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Antifungal use in plant agriculture is a widespread practice necessary to safeguard food safety and security. While the impact of antimicrobial resistance (AMR) is a significant global health concern, knowledge gaps exist surrounding antifungal resistance, the connection to plant agriculture, and its implications for human health. The National Academies Forum on Microbial Threats hosted a workshop series in June 2022 exploring the role of plant agricultural practices in AMR development and implications for human health, with a focus on plant crop production. Sessions explored the magnitude of environmentally induced/selected antifungal resistance connected to plant agriculture, agricultural practices that may contribute to AMR in human pathogens, and strategies for surveillance and mitigation.This Proceedings document summarizes workshop discussions.

The National Academies Forum on Traumatic Brain Injury (TBI) convened a workshop in September 2022 to explore biomarkers used to more precisely and objectively diagnose and categorize suspected TBIs. Session discussions addressed developments in TBI biomarker classes including neuroimaging, blood-based, electrophysiological, and other physiological markers; how biomarkers may be used to better guide and monitor treatment after injury; and how they can be used to refine future research studies. Speakers also discussed potential impacts of biomarkers across the trajectory of TBI care and research, efforts to translate and incorporate biomarkers from research settings into clinical practice, and opportunities to advance the field. This Proceedings of a Workshop summarizes the presentations and discussions from the event.

The Gulf Research Program of the National Academies of Sciences, Engineering, and Medicine has developed a program to strengthen community resilience, the Enhancing Community Resilience (EnCoRe) initiative. EnCoRe aims to reduce inequities in health and community resilience; advance research and practice in health and community resilience; and build the capacity of communities for addressing the impacts of climate change and disasters on at-risk populations. To achieve these goals, EnCoRe will support long-term, multiyear community engagement projects that partner directly with select communities across the Gulf region and Alaska. This report develops findings and recommendations intended to help guide EnCoRe in identifying, selecting, and engaging with communities as it moves forward with the initiative. Strengthening Equitable Community Resilience examines past and current community engagement efforts and other relevant materials, particularly those that have included communities in the Gulf region and Alaska, for the purpose of identifying guiding principles and lessons learned and then develops a set of guiding principles to identify criteria for selecting the participating communities in the EnCoRe program.

The National Academies Roundtable on Genomics and Precision Health, in collaboration with the National Cancer Policy Forum, hosted a public workshop that examined how genomic data are used in health care, outside of the traditional settings for clinical genetics. The workshop identified opportunities for advancement of precision health care delivery. The event also explored how patients, clinicians, and payers assess and act upon the risks and benefits of genomic screening and diagnostic testing. Discussions focused on strategies to ensure that genomic applications are responsibly and equitably adopted to benefit populations as well as individuals over time. This Proceedings of a Workshop summarizes content from the event.

"An accurate measure of poverty is necessary to fully understand how the economy is performing across all segments of the population and to assess the effects of government policies on communities and families. In addition, poverty statistics are essential in determining the size and composition of the population whose basic needs are going unmet and to help society target resources to address those needs.An Updated Measure of Poverty: (Re)Drawing the Line recommends updating the methodology used by the Census Bureau to calculate the Supplemental Poverty Measure (SPM) to reflect household basic needs. This report recommends that the more comprehensive SPM replace the current Official Poverty Measure as the primary statistical measure of poverty the Census Bureau uses. The report assesses the strengths and weaknesses of the SPM and provides recommendations for updating its methodology and expanding its use in recognition of the needs of most American families such as medical care, childcare, and housing costs."--

Genetic and genomic information has become far more accessible, and research using human genetic data has grown exponentially over the past decade. Genetics and genomics research is now being conducted by a wide range of investigators across disciplines, who often use population descriptors inconsistently and/or inappropriately to capture the complex patterns of continuous human genetic variation. In response to a request from the National Institutes of Health, the National Academies assembled an interdisciplinary committee of expert volunteers to conduct a study to review and assess existing methodologies, benefits, and challenges in using race, ethnicity, ancestry, and other population descriptors in genomics research. The resulting report focuses on understanding the current use of population descriptors in genomics research, examining best practices for researchers, and identifying processes for adopting best practices within the biomedical and scientific communities.

