Bøger udgivet af National Academies Press

"Advance Care Planning(ACP)has long been a staple of caring for people with serious illness. Over its history, it has been defined in different ways. Clinicians, researchers, patients, and the public have developed a variety of perspectives about the many aspects of ACP, ranging from the definition to the timing, goals, outcomes, and value of ACP. To better understand the challenges and opportunities for ACP, acknowledge and highlight divergent viewpoints, and examine what is empirically known and not known about ACP and its outcomes, the National Academies of Sciences, Engineering, and Medicine's Roundtable on Quality Care for People with Serious Illness hosted a virtual public workshop, Advance Care Planning: Challenges and Opportunities, on October 26 and November 2, 2020. The workshop explored the paradox of ACP, its evidence base, ways to think differently about ACP, and various approaches to making it more effective.This Proceedings of a Workshop summarizes the presentations and discussions from that workshop." --

"At the request of Congress, this report presents findings and recommendations related to governance of the U.S. government's monitoring, detection, and verification (MDV) enterprise and offers findings and recommendations related to technical MDV capabilities and research, development, test, and evaluation efforts, focused in particular on the nuclear fuel cycle, nuclear test explosions, and arms control." --

"A virtual workshop titled Integrating Systems and Sectors Toward Obesity Solutions, held April 6, 2020 (Part I), and June 30, 2020 (Part II), was convened by the Roundtable on Obesity Solutions, Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine. The workshop introduced the concept of complex systems and the field of systems science, and explored systems science approaches to obesity solutions. Speakers provided an overview of systems science theories, approaches, and applications, highlighting examples from within and outside the obesity field. Presentations and discussions examined complex systems in society that have the potential to shape public health and well-being, and considered opportunities for systems change as they relate to obesity solutions. Specifically, the workshop explored factors that can influence obesity - such as (in)equity, relationships, connections, networks, capacity, power dynamics, social determinants, and political will - and how these factors can impact communications and cross-sector collaboration to address obesity. This publication summarizes the presentations and discussion of the workshop." --

"One in five people in the United States had a sexually transmitted infection (STI) on any given day in 2018, totaling nearly 68 million estimated infections. STIs are often asymptomatic (especially in women) and are therefore often undiagnosed and unreported. Untreated STIs can have severe health consequences, including chronic pelvic pain, infertility, miscarriage or newborn death, and increased risk of HIV infection, genital and oral cancers, neurological and rheumatological effects. In light of this, the Centers for Disease Control and Prevention, through the National Association of County and City Health Officials, commissioned the National Academies of Sciences, Engineering, and Medicine to convene a committee to examine the prevention and control of sexually transmitted infections in the United States and provide recommendations for action. In 1997, the Institute of Medicine released a report, The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Although significant scientific advances have been made since that time, many of the problems and barriers described in that report persist today; STIs remain an underfunded and comparatively neglected field of public health practice and research. The committee reviewed the current state of STIs in the United States, and the resulting report, Sexually Transmitted Infections: Advancing a Sexual Health Paradigm, provides advice on future public health programs, policy, and research." --

"Government statistics are widely used to inform decisions by policymakers, program administrators, businesses and other organizations as well as households and the general public. Principles and Practices for a Federal Statistical Agency, Seventh Edition will assist statistical agencies and units, as well as other agencies engaged in statistical activities, to carry out their responsibilities to provide accurate, timely, relevant, and objective information for public and policy use. This report will also inform legislative and executive branch decision makers, data users, and others about the characteristics of statistical agencies that enable them to serve the public good." --

Regenerative medicine products, which are intended to repair or replace damaged cells or tissues in the body, include a range of therapeutic approaches such as cell- and gene-based therapies, engineered tissues, and non-biologic constructs. The current approach to characterizing the quality of a regenerative medicine product and the manufacturing process often involves measuring as many endpoints as possible, but this approach has proved to be inadequate and unsustainable. The Forum on Regenerative Medicine of the National Academies of Sciences, Engineering, and Medicine convened experts across disciplines for a 2-day virtual public workshop to explore systems thinking approaches and how they may be applied to support the identification of relevant quality attributes that can help in the optimization of manufacturing and streamline regulatory processes for regenerative medicine. A broad array of stakeholders, including data scientists, physical scientists, industry researchers, regulatory officials, clinicians, and patient representatives, discussed new advances in data acquisition, data analysis and theoretical frameworks, and how systems approaches can be applied to the development of regenerative medicine products that can address the unmet needs of patients. This publication summarizes the presentation and discussion of the workshop.

