Bøger udgivet af National Academies Press

Many factors affect the amount of temperature-induced movement that occurs in a building and the extent to which this movement can occur before serious damage develops or extensive maintenance is required. In some cases joints are being omitted where they are needed, creating a risk of structural failures or causing unnecessary operations and maintenance costs. In other cases, expansion joints are being used where they are not required, increasing the initial cost of construction and creating space utilization problems. As of 1974, there were no nationally acceptable procedures for precise determination of the size and the location of expansion joints in buildings. Most designers and federal construction agencies individually adopted and developed guidelines based on experience and rough calculations leading to significant differences in the various guidelines used for locating and sizing expansion joints. In response to this complex problem, Expansion Joints in Buildings: Technical Report No. 65 provides federal agencies with practical procedures for evaluating the need for through-building expansion joints in structural framing systems. The report offers guidelines and criteria to standardize the practice of expansion joints in buildings and decrease problems associated with the misuse of expansions joints. Expansions Joints in Buildings: Technical Report No. 65 also makes notable recommendations concerning expansion, isolation, joints, and the manner in which they permit separate segments of the structural frame to expand and to contract in response to temperature fluctuations without adversely affecting the buildings structural integrity or serviceability.

"Although the progress of environmental restoration projects in the Florida Everglades remains slow overall, there have been improvements in the pace of restoration and in the relationship between the federal and state partners during the last two years. However, the importance of several challenges related to water quantity and quality have become clear, highlighting the difficulty in achieving restoration goals for all ecosystem components in all portions of the Everglades. Progress Toward Restoring the Everglades explores these challenges. The book stresses that rigorous scientific analyses of the tradeoffs between water quality and quantity and between the hydrologic requirements of Everglades features and species are needed to inform future prioritization and funding decisions."--Publisher's description.

Guidelines for the clinical practice of medicine have been proposed as the solution to the whole range of current health care problems. This new book presents the first balanced and highly practical view of guidelines--their strengths, their limitations, and how they can be used most effectively to benefit health care. The volume offers: Recommendations and a proposed framework for strengthening development and use of guidelines. Numerous examples of guidelines. A ready-to-use instrument for assessing the soundness of guidelines. Six case studies exploring issues involved when practitioners use guidelines on a daily basis. With a real-world outlook, the volume reviews efforts by agencies and organizations to disseminate guidelines and examines how well guidelines are functioning--exploring issues such as patient information, liability, costs, computerization, and the adaptation of national guidelines to local needs.

As part of a long-standing collaboration on nuclear nonproliferation, the National Academy of Sciences and the Russian Academy of Sciences held a joint workshop in Moscow in 2003 on the scientific aspects of an international radioactive disposal site in Russia. The passage of Russian laws permitting the importation and storage of high-level radioactive material (primarily spent nuclear fuel from reactors) has engendered interest from a number of foreign governments, including the U.S., in exploring the possibility of transferring material to Russia on a temporary or permanent basis. The workshop focused on the environmental aspects of the general location and characteristics of a possible storage site, transportation to and within the site, containers for transportation and storage, inventory and accountability, audits and inspections, and handling technologies.

The rapid evolution of information technology (IT) is transforming our society and its institutions. For the most knowledge-intensive entities of all, research universities, profound IT-related challenges and opportunities will emerge in the next decade or so. Yet, there is a sense that some of the most significant issues are not well understood by academic administrators, faculty, and those who support or depend on the institution's activities. This study identifies those information technologies likely to evolve in the near term (a decade or less) that could ultimately have a major impact on the research university. It also examines the possible implications of these technologies for the research university--its activities (learning, research, outreach) and its organization, management, and financing--and for the broader higher education enterprise. The authoring committee urges research universities and their constituents to develop new strategies to ensure that they survive and thrive in the digital age.

"Determinants of health - like physical activity levels and living conditions - have traditionally been the concern of public health and have not been linked closely to clinical practice. However, if standardized social and behavioral data can be incorporated into patient electronic health records (EHRs), those data can provide crucial information about factors that influence health and the effectiveness of treatment. Such information is useful for diagnosis, treatment choices, policy, health care system design, and innovations to improve health outcomes and reduce health care costs. Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2 identifies domains and measures that capture the social determinants of health to inform the development of recommendations for the meaningful use of EHRs. This report is the second part of a two-part study. The Phase 1 report identified 17 domains for inclusion in EHRs. This report pinpoints 12 measures related to 11 of the initial domains and considers the implications of incorporating them into all EHRs. This book includes three chapters from the Phase 1 report in addition to the new Phase 2 material. Standardized use of EHRs that include social and behavioral domains could provide better patient care, improve population health, and enable more informative research. The recommendations of Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2 will provide valuable information on which to base problem identification, clinical diagnoses, patient treatment, outcomes assessment, and population health measurement."--

