meeting restoration objectives. The report makes recommendations for restoration activities, project management strategies, management of invasive nonnative species, and high-priority research needs.

"Advancing Diversity in the US Industrial Science and Engineering Workforce is the summary of a workshop held in May, 2012 by the National Academy of Engineering, focusing on the needs and challenges facing industry in particular, and it is intended to facilitate further discussion and actions to address these complex issues. The workshop provided a forum for leaders from industry, academia, and professional associations to share best practices and innovative approaches to recruiting, retaining, and advancing women and underrepresented minorities in the scientific and engineering workforce throughout the nation's industries."--

Every year, public and private funders spend many billions of dollars on large-scale, complex, multi-national health initiatives. The only way to know whether these initiatives are achieving their objectives is through evaluations that examine the links between program activities and desired outcomes. Investments in such evaluations, which, like the initiatives being evaluated, are carried out in some of the world's most challenging settings, are a relatively new phenomenon. In the last five years, evaluations have been conducted to determine the effects of some of the world's largest and most complex multi-national health initiatives. Evaluation Design for Complex Global Initiatives is the summary of a workshop convened by the Institute of Medicine in January 2014 to explore these recent evaluation experiences and to consider the lessons learned from how these evaluations were designed, carried out, and used. The workshop brought together more than 100 evaluators, researchers in the field of evaluation science, staff involved in implementing large-scale health programs, local stakeholders in the countries where the initiatives are carried out, policy makers involved in the initiatives, representatives of donor organizations, and others to derive lessons learned from past large-scale evaluations and to discuss how to apply these lessons to future evaluations. This report discusses transferable insights gained across the spectrum of choosing the evaluator, framing the evaluation, designing the evaluation, gathering and analyzing data, synthesizing findings and recommendations, and communicating key messages. The report also explores the relative benefits and limitations of different quantitative and qualitative approaches within the mixed methods designs used for these complex and costly evaluations.

The United States military is arguably the most intensely technological, complex enterprise in existence. When compared to the gross domestic products of other countries, the Department of Defense (DoD) budget ranks above all but about 20 nations. If viewed as a company, it would be the largest globally with the most employees. Major investments in weapons systems using advanced technologies provide an advantage over competing systems. Each weapon, platform, vehicle, and person in an operating force is a node in one or more advanced networks that provide the ability to rapidly form a coherent force from a large number of broadly distributed elements. DoD's ability to create and operate forces of this nature demands a competent understanding by its workforce of the composition, acquisition, and employment of its technology-enabled forces.Review of Specialized Degree-Granting Graduate Programs of the Department of Defense in STEM and Management focuses on the graduate science, technology, engineering, mathematics and management (STEM+M) education issues of the Air Force, Navy, and Marines. This report assesses the cost, benefits, and organizational placement of DoD institutions that grant degrees in STEM+M and evaluates alternative ways - for example, civilian institutions and distance learning - to ensure adequate numbers and high-quality education outcomes for DoD personnel.

Posttraumatic stress disorder (PTSD) is one of the signature injuries of the U.S. conflicts in Afghanistan and Iraq, but it affects veterans of all eras. It is estimated that 7-20% of service members and veterans who served in Operation Enduring Freedom and Operation Iraqi Freedom may have the disorder. PTSD is characterized by a combination of mental health symptoms - re-experiencing of a traumatic event, avoidance of trauma-associated stimuli, adverse alterations in thoughts and mood, and hyperarousal - that last at least 1 month and impair functioning. PTSD can be lifelong and pervade all aspects of a service member's or veteran's life, including mental and physical health, family and social relationships, and employment. It is often concurrent with other health problems, such as depression, traumatic brain injury, chronic pain, substance abuse disorder, and intimate partner violence. The Department of Defense (DoD) and the Department of Veterans Affairs (VA) provide a spectrum of programs and services to screen for, diagnose, treat for, and rehabilitate service members and veterans who have or are at risk for PTSD. The 2010 National Defense Authorization Act asked the Institute of Medicine to assess those PTSD programs and services in two phases. The Phase 1 study, Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Initial Assessment, focused on data gathering. Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations Final Assessment is the report of the second phase of the study. This report analyzes the data received in Phase 1 specifically to determine the rates of success for each program or method. Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations Final Assessment considers what a successful PTSD management system is and whether and how such a system is being implemented by DoD and VA. This includes an assessment of what care is given and to whom, how effectiveness is measured, what types of mental health care providers are available, what influences whether a service member or veteran seeks care, and what are the costs associated with that care. This report focuses on the opportunities and challenges that DoD and VA face in developing, implementing, and evaluating services and programs in the context of achieving a high-performing system to care for service members and veterans who have PTSD. The report also identifies where gaps or new emphases might be addressed to improve prevention of, screening for, diagnosis of, and treatment and rehabilitation for the disorder. The findings and recommendations of Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Final Assessment will encourage DoD and VA to increase their efforts in moving toward a high-performing, comprehensive, integrated PTSD management strategy that addresses the needs of current and future service members, veterans, and their families.