The Comprehensive Addiction and Recovery Act (CARA; P.L. 114-198) was signed into law in 2016 to help address the challenges of overdose deaths and opioid use disorder, and to expand access to evidence-based treatment. Among these efforts was the authorization of four grant programs to be overseen by the Substance Abuse and Mental Health Services Administration (SAMHSA). In 2018, SAMHSA requested that the National Academies establish a committee to conduct a review of the four programs, which focus primarily on opioids, but occasionally include treatment and recovery services for co-occurring substance use disorders. The review resulted in three consensus study reports over five years. This third and final report aims to (1) understand the processes of the four grant programs; actions taken by grantees and their partners; impacts to clients, patients, the community, and public; and structural or environmental changes that might have resulted from grant funding, and (2) analyze how future congressionally mandated evaluations can be structured and carried out to better support policy makers.

Most of the offshore oil and gas industry in the Gulf of Mexico has shown considerable improvement in systemic risk management, which is now approaching a middle stage of maturity across most risk elements. Advancing Understanding of Offshore Oil and Gas Systemic Risk in the U.S. Gulf of Mexico: Current State and Safety Reforms Since the Macondo Well-Deepwater Horizon Blowout assesses both industry and regulatory progress against the reforms that were recommended following the Deepwater Horizon disaster in 2010. The report also states that progress has been uneven, and critical gaps remain in comprehensively addressing the management of systemic risk offshore.

Roughly every four years, the U.S. Global Change Research Program produces a congressionally mandated assessment of global change science and the impacts, adaptation, and mitigation of climate change in the United States. The draft Fifth National Climate Assessment (NCA5), released publicly in November 2022, covers a wide range of U.S. impacts, from human health and community well-being to the built environment, businesses and economies, and ecosystems and water resources. NCA5 had the largest scale of collaboration to date in the series, with input from hundreds of experts from all levels of governments, academia, non-government organizations, the private sector, and the public. The National Academies report provides an independent, comprehensive review and makes recommendations to strengthen the accuracy, credibility, and accessibility of the draft NCA5 report. The National Academies' review of the draft NCA5 report finds that it successfully meets the requirements of the federal mandate, provides accurate information, and effectively communicates climate science to the public, decision makers, and other stakeholders. The review makes recommendations for ways the draft NCA5 report could be strengthened, including: adopting more clear and consistent structure for key messages and figures across the report; resolving inconsistencies between chapters in how terms and topics are discussed, for example the use of scenarios and projections; intentionally applying an equity and justice lens across chapters; and increasing emphasis on certain topical areas.

The COVID-19 pandemic has had an unprecedented impact on the lives of children and their families, who have faced innumerable challenges such as illness and death; school closures; social isolation; financial hardship; food insecurity; deleterious mental health effects; and difficulties accessing health care. In almost every outcome related to social, emotional, behavioral, educational, mental, physical, and economic health and well-being, families identifying as Black, Latino, and Native American, and those with low incomes, have disproportionately borne the brunt of the negative effects of the pandemic. The effects of the COVID-19 pandemic on children and families will be felt for years to come. While these long-term effects are unknown, they are likely to have particularly significant implications for children and families from racially and ethnically minoritized communities and with low incomes. Addressing the Long-Term Effects of the COVID-19 Pandemic on Children and Families identifies social, emotional, behavioral, educational, mental, physical, and economic effects of the COVID-19 pandemic and looks at strategies for addressing the challenges and obstacles that the pandemic introduced for children and families in marginalized communities. This report provides recommendations for programs, supports, and interventions to counteract the negative effects of the pandemic on child and family well-being and offers a path forward to recover from the harms of the pandemic, address inequities, and prepare for the future.

Spatial justice is about equitable access to parks, housing, and more. During societal emergencies, including pandemics and climate change, the relationship between people and places requires greater attention and action to integrate the knowledge of people with lived experience, especially historically marginalized communities. On September 20 and 21, 2021, the National Academies Roundtable on Population Health Improvement hosted a virtual workshop to explore the nature, use, design of, threats, and changes to places as a resource for health and public spaces as a shared resource. This Proceedings document summarizes workshop discussions.