The National Academies Global Forum on Innovation in Health Professional Education hosted a Fall 2022 workshop series to explore the various needs of an aging population and an ideal health workforce with the numbers and skillset to match those needs. Discussions included the composition of the intended health workforce, training requirements for each level of care provider, who would provide the training and education, and in what setting the training would take place. Given these considerations and learner reluctance to work with elder adults, implementation science was introduced as a path forward. Implementation science is the study of methods and strategies that facilitate the use of evidence-based practice and research into regular use by practitioners and policymakers. This proceedings document summarizes workshop discussions.

The effective use of data is foundational to the concept of a learning health system--one that leverages and shares data to learn from every patient experience, and feeds the results back to clinicians, patients and families, and health care executives to transform health, health care, and health equity. More than ever, the American health care system is in a position to harness new technologies and new data sources to improve individual and population health. Learning health systems are driven by multiple stakeholders--patients, clinicians and clinical teams, health care organizations, academic institutions, government, industry, and payers. Each stakeholder group has its own sources of data, its own priorities, and its own goals and needs with respect to sharing that data. However, in America's current health system, these stakeholders operate in silos without a clear understanding of the motivations and priorities of other groups. The three stakeholder working groups that served as the authors of this Special Publication identified many cultural, ethical, regulatory, and financial barriers to greater data sharing, linkage, and use. What emerged was the foundational role of trust in achieving the full vision of a learning health system. This Special Publication outlines a number of potentially valuable policy changes and actions that will help drive toward effective, efficient, and ethical data sharing, including more compelling and widespread communication efforts to improve awareness, understanding, and participation in data sharing. Achieving the vision of a learning health system will require eliminating the artificial boundaries that exist today among patient care, health system improvement, and research. Breaking down these barriers will require an unrelenting commitment across multiple stakeholders toward a shared goal of better, more equitable health. We can improve together by sharing and using data in ways that produce trust and respect. Patients and families deserve nothing less.

The emergence of artificial intelligence (AI) in health care offers unprecedented opportunities to improve patient and clinical team outcomes, reduce costs, and impact population health. While there have been a number of promising examples of AI applications in health care, it is imperative to proceed with caution or risk the potential of user disillusionment, another AI winter, or further exacerbation of existing health- and technology-driven disparities. This Special Publication synthesizes current knowledge to offer a reference document for relevant health care stakeholders. It outlines the current and near-term AI solutions; highlights the challenges, limitations, and best practices for AI development, adoption, and maintenance; offers an overview of the legal and regulatory landscape for AI tools designed for health care application; prioritizes the need for equity, inclusion, and a human rights lens for this work; and outlines key considerations for moving forward. AI is poised to make transformative and disruptive advances in health care, but it is prudent to balance the need for thoughtful, inclusive health care AI that plans for and actively manages and reduces potential unintended consequences, while not yielding to marketing hype and profit motives.

Evidence-based medicine arose from a clear need and represents a major advance in the science of clinical decision making. Despite broad acceptance of evidence-based medicine, however, a fundamental issue remains unresolved: evidence is derived from groups of people, yet medical decisions are made by and for individuals. Despite persistent assertions from clinicians that determining the best therapy for each patient is a more complicated endeavor than just picking the best treatment on average, traditional approaches have been overly reliant on the average effects estimated from the outcomes of clinical trials. This Special Publication is based on a workshop, held by the National Academy of Medicine, that considered patient and stakeholder perspectives on the importance of understanding heterogeneous treatment effects (HTE) and best practices for implementing clinical programs that take HTE into account. For evidence to be more applicable to individual patients, we need to combine methods for strong causal inference (first and foremost, randomization) with methods for prediction that permit inferences about which particular patients are likely to benefit and which are not. Better population-based outcomes will only be realized when we understand more completely how to treat patients as the unique individuals they are.