Subjective well-being refers to how people experience and evaluate their lives and specific domains and activities in their lives. This information has already proven valuable to researchers, who have produced insights about the emotional states and experiences of people belonging to different groups, engaged in different activities, at different points in the life course, and involved in different family and community structures. Research has also revealed relationships between people's self-reported, subjectively assessed states and their behavior and decisions. Research on subjective well-being has been ongoing for decades, providing new information about the human condition. During the past decade, interest in the topic among policy makers, national statistical offices, academic researchers, the media, and the public has increased markedly because of its potential for shedding light on the economic, social, and health conditions of populations and for informing policy decisions across these domains. Subjective Well-Being: Measuring Happiness, Suffering, and Other Dimensions of Experience explores the use of this measure in population surveys. This report reviews the current state of research and evaluates methods for the measurement. In this report, a range of potential experienced well-being data applications are cited, from cost-benefit studies of health care delivery to commuting and transportation planning, environmental valuation, and outdoor recreation resource monitoring, and even to assessment of end-of-life treatment options. Subjective Well-Being finds that, whether used to assess the consequence of people's situations and policies that might affect them or to explore determinants of outcomes, contextual and covariate data are needed alongside the subjective well-being measures. This report offers guidance about adopting subjective well-being measures in official government surveys to inform social and economic policies and considers whether research has advanced to a point which warrants the federal government collecting data that allow aspects of the population's subjective well-being to be tracked and associated with changing conditions.

The electric vehicle offers many promises--increasing U.S. energy security by reducing petroleum dependence, contributing to climate-change initiatives by decreasing greenhouse gas (GHG) emissions, stimulating long-term economic growth through the development of new technologies and industries, and improving public health by improving local air quality. There are, however, substantial technical, social, and economic barriers to widespread adoption of electric vehicles, including vehicle cost, small driving range, long charging times, and the need for a charging infrastructure. In addition, people are unfamiliar with electric vehicles, are uncertain about their costs and benefits, and have diverse needs that current electric vehicles might not meet. Although a person might derive some personal benefits from ownership, the costs of achieving the social benefits, such as reduced GHG emissions, are borne largely by the people who purchase the vehicles. Given the recognized barriers to electric-vehicle adoption, Congress asked the Department of Energy (DOE) to commission a study by the National Academies to address market barriers that are slowing the purchase of electric vehicles and hindering the deployment of supporting infrastructure. As a result of the request, the National Research Council (NRC)--a part of the National Academies--appointed the Committee on Overcoming Barriers to Electric-Vehicle Deployment. This committee documented their findings in two reports--a short interim report focused on near-term options, and a final comprehensive report. Overcoming Barriers to Electric-Vehicle Deployment fulfills the request for the short interim report that addresses specifically the following issues: infrastructure needs for electric vehicles, barriers to deploying the infrastructure, and possible roles of the federal government in overcoming the barriers. This report also includes an initial discussion of the pros and cons of the possible roles. This interim report does not address the committee's full statement of task and does not offer any recommendations because the committee is still in its early stages of data-gathering. The committee will continue to gather and review information and conduct analyses through late spring 2014 and will issue its final report in late summer 2014. Overcoming Barriers to Electric-Vehicle Deployment focuses on the light-duty vehicle sector in the United States and restricts its discussion of electric vehicles to plug-in electric vehicles (PEVs), which include battery electric vehicles (BEVs) and plug-in hybrid electric vehicles (PHEVs). The common feature of these vehicles is that their batteries are charged by being plugged into the electric grid. BEVs differ from PHEVs because they operate solely on electricity stored in a battery (that is, there is no other power source); PHEVs have internal combustion engines that can supplement the electric power train. Although this report considers PEVs generally, the committee recognizes that there are fundamental differences between PHEVs and BEVs.