On September 22, 2022, the National Academy of Sciences held a symposium entitled Endless Frontier 2022: Research and Higher Education Institutions for the Next 75 Years. The event was a follow up to a February 2020 NAS symposium convened to celebrate the 75th anniversary of the landmark report Science, the Endless Frontier. Building on the 2020 symposium and on lessons learned during the COVID-19 pandemic, the September 2022 symposium sought to generate tools, strategies, and actionable steps that people and institutions can implement to ensure that science and technology continue to serve the public good. The symposium was designed to progress from broad perspectives that encompass the entire science and technology enterprise to consideration of more specific issues. This proceedings summarizes the 2022 symposium.

After the Exxon Valdez oil spill in 1989, advancing oil pollution research and technology to limit the environmental impacts of oil spills became a national and international priority. Congress responded by enacting the Oil Pollution Act of 1990 and forming the Interagency Coordinating Committee on Oil Pollution Research (ICCOPR) to coordinate research for preventing, planning for, responding to, and mitigating the effects of oil pollution on the environment. To achieve this end, ICCOPR published the oil pollution research and technology plan to guide research and funding priorities in 1992, with updates released over the years, most recently, the 2022-2027 Research and Technology Plan. This new report provides advice and guidance on the approach, structure, adequacy, and implementation of ICCOPR 2022-2027 Research and Technology Plan. Coordinated research efforts are necessary so knowledge and capacity related to oil spill prevention, preparedness, response, mitigation, and restoration can be advanced. Future updates of the plan should utilize a more streamlined, transparent, and community-driven development process including development of an oil pollution research dashboard and inclusion of metrics to assess and communicate progress on oil pollution research priorities. ICCOPR should also initiate processes to allow for open-water field trials when appropriate. The report recommendations were developed to assist ICCOPR with developing a Research and Technology Plan that can be widely used to promote progress, coordination, and collaboration on priority oil pollution research needs within the United States and globally - research needs that are important for improving knowledge, capacity, and regulations to safeguard the environment.

On September 13 and 14, 2022, the Board on Science Education at the National Academies of Sciences, Engineering, and Medicine held a workshop entitled Foundations of Data Science for Students in Grades K-12. Speakers and participants explored the rapidly growing field of K-12 data science education, by surveying the current landscape, surfacing what is known, and identifying what is needed to support student learning, develop curriculum and tools, and prepare educators. To support these conversations, four papers were commissioned and discussed during the workshop. This publication summarizes the presentations and discussion of the workshop.

Since its establishment in 1970, the mission of the Environmental Protection Agency is to protect human health and the environment. EPA develops regulations, ensures compliance, and issues policies, in coordination with state, tribal, and local governments. To accomplish its mission, EPA should be equipped to produce and access the highest quality and most advanced science. The Office of Research and Development (ORD) provides the scientific bases for regulatory and public health policies that have broad impacts on the nation's natural resources and quality of human life, and that yield economic benefits and incur compliance costs for the regulated community. In addition, ORD develops the agency core research capabilities, providing tools and methods for meeting current and anticipating future environmental challenges, such as the risks to health and the environment posed by climate change. Because challenges associated with environmental protection today are complex and affected by many interacting factors, the report points to the need for a substantially broader and better integrated approach to environmental protection. This report calls for EPA ORD to pursue all of its scientific aims in a new framework--to apply systems thinking to a One Environment ? One Health approach in all aspects of ORD work. To accomplish this, the report provides actionable recommendations on how ORD might consider incorporating emerging science and systems thinking into the agency research planning, so that ORD can become an increasingly impactful organization. The report identifies a number of high-priority recommendations for ORD to pursue in taking advantage of a broad range of advanced tools, in concert with collaborators in other federal agencies and the broader scientific community. Given the resource constraints, the report recognizes that ORD will have to make decisions about priorities for implementing its recommendations, and that ORD leadership is in the best position to set those priorities as implementation begins. The report concluded by stating that shifting to a systems-thinking approach will require renewed support from science leadership, enhanced strategic planning, investment in new and broader expertise and tools, and a reimagined and inclusive commitment to communication and collaboration.

Whole health is physical, behavioral, spiritual, and socioeconomic well-being as defined by individuals, families, and communities. Whole health care is an interprofessional, team-based approach anchored in trusted relationships to promote well-being, prevent disease, and restore health. It aligns with a person's life mission, aspiration, and purpose. It shifts the focus from a reactive disease-oriented medical care system to one that prioritizes disease prevention, health, and well-being. It changes the health care conversation from "What's wrong with you?" to "What matters to you?"The Department of Veterans Affairs (VA), the Samueli Foundation, and the Whole Health Institute commissioned the National Academies of Sciences, Engineering, and Medicine to establish a committee to provide guidance on how to fill gaps and create processes to accelerate the transformation to whole health care for veterans, both inside and outside the VA system, and the rest of the U.S. population. The resulting report presents findings and recommendations that provide a roadmap for improving health and well-being for veterans and the nation.