Climate change is creating impacts that are widespread and severe for individuals, communities, economies, and ecosystems around the world. While efforts to reduce emissions and adapt to climate impacts are the first line of defense, researchers are exploring other options to reduce warming. Solar geoengineering strategies are designed to cool Earth either by adding small reflective particles to the upper atmosphere, by increasing reflective cloud cover in the lower atmosphere, or by thinning high-altitude clouds that can absorb heat. While such strategies have the potential to reduce global temperatures, they could also introduce an array of unknown or negative consequences. This report concludes that a strategic investment in research is needed to enhance policymakers' understanding of climate response options. The United States should develop a transdisciplinary research program, in collaboration with other nations, to advance understanding of solar geoengineering's technical feasibility and effectiveness, possible impacts on society and the environment, and social dimensions such as public perceptions, political and economic dynamics, and ethical and equity considerations. The program should operate under robust research governance that includes such elements as a research code of conduct, a public registry for research, permitting systems for outdoor experiments, guidance on intellectual property, and inclusive public and stakeholder engagement processes.

Accumulating evidence gathered over the past three decades has demonstrated a biological basis for differences between men and women with respect to clinical features and treatment responses to several neuropsychiatric, neurodevelopmental, and neurodegenerative disorders. Dramatic sex differences have also been identified in the brain transcriptomes of individuals with multiple brain disorders, including depression, posttraumatic stress disorder, and autism. The brain transcriptome includes all of the messenger RNA as well as the non-protein-coding RNA molecules expressed in brain tissue and thus represents gene activity. To explore these sex-based transcriptomic differences further, the National Academies of Sciences, Engineering, and Medicine's Forum on Neuroscience and Nervous System Disorders hosted a workshop on September 23, 2020, titled Sex Differences in Brain Disorders: Emerging Transcriptomic Evidence and Implications for Therapeutic Development. The workshop brought together a broad spectrum of stakeholders to share cutting-edge emerging evidence, discuss challenges, and identify future opportunities and potential directions. This publication summarizes the presentation and discussion of the workshop.

Space Nuclear Propulsion for Human Mars Exploration identifies primary technical and programmatic challenges, merits, and risks for developing and demonstrating space nuclear propulsion technologies of interest to future exploration missions. This report presents key milestones and a top-level development and demonstration roadmap for performance nuclear thermal propulsion and nuclear electric propulsion systems and identifies missions that could be enabled by successful development of each technology.

"Millions of people are living with dementia in the United States and globally. To live well with dementia, people need care, services, and supports that reflect their values and preferences, build on their strengths and abilities, promote well-being, and address needs that evolve as cognitive impairment deepens. Persons living with dementia co-manage their care with or rely on the support of a wide range of care partners and caregivers, including spouses, other family members and friends, and direct care workers in homes or residential care settings. While dementia care has improved since the 1970s, many individuals still lack access to high-quality care and are not living as well as they might. Disadvantaged groups, especially racial and ethnic minorities, still face challenges in access to care, services, and supports, due to deep and persistent inequities. Meeting the Challenge of Caring for Persons Living with Dementia and Their Care Partners and Caregivers: A Way Forward examines the complex body of evidence on dementia care and informs decision making about which interventions are ready to be broadly disseminated and implemented. It also offers a blueprint to guide future research using rigorous, cutting-edge methods that are inclusive, equitable, and yield critical information for real-world implementation, toward the ultimate goal of better supporting persons living with dementia and their care partners and caregivers in living as well as possible." --

To explore various aspects of faculty development, the Global Forum on Innovation in Health Professional Education of the National Academies of Sciences, Engineering, and Medicine held a virtual workshop in August 2020 titled Health Professions Faculty for the Future. At the workshop, presenters provided examples of how educators are using effective teaching strategies and of practices in health professional education. This publication summarizes the presentation and discussion of the workshop.