"Workshop I: Interprofessional Education for Collaboration: Learning How to Improve Health from Interprofessional Models Across the Continuum of Education to Practice, August 29-30, 2012, The Keck Center of The National Academies"--Page 97.

Climate is changing, forced out of the range of the past million years by levels of carbon dioxide and other greenhouse gases not seen in the Earth's atmosphere for a very, very long time. Lacking action by the world's nations, it is clear that the planet will be warmer, sea level will rise, and patterns of rainfall will change. But the future is also partly uncertain--there is considerable uncertainty about how we will arrive at that different climate. Will the changes be gradual, allowing natural systems and societal infrastructure to adjust in a timely fashion? Or will some of the changes be more abrupt, crossing some threshold or "tipping point" to change so fast that the time between when a problem is recognized and when action is required shrinks to the point where orderly adaptation is not possible? Abrupt Impacts of Climate Change is an updated look at the issue of abrupt climate change and its potential impacts. This study differs from previous treatments of abrupt changes by focusing on abrupt climate changes and also abrupt climate impacts that have the potential to severely affect the physical climate system, natural systems, or human systems, often affecting multiple interconnected areas of concern. The primary timescale of concern is years to decades. A key characteristic of these changes is that they can come faster than expected, planned, or budgeted for, forcing more reactive, rather than proactive, modes of behavior. Abrupt Impacts of Climate Change summarizes the state of our knowledge about potential abrupt changes and abrupt climate impacts and categorizes changes that are already occurring, have a high probability of occurrence, or are unlikely to occur. Because of the substantial risks to society and nature posed by abrupt changes, this report recommends the development of an Abrupt Change Early Warning System that would allow for the prediction and possible mitigation of such changes before their societal impacts are severe. Identifying key vulnerabilities can help guide efforts to increase resiliency and avoid large damages from abrupt change in the climate system, or in abrupt impacts of gradual changes in the climate system, and facilitate more informed decisions on the proper balance between mitigation and adaptation. Although there is still much to learn about abrupt climate change and abrupt climate impacts, to willfully ignore the threat of abrupt change could lead to more costs, loss of life, suffering, and environmental degradation. Abrupt Impacts of Climate Change makes the case that the time is here to be serious about the threat of tipping points so as to better anticipate and prepare ourselves for the inevitable surprises.

Humans possess certain unique mental traits. Self-reflection, as well as ethic and aesthetic values, is among them, constituting an essential part of what we call the human condition. The human mental machinery led our species to have a self-awareness but, at the same time, a sense of justice, willing to punish unfair actions even if the consequences of such outrages harm our own interests. Also, we appreciate searching for novelties, listening to music, viewing beautiful pictures, or living in well-designed houses. But why is this so? What is the meaning of our tendency, among other particularities, to defend and share values, to evaluate the rectitude of our actions and the beauty of our surroundings? What brain mechanisms correlate with the human capacity to maintain inner speech, or to carry out judgments of value? To what extent are they different from other primates' equivalent behaviors? In the Light of Evolution Volume VII aims to survey what has been learned about the human "mental machinery." This book is a collection of colloquium papers from the Arthur M. Sackler Colloquium "The Human Mental Machinery," which was sponsored by the National Academy of Sciences on January 11-12, 2013. The colloquium brought together leading scientists who have worked on brain and mental traits. Their 16 contributions focus the objective of better understanding human brain processes, their evolution, and their eventual shared mechanisms with other animals. The articles are grouped into three primary sections: current study of the mind-brain relationships; the primate evolutionary continuity; and the human difference: from ethics to aesthetics. This book offers fresh perspectives coming from interdisciplinary approaches that open new research fields and constitute the state of the art in some important aspects of the mind-brain relationships.

