Bøger udgivet af National Academies Press

Humans are potentially exposed to more than 80,000 toxic chemicals in the environment, yet their impacts on brain health and disease are not well understood. The sheer number of these chemicals has overwhelmed the ability to determine their individual toxicity, much less potential interactive effects. Early life exposures to chemicals can have permanent consequences for neurodevelopment and for neurodegeneration in later life. Toxic effects resulting from chemical exposure can interact with other risk factors such as prenatal stress, and persistence of some chemicals in the brain over time may result in cumulative toxicity. Because neurodevelopmental and neurodegenerative disorders - such as attention-deficit hyperactivity disorder and Parkinson's disease - cannot be fully explained by genetic risk factors alone, understanding the role of individual environmental chemical exposures is critical. On June 25, 2020, the National Academies of Sciences, Engineering, and Medicine's Forum on Neuroscience and Nervous System Disorders hosted a workshop to lay the foundation for future advances in environmental neuroscience. The workshop was designed to explore new opportunities to bridge the gap between what is known about the genetic contribution to brain disorders and what is known, and not known, about the contribution of environmental influences, as well as to discuss what is known about how genetic and environmental factors interact. This publication summarizes the presentation and discussion of the workshop.

Behavioral health conditions, which include mental health and substance use disorders, affect approximately 20 percent of Americans. Of those with a substance use disorder, approximately 60 percent also have a mental health disorder. As many as 80 percent of patients with behavioral health conditions seek treatment in emergency rooms and primary care clinics, and between 60 and 70 percent of them are discharged without receiving behavioral health care services. More than two-thirds of primary care providers report that they are unable to connect patients with behavioral health providers because of a shortage of mental health providers and health insurance barriers. Part of the explanation for the lack of access to care lies in a historical legacy of discrimination and stigma that makes people reluctant to seek help and also led to segregated and inhumane services for those facing mental health and substance use disorders. In an effort to understanding the challenges and opportunities of providing essential components of care for people with mental health and substance use disorders in primary care settings, the National Academies of Sciences, Engineering, and Medicine's Forum on Mental Health and Substance Use Disorders convened three webinars held on June 3, July 29, and August 26, 2020. The webinars addressed efforts to define essential components of care for people with mental health and substance use disorders in the primary care setting for depression, alcohol use disorders, and opioid use disorders; opportunities to build the health care workforce and delivery models that incorporate those essential components of care; and financial incentives and payment structures to support the implementation of those care models, including value-based payment strategies and practice-level incentives. This publication summarizes the presentations and discussion of the webinars.

Across the United States, millions of acres of land have been so disturbed by human activities or severe climate events that significant portions of their native plant communities have been lost and their ecosystems have been seriously compromised. 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. Native seeds are also in demand for applications in urban land management, roadside maintenance, conservation agriculture, and other restorative activities that take into account the connection between native plant communities and the increasingly urgent need for resilient landscapes. Given the varied climatic and environmental niches of the more than 17,000 native plant species of the United States, supplying the desired seed types and species mixes for this wide range of activities is a challenge. As the first phase of a nationwide analysis of the full scope of needs for native plant seeds, this interim report describes the participants in the native plant seed supply chain, makes preliminary observations, and proposes an information-gathering plan for the second phase of the assessment.

As part of the overall disability determination process, the Social Security Administration uses a step-by-step approach to understand how severe an individual's condition is and whether it meets program criteria for disability. The use of various types of biomarkers has been suggested as a way to strengthen the amount and quality of objective evidence available to the review process. At the request of the Social Security Administration, the National Academies of Sciences, Engineering, and Medicine's Board on Health Care Services organized a virtual workshop on July 21, 2020, titled The State of the Science of the Use of Biomarkers to Establish the Presence and Severity of Impairments. Workshop discussions focused on the current and potential uses for biomarkers; explored legal and ethical implications associated with biomarker use in clinical decision making; and considered the possible uses of nongenetic biomarkers as tools for the diagnosis or prognosis of the severity of specific physical and mental impairments. This publication summarizes the presentations and discussion of the workshop.