The U.S. Department of Energy (DOE) and its predecessor agencies have conducted activities to develop atomic energy for civilian and defense purposes since the initiation of the World War II Manhattan Project in 1942. These activities took place at large federal land reservations of hundreds of square miles involving industrial-scale operations, but also at many smaller federal and non-federal sites such as uranium mines, materials processing and manufacturing facilities. The nuclear weapons and energy production activities at these facilities produced large quantities of radioactive and hazardous wastes and resulted in widespread groundwater and soil contamination at these sites. DOE initiated a concerted effort to clean up these sites beginning in the 1980s. Many of these sites have been remediated and are in long-term caretaker status, closed or repurposed for other uses. Review of the Effectiveness and Efficiency of Defense Environmental Cleanup Activities of the Department of Energy's Office of Environmental Management: First Report provides background information on the sites currently assigned to the DOE's Office of Environmental Management that are undergoing cleanup; discusses current practices for management and oversight of the cleanups; offers findings and recommendations on such practices and how progress is measured against them; and considers the contracts under which the cleanups proceed and how these have been and can be structured to include incentives for improved cost and schedule performance.

Student wellbeing is foundational to academic success. One recent survey of postsecondary educators found that nearly 80 percent believed emotional wellbeing is a "very" or "extremely" important factor in student success. Studies have found the dropout rates for students with a diagnosed mental health problem range from 43 percent to as high as 86 percent. While dealing with stress is a normal part of life, for some students, stress can adversely affect their physical, emotional, and psychological health, particularly given that adolescence and early adulthood are when most mental illnesses are first manifested. In addition to students who may develop mental health challenges during their time in postsecondary education, many students arrive on campus with a mental health problem or having experienced significant trauma in their lives, which can also negatively affect physical, emotional, and psychological wellbeing. The nation's institutions of higher education are seeing increasing levels of mental illness, substance use and other forms of emotional distress among their students. Some of the problematic trends have been ongoing for decades. Some have been exacerbated by the COVID-19 pandemic and resulting economic consequences. Some are the result of long-festering systemic racism in almost every sphere of American life that are becoming more widely acknowledged throughout society and must, at last, be addressed. Mental Health, Substance Use, and Wellbeing in Higher Education lays out a variety of possible strategies and approaches to meet increasing demand for mental health and substance use services, based on the available evidence on the nature of the issues and what works in various situations. The recommendations of this report will support the delivery of mental health and wellness services by the nation's institutions of higher education.

To address approaches to the respirator approval process in the current landscape for both occupational and non-occupational use of respirators, the National Academies of Sciences, Engineering, and Medicine's Standing Committee on Personal Protective Equipment for Workplace Safety and Health convened a virtual workshop, Current Issues in the Assessment of Respiratory Protective Devices: Nontraditional Workers and Public Use on August 4-5, 2020. Additionally, the workshop considered gaps in respiratory protection for outdoor workers and the general public. This publication summarizes the presentation and discussion of the workshop.--Publisher's website.

"The Committee on National Statistics of the National Academies of Sciences, Engineering, and Medicine convened a 2-day public workshop from December 11-12, 2019, to discuss the suite of data products the Census Bureau will generate from the 2020 Census. The workshop featured presentations by users of decennial census data products to help the Census Bureau better understand the uses of the data products and the importance of these uses and help inform the Census Bureau's decisions on the final specification of 2020 data products. This publication summarizes the presentation and discussion of the workshop." --