"Science of Science and Innovation Policy summarizes a public conference convened by the Committee on National Statistics of the National Academy of Sciences/National Research Council to present research funded by SciSIP and foster intellectual exchange among funded researchers, science, technology, and innovation policy practitioners, and other members of the science community. The conference highlighted advances in the emerging field of the science of science and innovation policy, in particular, models, frameworks, tools, and datasets comprising the evidentiary basis for science and innovation policy. This report focuses on return on investment models; organizational structures that foster accelerated scientific productivity; linkages between commercialized scientific knowledge and job creation; the roles of universities and government in technology transfer and innovation; technology diffusion and economic growth; non-economic impacts of science and innovation expenditures; regional and global networks of knowledge generation and innovation; mechanisms for encouraging creativity and measuring outputs and outcomes from transformative research; and development, manipulation and visualization of data representing scientific activities."

"Benefit-cost analyses hold great promise for influencing policies related to children, youth, and families. By comparing the costs of preventive interventions with the long-term benefits of those interventions, benefit-cost analysis provides a tool for determining what kinds of investments have the greatest potential to reduce the physical, mental, and behavioral health problems of young people. More generally, the growth of benefit-cost analysis as a field of research and practice represents an exciting and promising trend in the development and implementation of public policies. [...] This report discusses a wide range of issues about benefit-cost analysis, including the level of research rigor that should be met before results from an evaluation are used to estimate or predict outcomes in a cost-benefit analysis; best practices and methodologies for costing prevention interventions; prevention outcomes that currently lend themselves to monetization; processes and methodologies that should be used when linking prevention outcomes to avoided costs or increased revenues; and best methods for handling risk and uncertainty in estimates."--Publisher's description

Convergence of the life sciences with fields including physical, chemical, mathematical, computational, engineering, and social sciences is a key strategy to tackle complex challenges and achieve new and innovative solutions. However, institutions face a lack of guidance on how to establish effective programs, what challenges they are likely to encounter, and what strategies other organizations have used to address the issues that arise. This advice is needed to harness the excitement generated by the concept of convergence and channel it into the policies, structures, and networks that will enable it to realize its goals. Convergence investigates examples of organizations that have established mechanisms to support convergent research. This report discusses details of current programs, how organizations have chosen to measure success, and what has worked and not worked in varied settings. The report summarizes the lessons learned and provides organizations with strategies to tackle practical needs and implementation challenges in areas such as infrastructure, student education and training, faculty advancement, and inter-institutional partnerships.

"Substantial empirical evidence of the contribution of social and behavioral factors to functional status and the onset and progression of disease has accumulated over the past few decades. Electronic health records (EHRs) provide crucial information to providers treating individual patients, to health systems, including public health officials, about the health of populations, and to researchers about the determinants of health and the effectiveness of treatment. Inclusion of social and behavioral health domains in EHRs is vital to all three uses. The Health Information Technology for Economic and Clinical Health Act and the Patient Protection and Affordable Care Act place new importance on the widespread adoption and meaningful use of EHRs. "Meaningful use" in a health information technology context refers to the use of EHRs and related technology within a health care organization to achieve specified objectives. Achieving meaningful use also helps determine whether an organization can receive payments from the Medicare EHR Incentive Program or the Medicaid EHR Incentive Program. Capturing Social and Behavioral Domains in Electronic Health Records is the first phase of a two-phase study to identify domains and measures that capture the social determinants of health to inform the development of recommendations for meaningful use of EHRs. This report identifies specific domains to be considered by the Office of the National Coordinator, specifies criteria that should be used in deciding which domains should be included, identifies core social and behavioral domains to be included in all EHRs, and identifies any domains that should be included for specific populations or settings defined by age, socioeconomic status, race/ethnicity, disease, or other characteristics."--