The United States real property portfolio is critical infrastructure that provides places and means for the federal government to operate and generate the products, services, security, and assurances that contribute to national prosperity and values. This report identifies broad-based, practical, and compelling strategies for securing continuing investment in the renewal of federal real properties and portfolios. Strategies to Renew Federal Facilities focuses on the how- not the what - for adapting, repurposing, restoring, recapitalizing, and replacing real property assets.

On August 18-19, 2022, the National Academy of Engineering (NAE) held a symposium to explore how support of fundamental engineering and engineering education research by the National Science Foundation (NSF) has led to positive societal and economic impacts. The symposium - which was sponsored by the NSF Directorate for Engineering - was held to provide input to the NAE Committee on Extraordinary Engineering Impacts on Society as part of a larger effort to develop clear, compelling narratives for the public about the sources and effects of engineering innovations. Speakers at the symposium shared their personal stories and provided insights on how engineers influence not only technology and the national infrastructure but the economy, population health, manufacturing, disaster resilience, and many other aspects of daily life. This publication summarizes the presentations and discussion of the symposium.

The National Institute of Standards and Technology (NIST) provides critical impact to the nation through standards development and cutting-edge research, with a mission to promote U.S. innovation and industrial competitiveness by advancing measurement science, standards, and technology in ways that enhance economic security and improve quality of life. NIST supports innovative manufacturing that impacts the U.S. economy and national security. The NIST mission is accomplished primarily at its campuses in Gaithersburg, Maryland, and Boulder, Colorado. At the request of NIST, Technical Assessment of the Capital Facility Needs of the National Institute of Standards and Technology assesses the comprehensive capital needs of the NIST campuses. This report evaluates current strategies and tools for capital facilities assessment, and methods for determining annual funding levels for sustainment, restoration, and modernization. The report makes recommendations for facility management strategies that will provide the functionality needed by world-class scientists on vital assignments of national consequence.

Studies show that people commonly have psychotic symptoms for over a year before receiving treatment. Reducing this duration is critical, because early treatment is strongly associated with better outcomes. The National Academies Forum on Mental Health and Substance Use Disorders hosted a workshop in July 2022 to examine the current evidence on short- and long-term outcomes for people at high risk for psychosis. Speakers explored potential policy solutions and strategies that are most effective for coordinated, early-intervention specialty services. This Proceedings document summarizes workshop discussions.

At the request of the director of the National Institute of Standards and Technology, this report assesses the management of Standards and Technology Communications Technology Laboratory (CTL), focusing on the work, facilities, equipment, personnel, portfolios of scientific expertise, and effective dissemination of the results.

"Extreme weather and wildfires, intensified by climate change, are damaging the native plant communities of landscapes across the United States. Native plant communities are foundational to thriving ecosystems, delivering goods and services that regulate the environment and support life, provide food and shelter for a wide range of native animals, and embody a wealth of genetic information with many beneficial applications. Restoring impaired ecosystems requires a supply of diverse native plant seeds that are well suited to the climates, soils, and other living species of the system.This report examines the needs for native plant restoration and other activities, provides recommendations for improving the reliability, predictability, and performance of the native seed supply, and presents an ambitious agenda for action. An Assessment of Native Seed Needs and the Capacity for Their Supply considers the various challenges facing our natural landscapes and calls for a coordinated public-private effort to scale-up and secure a cost-effective national native seed supply."--

The National Academies Board on Population Health and Public Health Practice, Board on Environmental Studies and Toxicology, and Board on Children Youth and Families convened a workshop in August 2022 to explore the impact of specific environmental exposures in utero, infancy, early childhood, and adolescence. Experts in epidemiology, toxicology, dose response methodology, and exposure science explored gaps in knowledge around vulnerabilities to environmental hazards as well as opportunities to inform public policy moving forward. This Proceedings of the workshop summarizes important discussions held during the virtual event and outlines recommendations for ways the Environmental Protection Agency can incorporate new research methods into its risk assessments.