"Young people develop health literacy skills in a variety of environments, facing critical thinking challenges about their health from school, home and family life, peers and social life, and online. To explore the development of health literacy skills in youth, the Roundtable on Health Literacy convened a workshop on November 19, 2019, in Washington, DC. Presenters at the workshop discussed factors relating to health literacy skills and ways to further develop those skills among youth from early childhood to young adulthood. This publication summarizes the presentation and discussion of the workshop."--

The COVID-19 pandemic is resulting in widespread and ongoing changes to how the K-12 education system functions, including disruptions to science teaching and learning environments. Students and teachers are all figuring out how to do schooling differently, and districts and states are working overtime to reimagine systems and processes. This is difficult and stressful work in the middle of the already stressful and sometimes traumatic backdrop of the global pandemic. In addition, students with disabilities, students of color, immigrants, English learners, and students from under-resourced communities have been disproportionately affected, both by the pandemic itself and by the resulting instructional shifts. Teaching K-12 Science and Engineering During a Crisis aims to describe what high quality science and engineering education can look like in a time of great uncertainty and to support practitioners as they work toward their goals. This book includes guidance for science and engineering practitioners - with an emphasis on the needs of district science supervisors, curriculum leads, and instructional coaches. Teaching K-12 Science and Engineering During a Crisis will help K-12 science and engineering teachers adapt learning experiences as needed to support students and their families dealing with ongoing changes to instructional and home environments and at the same time provide high quality in those experiences.

More than 3.7 million U.S. service members have participated in operations taking place in the Southwest Asia Theater of Military Operations since 1990. These operations include the 1990-1991 Persian Gulf War, a post-war stabilization period spanning 1992 through September 2001, and the campaigns undertaken in the wake of the September 11, 2001, attacks. Deployment to Iraq, Kuwait, Saudi Arabia, Bahrain, Gulf of Aden, Gulf of Oman, Oman, Qatar, the United Arab Emirates, and Afghanistan exposed service members to a number of airborne hazards, including oil-well fire smoke, emissions from open burn pits, dust and sand suspended in the air, and exhaust from diesel vehicles. The effects of these were compounded by stressors like excessive heat and noise that are inevitable attributes of service in a combat environment. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations reviews the scientific evidence regarding respiratory health outcomes in veterans of the Southwest Asia conflicts and identifies research that could feasibly be conducted to address outstanding questions and generate answers, newly emerging technologies that could aid in these efforts, and organizations that the Veterans Administration might partner with to accomplish this work.

In the wake of a large-scale disaster, from the initial devastation through the long tail of recovery, protecting the health and well-being of the affected individuals and communities is paramount. Accurate and timely information about mortality and significant morbidity related to the disaster are the cornerstone of the efforts of the disaster management enterprise to save lives and prevent further health impacts. Conversely, failure to accurately capture mortality and significant morbidity data undercuts the nation's capacity to protect its population. Information about disaster-related mortality and significant morbidity adds value at all phases of the disaster management cycle. As a disaster unfolds, the data are crucial in guiding response and recovery priorities, ensuring a common operating picture and real-time situational awareness across stakeholders, and protecting vulnerable populations and settings at heightened risk. A Framework for Assessing Mortality and Morbidity After Large-Scale Disasters reviews and describes the current state of the field of disaster-related mortality and significant morbidity assessment. This report examines practices and methods for data collection, recording, sharing, and use across state, local, tribal, and territorial stakeholders; evaluates best practices; and identifies areas for future resource investment.

Biological collections are a critical part of the nation's science and innovation infrastructure and a fundamental resource for understanding the natural world. Biological collections underpin basic science discoveries as well as deepen our understanding of many challenges such as global change, biodiversity loss, sustainable food production, ecosystem conservation, and improving human health and security. They are important resources for education, both in formal training for the science and technology workforce, and in informal learning through schools, citizen science programs, and adult learning. However, the sustainability of biological collections is under threat. Without enhanced strategic leadership and investments in their infrastructure and growth many biological collections could be lost. Biological Collections: Ensuring Critical Research and Education for the 21st Century recommends approaches for biological collections to develop long-term financial sustainability, advance digitization, recruit and support a diverse workforce, and upgrade and maintain a robust physical infrastructure in order to continue serving science and society. The aim of the report is to stimulate a national discussion regarding the goals and strategies needed to ensure that U.S. biological collections not only thrive but continue to grow throughout the 21st century and beyond.