"Since its inception, the U.S. human spaceflight program has grown from launching a single man into orbit to an ongoing space presence involving numerous crewmembers. As the U.S. space program evolves, propelled in part by increasing international and commercial collaborations, long duration or exploration spaceflights - such as extended stays on the International Space Station or missions to Mars - become more realistic. These types of missions will likely expose crews to levels of known risk that are beyond those allowed by current health standards, as well as to a range of risks that are poorly characterized, uncertain, and perhaps unforeseeable. As the National Aeronautics and Space Administration (NASA) and Congress discuss the next generation of NASA's missions and the U.S. role in international space efforts, it is important to understand the ethical factors that drive decision making about health standards and mission design for NASA activities. NASA asked the Institute of Medicine to outline the ethics principles and practices that should guide the agency's decision making for future long duration or exploration missions that fail to meet existing health standards. Health Standards for Long Duration and Exploration Spaceflight identifies an ethics framework, which builds on the work of NASA and others, and presents a set of recommendations for ethically assessing and responding to the challenges associated with health standards for long duration and exploration spaceflight. As technologies improve and longer and more distant spaceflight becomes feasible, NASA and its international and commercial partners will continue to face complex decisions about risk acceptability. This report provides a roadmap for ethically assessing and responding to the challenges associated with NASA's health standards for long duration and exploration missions. Establishing and maintaining a firmly grounded ethics framework for this inherently risky activity is essential to guide NASA's decisions today and to create a strong foundation for decisions about future challenges and opportunities"--

"Although health literacy is commonly defined as an individual trait, it does not depend on the skills of individuals alone. Health literacy is the product of the interaction between individuals' capacities and the health literacy-related demands and complexities of the health care system. Specifically, the ability to understand, evaluate, and use numbers is important to making informed health care choices. Health Literacy and Numeracy is the summary of a workshop convened by The Institute of Medicine Roundtable on Health Literacy in July 2013 to discuss topics related to numeracy, including the effects of ill health on cognitive capacity, issues with communication of health information to the public, and communicating numeric information for decision making. This report includes a paper commissioned by the Roundtable, "Numeracy and the Affordable Care Act: Opportunities and Challenges," that discusses research findings about people's numeracy skill levels; the kinds of numeracy skills that are needed to select a health plan, choose treatments, and understand medication instructions; and how providers should communicate with those with low numeracy skills. The paper was featured in the workshop and served as the basis of discussion."--

Extremely hazardous substances can be released accidentally as a result of chemical spills, industrial explosions, fires, or accidents involving railroad cars and trucks transporting EHSs. Workers and residents in communities surrounding industrial facilities where these substances are manufactured, used, or stored and in communities along the nation's railways and highways are potentially at risk of being exposed to airborne extremely hazardous substances during accidental releases or intentional releases by terrorists. Pursuant to the Superfund Amendments and Reauthorization Act of 1986, the U.S. Environmental Protection Agency has identified approximately 400 extremely hazardous substances on the basis of acute lethality data in rodents. Acute Exposure Guideline Levels for Selected Airborne Chemicals, Volume 16 identifies, reviews, and interprets relevant toxicologic and other scientific data for selected aliphatic nitriles, benzonitrile, methacrylonitrile, allyl alcohol, hydrogen selenide, ketene, and tear gasin order to develop acute exposure guideline levels (AEGLs) for these high-priority, acutely toxic chemicals. AEGLs represent threshold exposure limits (exposure levels below which adverse health effects are not likely to occur) for the general public and are applicable to emergency exposures ranging from 10 minutes (min) to 8 h. Three levels - AEGL-1, AEGL-2, and AEGL-3 - are developed for each of five exposure periods (10 min, 30 min, 1 h, 4 h, and 8 h) and are distinguished by varying degrees of severity of toxic effects. This report will inform planning, response, and prevention in the community, the workplace, transportation, the military, and the remediation of Superfund sites.