"The COVID-19 pandemic spurred a rapid expansion of wastewater-based infectious disease surveillance systems to monitor and anticipate disease trends in communities.The Centers for Disease Control and Prevention (CDC) launched the National Wastewater Surveillance System in September 2020 to help coordinate and build upon those efforts. Produced at the request of CDC, this report reviews the usefulness of community-level wastewater surveillance during the pandemic and assesses its potential value for control and prevention of infectious diseases beyond COVID-19.Wastewater-based Disease Surveillance for Public Health Action concludes that wastewater surveillance is and will continue to be a valuable component of infectious disease management. This report presents a vision for a national wastewater surveillance system that would track multiple pathogens simultaneously and pivot quickly to detect emerging pathogens, and it offers recommendations to ensure that the system is flexible, equitable, and economically sustainable for informing public health actions. The report also recommends approaches to address ethical and privacy concerns and develop a more representative wastewater surveillance system. Predictable and sustained federal funding as well as ongoing coordination and collaboration among many partners will be critical to the effectiveness of efforts moving forward."--

In 2021, the Gulf Research Program of the National Academies of Sciences, Engineering, and Medicine sponsored a two-year consensus study, Managed Retreat in the U.S. Gulf Coast Region, to examine and make findings and recommendations regarding the unique challenges associated with managed retreat among vulnerable coastal communities in the region. To gather information for the consensus report, the authoring committee convened a series of three public workshops in the Gulf Coast region. The workshops, held in June and July of 2022, focused on policy and practice considerations, research and data needs, and community engagement strategies. This publication summarizes the presentations and discussions of the workshops.

"The Dietary Reference Intakes (DRIs) are a set of reference values that encompass a safe range of intake and provide recommended nutrient intakes for the United States and Canada. The DRIs for energy are used widely to provide guidance for maintaining energy balance on both an individual and group level.U.S. and Canadian governments asked the National Academies to convene an expert committee to examine available evidence and provide updated Estimated Energy Requirements (EERs) for their populations. The resulting report presents EER equations that provide a baseline for dietary planners and assessors who are estimating energy needs and monitoring energy balance to enhance the general health of individuals and populations."--

Antarctica and the Southern Ocean are important research locations for many scientific disciplines, including oceanography, biology, and astronomy. Because of its remoteness and the extreme and dangerous weather conditions in which researchers must operate, research in this region presents many unique challenges. New and improved technologies can make Antarctic research safer, more efficient, and capable of covering a greater spatial and temporal range, all while minimizing the costs and environmental impacts of this research. At the request of the National Science Foundation Office of Polar Programs, the Polar Research Board of the National Academies of Sciences, Engineering, and Medicine convened a workshop on May 3-5, 2022, to solicit broad community ideas regarding how technological developments can advance and expand Antarctic research and polar research more generally. Workshop participants discussed recent and potential technological breakthroughs, cross-cutting research themes, and how new technologies can facilitate broader, more diverse participation in Antarctic research. This publication summarizes the presentations and discussions of the workshop.

The U.S. Army is working on a major science and technology development program to build the Strategic Long Range Cannon to fire a hypersonic projectile 1,000 miles. At the request of the Deputy Assistant Secretary of the Army for Research and Technology, the Committee on Assessing the Feasibility of the Strategic Long Range Cannon made recommendations for the U.S. Army in the following categories: organizational, operational, and technical demonstration development areas. This publication is the unclassified summary of the full, classified report.

COVID-19 has proven among the worst public health crises in a generation. Public health emergencies (PHE) have always been anticipated. Despite the growing field of PHE preparedness and planning since the turn of the twenty-first century and the preparedness plans and exercises developed, the U.S. experienced a suboptimal national response to the emergence of COVID-19 in early 2020 compared to other countries. To explore the U.S. PHE preparedness enterprise, the National Academies Forum on Medical and Public Health Preparedness for Disasters and Emergencies convened a workshop in May 2022. They invited participants from government, NGO, and private sector organizations to consider key components, success stories, and failure points in order to identify opportunities for more effective catastrophic disaster, pandemic, and other large scale PHEs planning at the federal, state, local, tribal, and territorial levels. This Proceedings of a Workshop summarizes the discussions held during the workshop.