Providing a reliable and resilient supply of electric power to communities across the United States has always posed a complex challenge. Utilities must support daily operations to serve a diverse array of customers across a heterogeneous landscape while simultaneously investing in infrastructure to meet future needs, all while juggling an enormous array of competing priorities influenced by costs, capabilities, environmental and social impacts, regulatory requirements, and consumer preferences. A rapid pace of change in technologies, policies and priorities, and consumer needs and behaviors has further compounded this challenge in recent years. The National Academies of Sciences, Engineering, and Medicine convened a workshop on February 3, 2020 to explore strategies for incorporating new technologies, planning and operating strategies, business models, and architectures in the U.S. electric power system. Speakers and participants from industry, government, and academia discussed available models for long-term transmission and distribution planning, as well as the broader context of how these models are used and future opportunities and needs. This publication summarizes the presentations and discussions from the workshop.

Approximately 30 percent of the edible food produced in the United States is wasted and a significant portion of this waste occurs at the consumer level. Despite food's essential role as a source of nutrients and energy and its emotional and cultural importance, U.S. consumers waste an estimated average of 1 pound of food per person per day at home and in places where they buy and consume food away from home. Many factors contribute to this waste--consumers behaviors are shaped not only by individual and interpersonal factors but also by influences within the food system, such as policies, food marketing and the media. Some food waste is unavoidable, and there is substantial variation in how food waste and its impacts are defined and measured. But there is no doubt that the consequences of food waste are severe: the wasting of food is costly to consumers, depletes natural resources, and degrades the environment. In addition, at a time when the COVID-19 pandemic has severely strained the U.S. economy and sharply increased food insecurity, it is predicted that food waste will worsen in the short term because of both supply chain disruptions and the closures of food businesses that affect the way people eat and the types of food they can afford. A National Strategy to Reduce Food Waste at the Consumer Level identifies strategies for changing consumer behavior, considering interactions and feedbacks within the food system. It explores the reasons food is wasted in the United States, including the characteristics of the complex systems through which food is produced, marketed, and sold, as well as the many other interconnected influences on consumers' conscious and unconscious choices about purchasing, preparing, consuming, storing, and discarding food. This report presents a strategy for addressing the challenge of reducing food waste at the consumer level from a holistic, systems perspective.

The COVID-19 pandemic has presented unprecedented challenges to the nation's K-12 education system. The rush to slow the spread of the virus led to closures of schools across the country, with little time to ensure continuity of instruction or to create a framework for deciding when and how to reopen schools. States, districts, and schools are now grappling with the complex and high-stakes questions of whether to reopen school buildings and how to operate them safely if they do reopen. These decisions need to be informed by the most up-to-date evidence about the SARS-CoV-2 virus that causes COVID-19; about the impacts of school closures on students and families; and about the complexities of operating school buildings as the pandemic persists. Reopening K-12 Schools During the COVID-19 Pandemic: Prioritizing Health, Equity, and Communities provides guidance on the reopening and operation of elementary and secondary schools for the 2020-2021 school year. The recommendations of this report are designed to help districts and schools successfully navigate the complex decisions around reopening school buildings, keeping them open, and operating them safely.

"New York City's municipal water supply system provides about 1 billion gallons of drinking water a day to over 8.5 million people in New York City and about 1 million people living in nearby Westchester, Putnam, Ulster, and Orange counties. The combined water supply system includes 19 reservoirs and three controlled lakes with a total storage capacity of approximately 580 billion gallons. The city's Watershed Protection Program is intended to maintain and enhance the high quality of these surface water sources. Review of the New York City Watershed Protection Program assesses the efficacy and future of New York City's watershed management activities. The report identifies program areas that may require future change or action, including continued efforts to address turbidity and responding to changes in reservoir water quality as a result of climate change."--Publisher's website

On March 24, 2020, a 1-day public workshop titled The Role of Digital Health Technologies in Drug Development was convened by the National Academies of Sciences, Engineering, and Medicine. This workshop builds on prior efforts to explore how virtual clinical trials facilitated by digital health technologies (DHTs) might change the landscape of drug development. To explore the challenges and opportunities in using DHTs for improving the probability of success in drug R&D, enabling better patient care, and improving precision medicine, the workshop featured presentations and panel discussions on the integration of DHTs across all phases of drug development. Throughout the workshop, participants considered how DHTs could be applied to achieve the greatest impact--and perhaps even change the face of how clinical trials are conducted--in ways that are also ethical, equitable, safe, and effective. This publication summarizes the presentations and discussions from the workshop.