"During the last century and today, the Tennessee walking horse has been used primarily for pleasure and show competition. Unique and natural to the breed is a smooth four-beat "running walk" gait. In the 1950s the accentuated or exaggerated running walk, known as the "big lick" became popular at high-level competitions. The combination of exaggerated high-action step in front and long stride behind is still considered desirable in today's horse show competitions, and it is often achieved through soring. Soring is the practice of applying a substance or mechanical device to the lower limb of a horse that will create enough pain that the horse will exaggerate its gait to relieve the discomfort. In 1970 Congress put into law the Horse Protection Act (HPA) to specifically address the practice of soring by prohibiting the showing, exhibition, or sale of Tennessee walking horses that are found to be sore. Sadly, soring is still being done even after 50 years of HPA enforcement. This report reviews the methods for detecting soreness in horses, in hopes of advancing the goal of ultimately eliminating the act of soring in horses and improving the welfare of Tennessee walking horses. A Review of Methods for Detecting Soreness in Horses examines what is known about the quality and consistency of available methods to identify soreness in horses; identifies potential new and emerging methods, approaches, and technologies for detecting hoof and pastern pain and its causes; and identifies research and technology needs to improve the reliability of methods to detect soreness. This independent study will help ensure that HPA inspection protocols are based on sound scientific principles that can be applied with consistency and objectivity." --

The conditions and characteristics of correctional facilities - overcrowded with rapid population turnover, often in old and poorly ventilated structures, a spatially concentrated pattern of releases and admissions in low-income communities of color, and a health care system that is siloed from community public health - accelerates transmission of the novel coronavirus (SARS-CoV-2) responsible for COVID-19. Such conditions increase the risk of coming into contact with the virus for incarcerated people, correctional staff, and their families and communities. Relative to the general public, moreover, incarcerated individuals have a higher prevalence of chronic health conditions such as asthma, hypertension, and cardiovascular disease, making them susceptible to complications should they become infected. Indeed, cumulative COVID-19 case rates among incarcerated people and correctional staff have grown steadily higher than case rates in the general population. Decarcerating Correctional Facilities during COVID-19 offers guidance on efforts to decarcerate, or reduce the incarcerated population, as a response to COIVD-19 pandemic. This report examines best practices for implementing decarceration as a response to the pandemic and the conditions that support safe and successful reentry of those decarcerated.

Over the past decade there has been a growing interest in sustainability education in colleges and universities across the United States, with a marked increase in the number of undergraduate and graduate degree programs, research institutes, and centers focused on sustainability. Evidence-based core competencies for interdisciplinary sustainability programs can provide suitable guidance for curricular and program development, research, policy, communication, and pedagogical approaches at academic institutions. They can also serve as a guide for students to select academic programs and potential career options, a reference for employers to understand qualifications of graduates, and the foundation for a potential specialized accreditation for interdisciplinary sustainability programs. The growing demand for well-qualified sustainability professionals within the public, private, and nonprofit sectors also points to the value of developing core competencies. Strengthening Sustainability Programs and Curricula at the Undergraduate and Graduate Levels provides expert insights for strengthening the emerging discipline of sustainability in higher education in the United States. This report describes the local, national, and global landscape related to sustainability education; examines the history and current status of sustainability education programs in the United States and globally; discusses employment prospects for sustainability graduates in terms of the opportunities and the skills that employers seek; and addresses diversity, equity, and inclusion in sustainability-related education and employment.

"Committe on the role of authentic STEM learning experiences in developing interest and competencies for computing"

The radio frequency spectrum is a limited resource with ever increasing demand from an expansive range of applications--all the way from commercial, such as mobile phones, to scientific, such as hurricane monitoring from space. Since radio waves do not stop at national borders, international regulation is necessary to ensure effective use of the radio spectrum for all parties. Every 2 to 5 years, the International Telecommunication Union convenes a World Radiocommunication Conference (WRC) to review and revise the international radio regulations. This report provides guidance to U.S. spectrum managers and policymakers as they prepare for the WRC in 2019. While the resulting document is targeted primarily at U.S. agencies dealing with radio spectrum issues, other Administrations and foreign scientific users may find its recommendations useful in their own WRC planning.

"Plasma Science and Engineering transforms fundamental scientific research into powerful societal applications, from materials processing and healthcare to forecasting space weather. Plasma Science: Enabling Technology, Sustainability, Security and Exploration discusses the importance of plasma research, identifies important grand challenges for the next decade, and makes recommendations on funding and workforce. This publication will help federal agencies, policymakers, and academic leadership understand the importance of plasma research and make informed decisions about plasma science funding, workforce, and research directions." --

On December 5, 2019, the Roundtable on Population Health Improvement of the National Academies of Sciences, Engineering, and Medicine convened a workshop to explore the factors that affect the health and well-being of middle-school-aged adolescents. The workshop included presentations on the risk factors of poor physical, social, and emotional outcomes and their prevalence; the identification of resilience factors; current policies and programs designed to support middle school success and address issues of equity and financing as they apply to these; and how the health and human services sectors can support and align with the education sector to promote health and well-being in middle school. This publication summarizes the presentations and discussions that took place during the workshop.