In response to a growing national awareness that the development and use of new diagnostic, therapeutic, and preventive interventions had been occurring at a quickening pace--one far outstripping the evidence necessary to make informed decisions about their comparative advantage--the Patient-Centered Outcomes Research Institute (PCORI) was established in 2010 as part of the Affordable Care Act legislation. PCORI is guided by the imperative to help patients, families, clinicians, and other health care stakeholders make better informed health care decisions and improve care and outcomes. To inform the next steps in its organizational strategy, PCORI enlisted the National Academy of Medicine (NAM) to leverage its deep experience in convening experts on matters of significant national importance, including its long-standing thought leadership role in the realization of a learning health system. The NAM formed a multi-stakeholder workgroup and held two virtual convenings with the objective of engaging with patients, clinicians, health system leaders, researchers, and other stakeholders from the broader health community to identify and discuss high-priority emerging issues in health, health care, and biomedical science and technology. The key messages from these meetings are outlined in the Special Publication Priorities on the Health Horizon: Informing PCORI's Strategic Plan. Given the breadth of the domains considered in the Priorities on the Health Horizon meetings--emerging technologies, social and environmental factors, optimizing value, and infrastructure--a formidable set of pressing health and health care research needs were reviewed and discussed. In addition, certain fundamental strategic priorities emerged as basic and critical to progress in the field: (1) the need to reorient research perspectives and activities to patient and family priorities and values, and in particular, those conditions that drive inequities; (2) the need to foster strategic learning partnerships across groups, organizations, and sectors; and (3) the need to build the continuous learning infrastructure to produce new insights at the pace and scale necessary for health and health care improvement. Moving forward, building the capacity to continuously improve learning and sharing throughout the system will entail stakeholders working together as seamlessly as possible. The NAM and PCORI worked together to facilitate an expansive dialogue with key stakeholders and engender trust through a focus on shared commitments to progress on improving health for all Americans in the decade ahead.

The United States is in the midst of an urgent and complex opioid crisis. To address how education and training can more effectively respond to this crisis, we must have a better understanding of problems in practice--or professional practice gaps--for health professionals and teams in practice. A coordinated response requires identifying and addressing professional practice gaps (PPGs) related to pain management, opioid use disorder, and other substance use disorder (SUD) care, as well as integrating evidence-based best practices into health professional education and training curricula across the continuum from undergraduate training into post-graduate continuing education This Special Publication presents two information-gathering efforts to assess persisting PPGs pertaining to pain management and SUD care and to better understand the current health professional education environment: the first is a comprehensive literature review, and the second is a survey of the regulatory landscape. The results underscore the need to collaboratively develop a harmonized interprofessional, person- and family-centered approach for the continuum of health professions education to more effectively address the opioid crisis. In this Special Publication, the Health Professional Education and Training Workgroup of the National Academy of Medicine's Action Collaborative on Countering the U.S. Opioid Epidemic identified five action-oriented priorities to support this goal: Establish minimum core competencies in pain management and substance use disorders for all health care professionals, and support tracking of health care professionals' competence Align accreditors' expectations for interprofessional collaboration in education for pain management and substance use disorders Foster interprofessional collaboration among licensing and certifying bodies to optimize regulatory approaches and outcomes Unleash the capacity for continuing education to meet health professions learners where they are through investment and leadership, and Collaborate to harmonize practice improvement initiatives With due effort and support, these approaches will amplify effective practices while harmonizing and improving the environment for health care professionals to best serve the needs of their patients and communities.

Sharing health data and information across stakeholder groups is the bedrock of a learning health system. As data and information are increasingly combined across various sources, their generative value to transform health, health care, and health equity increases significantly. Health data have proven their centrality in guiding action to change the course of individual and population health, if properly stewarded and used. In the context of the COVID-19 pandemic, both data and a lack of data illuminated profound shortcomings that affected health care and health equity. Yet, a silver lining of the pandemic was a surge in collaboration among data holders in public health, health care, and technology firms, suggesting that an evolution in health data sharing is visible and tangible. This Special Publication features some of these novel data-sharing collaborations, and has been developed to provide practical context and implementation guidance that is critical to advancing the lessons learned identified in its parent NAM Special Publication, Health Data Sharing: Building a Foundation of Stakeholder Trust. The focus of this publication is to identify and describe exemplar groups to dispel the myth that sharing health data more broadly is impossible and illuminate the innovative approaches that are being taken to make progress in the current environment. It also serves as a resource for those waiting in the wings, showing how barriers were addressed and harvesting lessons and insights from those on the front lines. In the meantime, knowledge is already available to foster better health care and health outcomes. The examples described in this volume suggest how intentional attention to health data sharing can enable unparalleled advances, securing a healthier and more equitable future for all.