The National Academies of Sciences, Engineering, and Medicine held the workshop Applying Big Data to Address the Social Determinants of Health in Oncology on October 28-29, 2019, in Washington, DC. This workshop examined social determinants of health (SDOH) in the context of cancer, and considered opportunities to effectively leverage big data to improve health equity and reduce disparities. The workshop featured presentations and discussion by experts in technology, oncology, and SDOH, as well as representatives from government, industry, academia, and health care systems. This publication summarizes the presentations and discussions from the workshop.

Women in the United States and Kuwait have made advances as researchers and leaders in science, engineering, and medical disciplines, yet challenges and barriers remain to enter and advance in these fields in both countries. Building on recent collaborations, the National Academies of Sciences, Engineering, and Medicine and the Kuwait Foundation for the Advancement of Sciences agreed on convening two workshops to identify evidence-based practices and resources for improving the inclusion of women as full participants in science, technology, engineering, and mathematics.This publication summarizes the presentations and discussion from the first workshop, held October 28-29, 2019, in Washington, D.C.

Headlines frequently appear that purport to highlight the differences among workers of different generations and explain how employers can manage the wants and needs of each generation. But is each new generation really that different from previous ones? Are there fundamental differences among generations that impact how they act and interact in the workplace? Or are the perceived differences among generations simply an indicator of age-related differences between older and younger workers or a reflection of all people adapting to a changing workplace? Are Generational Categories Meaningful Distinctions for Workforce Management? reviews the state and rigor of the empirical work related to generations and assesses whether generational categories are meaningful in tackling workforce management problems. This report makes recommendations for directions for future research and improvements to employment practices.

Established in December 2016, the National Academies of Sciences, Engineering, and Medicine's Roundtable on Data Science Postsecondary Education was charged with identifying the challenges of and highlighting best practices in postsecondary data science education. Convening quarterly for 3 years, representatives from academia, industry, and government gathered with other experts from across the nation to discuss various topics under this charge. The meetings centered on four central themes: foundations of data science; data science across the postsecondary curriculum; data science across society; and ethics and data science. This publication highlights the presentations and discussions of each meeting.

To draw attention to health determinants and health inequities among populations that live in urban environments and to explore challenges faced in establishing urban population health, the Forum on Public-Private Partnerships for Global Health and Safety hosted a 1.5-day workshop on the role of health-focused public-private partnerships (PPPs) in the urban context. The workshop, held June 13-14, 2019, in Washington, DC, aimed to illuminate some of the intervention strategies that have been designed to attenuate these urban health issues and highlighted the importance of PPPs and urban-level governance in remediation efforts. By facilitating discussion among participants in both the public and private sectors, as well as among policy makers, the workshop served as a platform to share best practices on how to address health challenges through interventions that target healthier urban populations. This publication highlights the presentations and discussion of the workshop.

Recommendations for feeding infants and young children have changed substantially over time owing to scientific advances, cultural influences, societal trends, and other factors. At the same time, stronger approaches to reviewing and synthesizing scientific evidence have evolved, such that there are now established protocols for developing evidence-based health recommendations. However, not all authoritative bodies have used such approaches for developing infant feeding guidance, and for many feeding questions there is little or no sound evidence available to guide best practices, despite the fact that research on infant and young child feeding has expanded in recent decades. Summarizing the current landscape of feeding recommendations for infants and young children can reveal the level of consistency of existing guidance, shed light on the types of evidence that underpin each recommendation, and provide insight into the feasibility of harmonizing guidelines. Feeding Infants and Children from Birth to 24 Months collects, compares, and summarizes existing recommendations on what and how to feed infants and young children from birth to 24 months of age. This report makes recommendations to stakeholders on strategies for communicating and disseminating feeding recommendations.