With rapidly rising rates of mental health disorders, changing patterns of occurrence, and increasing levels of morbidity, the need for a better understanding of the developmental origins and influence of mental health on children's behavioral health outcomes has become critical. This need for better understanding extends to both the growing prevalence of mental health disorders as well as the role and impact of neurodevelopmental pathways in their onset and expression. Addressing these changes in disease patterns and effects on children and families will require a multifaceted approach that goes beyond simply making changes to clinical care or adding personnel to the health services system. New policies, financing, and implementation can put established best practices and numerous research findings from around the country into action. The Maternal and Child Health Life Course Intervention Research Network and the Forum for Children's Well-Being at the National Academies of Sciences, Engineering, and Medicine jointly organized a webinar series to explore how mental health disorders develop over the life course, with a special emphasis on prenatal, early, middle, and later childhood development. This series centered on identifying gaps in our knowledge, exploring possible new strategies for using existing data to enhance understanding of the developmental origins of mental disorders, reviewing potential approaches to prevention and optimization, and proposing new ways of framing how to understand, address, and prevent these disorders from a life course development perspective. This publication summarizes the presentations and discussions from the series.

Adolescence is a dynamic time for both brain development and social pressures, making it a critical period to understand mental, emotional, and behavioral health, yet it is often overlooked in terms of policies and service interventions, which makes many young people feel unheard when communicating their own challenges. To explore best practices in providing and supporting adolescent health services and key messaging and communication strategies related to the mental, emotional, and behavioral health of adolescents, the National Academies of Sciences, Engineering, and Medicine's Forum for Children's Well-Being held a workshop on May 5, 2020. The workshop featured a panel of youth representatives who shared their own experiences related to mental, emotional, and behavioral health. This publication summarizes the presentation and discussion of the workshop.

"The Food and Nutrition Board (FNB) of the National Academies of Sciences, Engineering, and Medicine was convened in 1940 in response to a request from the U.S. National Defense Advisory Commission to the National Academy of Sciences for aid in studying problems of nutrition in the United States. Today the FNB is the focal point for activities concerned with food, nutrition, and food safety, and their roles in health maintenance and disease prevention. Now in its 80th year, the FNB has continued its growth and expanded its reach both domestically and internationally, providing visionary leadership across a range of nutrition and food science issues toward the improvement of human health. In honor of its 80 years of service to the nation, the FNB convened a public symposium to review the origin and history, policy influence, and future directions of the FNB. This publication summarizes the presentations of the event."--

In late 2016, U.S. Embassy personnel in Havana, Cuba, began to report the development of an unusual set of symptoms and clinical signs. For some of these patients, their case began with the sudden onset of a loud noise, perceived to have directional features, and accompanied by pain in one or both ears or across a broad region of the head, and in some cases, a sensation of head pressure or vibration, dizziness, followed in some cases by tinnitus, visual problems, vertigo, and cognitive difficulties. Other personnel attached to the U.S. Consulate in Guangzhou, China, reported similar symptoms and signs to varying degrees, beginning in the following year. As of June 2020, many of these personnel continue to suffer from these and/or other health problems. Multiple hypotheses and mechanisms have been proposed to explain these clinical cases, but evidence has been lacking, no hypothesis has been proven, and the circumstances remain unclear. The Department of State asked the National Academies to review the cases, their clinical features and management, epidemiologic investigations, and scientific evidence in support of possible causes, and advise on approaches for the investigation of potential future cases. In An Assessment of Illness in U.S. Government Employees and Their Families at Overseas Embassies, the committee identifies distinctive clinical features, considers possible causes, evaluates plausible mechanisms and rehabilitation efforts, and offers recommendations for future planning and responses.