"The National Academies Roundtable on Obesity Solutions hosted an April, July, and October, 2022 workshop series to explore the gaps in knowledge within the foundational drivers of obesity. Facilitating action will require improved health communication, deconstructing structural racism, and recognizing the biased mental models and social norms at odds with obesity solutions. Speakers discussed future research in evidence-based solutions and potential ways to translate current evidence into practice. This Proceedings of a Workshop summarizes the discussions held during the workshop."--

Population surveys collect information from participants by asking questions. Today, many surveys also collect biologic specimens that can be used to analyze a respondents DNA and other biomarkers. The National Health and Nutrition Examination Survey (NHANES) is a population survey that also administers a physical examination, collects biospecimens, and reports some test results (e.g., cholesterol levels) to the participant. While visiting communities large and small throughout the country, NHANES collects health and nutrition data from a representative sample of individuals through in-person interviews and health examinations that take place at special mobile examination centers. The examination component consists of medical, dental, and physiological examinations, as well as laboratory tests. On December 2, 7, and 8, 2022, a workshop was convened to focus on anticipated future collections of genomic data by NHANES. The 2022 workshop explored ethical considerations and current practices for returning genomic information from active research and population surveys. This Proceedings of a Workshop summarizes the presentations and discussions at the workshop.

Despite the integral contribution of oral health to general health status, it continues to be treated as a marginalized and less important practice of health care. Minimizing its importance begins with how U.S. dental professionals are educated. The National Academies Global Forum on Innovation in Health Professional Education held a public workshop in November 2022 to discuss definitions of community-engaged oral health and its application within, between, and across health professions. Discussions emphasized lifelong learning, the social determinants of health and community engagement, and the development of innovative approaches and models for oral health workforce education and training in a global context. This Proceedings of a Workshop summarizes the discussions held during the workshop.

Racially and ethnically minoritized populations and tribal communities often face preventable inequities in health outcomes due to structural disadvantages and diminished opportunities around health care, employment, education, and more. Federal Policy to Advance Racial, Ethnic, and Tribal Health Equity analyzes how past and current federal policies may create, maintain, and/or amplify racial, ethnic, and tribal health inequities. This report identifies key features of policies that have served to reduce inequities and makes recommendations to help achieve racial, ethnic, and tribal health equity.

"The United States is experiencing a decline in life expectancy despite high health care spending due to a multitude of factors, including the COVID-19 pandemic, opioid epidemic, high burden of chronic disease, and systemic and structural inequities. A response proportional to this crisis is required. Valuing America's Health: Aligning Financing to Reward Better Health and Well-Being explores opportunities to transform the current health and health care system to one that promotes whole person and whole population health. The publication emphasizes the need for a bold vision and sustainable financing strategies to prioritize health and well-being for all. Authors of the publication highlight the importance of building a movement to prioritize health, repairing systemic failures, holding stakeholders accountable, controlling health care costs, incentivizing health promotion, adopting collaborative financing and policy-making approaches, and empowering individuals and communities in health decision-making. The way is clear; what is needed now is the will to move forward. Learn more about how to ensure our nation's health and health care system can support optimal health for all"--

The National Strategy for a Resilient Public Health Supply Chain lays out the U.S. government vision to protect the health and security of Americans by ensuring a supply chain for personal protective equipment (PPE) and technology (PPT), medical devices, medicines, and other public health supplies that is resilient against disruptions from pandemics and other biological threats. Additional forethought and collaboration amongst policy makers, manufacturers, and users is needed to make PPE and PPT innovation, standardization, stockpiling, and use more resilient. The National Academies convened a public workshop in March 2023 to explore innovative approaches and technologies needed to update and streamline the U.S. standardization system for PPE and PPT in support of supply chain resiliency. Discussions included ways to improve the effectiveness, safety, supply stability, and accessibility of PPE and PPT designed for use in health care settings, by critical infrastructure workers, and by the general public. This Proceedings of a Workshop summarizes the discussions held during the workshop.

Foreign-funded language and culture institutes exist on U.S. campuses beyond Confucius Institutes (CIs)--Chinese government-funded centers established by the Chinese Communist Party to extend the reach of Chinese language and culture and to enhance worldwide opinion of China through offering classes in Mandarin Chinese and highlighting positive aspects of Chinese culture. Regardless of the sponsoring nation, foreign-funded language and culture institutes may pose risks for U.S. host institutions regarding academic freedom, freedom of expression, governance, and national security. This is particularly true if the values of the sponsoring nation do not align with the democratic values held in the United States and if the sponsoring nation is suspected of engaging in activities adversely affecting human rights, academic freedom, freedom of expression, association, dissent, and U.S. national security. This report explores the role of other foreign-funded institutes at U.S. institutions of higher education, describing characteristics and features of such institutes; determining characteristics and features of foreign-funded institutes at U.S. institutions of higher education that could be flags for institutions to engage in further deliberation and vetting prior to entering into a partnership; identifying implementable practices for U.S. institutions of higher education to ensure appropriate operations; and continuing exploration of what role the sensitivity of the research conducted on campus should play in determining which foreign-funded partnerships are appropriate. Foreign-Funded Language and Culture Institutes at U.S. Institutions of Higher Education recommends actions that U.S. colleges and universities can take to minimize risks associated with hosting foreign-funded language and culture institutions, such as a CI, on or near campus and protect academic freedom and national security.