Electric power is a critical infrastructure that is vital to the U.S. economy and national security. Today, the nation's electric power infrastructure is threatened by malicious attacks, accidents, and failures, as well as disruptive natural events. As the electric grid evolves and becomes increasingly interdependent with other critical infrastructures, the nation is challenged to defend against these threats and to advance grid capabilities with reliable defenses. On November 1, 2019, the National Academies of Sciences, Engineering, and Medicine convened a workshop to gather diverse perspectives on current and future threats to the electric power system, activities that the subsector is pursuing to defend itself, and how this work may evolve over the coming decades. This publications summarizes the presentations and discussions from the workshop.

"On December 4-5, 2019, the National Academies of Sciences, Engineering, and Medicine held a 1.5-day public workshop titled Exploring the Frontiers of Innovation to Tackle Microbial Threats. The workshop participants examined major advances in scientific, technological, and social innovations against microbial threats. Such innovations include diagnostics, vaccines (both development and production), and antimicrobials, as well as nonpharmaceutical interventions and changes in surveillance. This publication summarizes the presentations and discussions from the workshop."--

This report evaluates the In-House Laboratory Independent Research (ILIR) conducted at the Research, Development, and Engineering Centers (RDECs) of the U.S. Army's Research, Development, and Engineering Command (RDECOM) during 2018. It reviews and offers recommendations for each of the eight areas of ILIR research: chemistry, computational sciences, electronics, life sciences, materials science, mechanical sciences, network sciences, and physics.

Because of the individualized nature of drug and therapeutic treatments, clinical trials require participants who represent the diversity of the patient base. If early trials do not have a broad patient base, it can be difficult to know who may or may not benefit from or respond to a treatment later. In addition to diversity in recruitment, informed consent during participation is also crucial. If participants do not fully understand what they are signing up for, they may become confused, mistrustful, or drop out of a trial altogether, confusing investigators and possibly affecting the generalizability of a study. To explore the incorporation of health literacy practices into clinical trials, the Roundtable on Health Literacy convened a workshop titled Clinical Trials: Practice and Impact on April 11, 2019, in Washington, DC. The workshop presentations and discussion centered around issues related to the challenges or barriers for diverse populations' participation in clinical trials, best practices for clinical trial sites and researchers incorporating health literacy practices, and effective health literacy strategies for clear communication with participants. This publication summarizes the presentation and discussion of the workshop.

"Opioid use and infectious diseases are intertwined epidemics. Despite the fact that the United States is more than two decades into the opioid crisis - the cause of tens of thousands of deaths every year on its own - the health system has not sufficiently addressed the morbidity and mortality of drug use coupled with infectious diseases. This is at least in part due to traditional models of substance use disorder care wherein substance use disorder treatment is delivered independently of other medical care, thereby inhibiting the delivery of comprehensive care. As a result, the United States is experiencing a drastic increase in infectious diseases that spread with drug use. Opportunities to Improve Opioid Use Disorder and Infectious Disease Services examines current efforts to integrate care and describes barriers, such as inadequate workforce and training; lack of data integration and sharing; and stigma among people who use drugs and have also been diagnosed with an infectious disease. The conclusions and recommendations of this report will help to promote patient-centered, integrated programs to address this dual epidemic."--

Satellite remote sensing is the primary tool for measuring global changes in the land, ocean, biosphere, and atmosphere. Over the past three decades, active remote sensing technologies have enabled increasingly precise measurements of Earth processes, allowing new science questions to be asked and answered. As this measurement precision increases, so does the need for a precise geodetic infrastructure. Evolving the Geodetic Infrastructure to Meet New Scientific Needs summarizes progress in maintaining and improving the geodetic infrastructure and identifies improvements to meet new science needs that were laid out in the 2018 report Thriving on Our Changing Planet: A Decadal Strategy for Earth Observation from Space. Focusing on sea-level change, the terrestrial water cycle, geological hazards, weather and climate, and ecosystems, this study examines the specific aspects of the geodetic infrastructure that need to be maintained or improved to help answer the science questions being considered.--Publisher's website.