While there is a limited data on safety-sensitive professionals, substance use disorders potentially affect pilots and flight attendants at the same rate as the general population - around 15 percent - but due to the high-risk nature of their jobs, aircraft operators are held to a higher standard for substance misuse on the job. To protect the safety of the public and the aviation workforce, the Human Intervention Motivation Study (HIMS) and the Flight Attendant Drug and Alcohol Program (FADAP) were launched to help treat critical aviation workers - pilots and flight attendants, respectively - who misuse substances. In response to a congressional mandate, this new report reviews available evidence on the effectiveness of HIMS and FADAP and offers recommendations for improving these programs.

While technologies are clearly instrumental in transitioning away from fossil fuel-based energy and toward a decarbonized economy, decisions about which technologies are prioritized, how they are implemented, and the policies that drive these changes will have profound effects on people and communities, with important implications for equity, jobs, environmental and energy justice, health, and more. The National Academies of Sciences, Engineering, and Medicine Committee on Accelerating Decarbonization in the United States: Technology, Policy, and Societal Dimensions was tasked with assessing the broad range of technological, policy, and societal dimensions of decarbonizing the U.S. economy. The committee produced a 2021 report that provides the U.S. government with a roadmap of equitable and robust decarbonization policies. The next report of the committee will address the broader range of policy actors who play a role in equitable energy transition. To inform its deliberations, the committee hosted a 1-day workshop on July 26, 2022 to discuss critical issues of equity and justice during the energy transition. The goal of the workshop, titled Pathways to an Equitable and Just Transition: Principles, Best Practices, and Inclusive Stakeholder Engagement, was to move beyond energy technologies and elicit ideas and insights to inform the development of principles, best practices, and actionable recommendations for a broad range of policy actors and stakeholders in order to fully operationalize equity, justice, and inclusion. This publication summarizes the presentations and discussion of the workshop.

The mission of the Roundtable on Black Men and Black Women in Science, Engineering, and Medicine at the National Academies of Sciences, Engineering, and Medicine is to advance discussions on the barriers and opportunities encountered by Black students and professionals as they navigate the pathways from K-12 and postsecondary education to careers in science, engineering, and medicine (SEM) and highlight promising practices for increasing the representation, retention, and inclusiveness of Black men and Black women in SEM. This proceedings serves as a summary of the presentations and discussions from a capstone workshop, held virtually on December 6 and 7, 2021, to review how anti-Black racism had permeated across the topics covered by the Roundtable over the previous 2 years.

Sunscreens and a variety of other products contain chemical ultraviolet (UV) filters that absorb or block the sun's radiation and thereby help mitigate harms to human skin from the sun. The 2022 NASEM report Review of Fate, Exposure, and Effects of Sunscreens in Aquatic Environments and Implications for Sunscreen Usage and Human Health called on the EPA to conduct an ecological risk assessment of UV filters to characterize the possible risks to aquatic ecosystems and the species that live in them. However, the 2022 report also identified a number of knowledge gaps and research barriers that may limit understanding of those ecological risks. To share progress and identify opportunities to further address gaps and barriers, NASEM hosted a workshop in Washington, D.C., on January 23-24, 2023, entitled Workshop to Advance Research on Understanding Environmental Effects of UV Filters in Sunscreens. Through a series of prepared talks, panel discussions, and structured breakout discussions, participants examined the 2022 report and its management context; explored data needs and analytical challenges relevant to the development of accurate toxicity metrics for UV filters; and suggested opportunities to improve and standardize toxicity testing for these chemicals. These proceedings has been prepared by the workshop rapporteur as a factual summary of what occurred at the workshop.

Consequences of natural disasters and the COVID-19 pandemic have taken a cumulative toll on the health and well-being of people in the Gulf of Mexico region. Long-standing societal challenges related to racism, poverty, education, housing, and underemployment are compounding the trauma, leading to chronic stress for many Gulf residents. The Committee on Progress Toward Human Health and Community Resilience in the Gulf of Mexico Region new report, Advancing Health and Community Resilience in the Gulf of Mexico Region: A Roadmap for Progress, explores key challenges and priorities in Gulf states, including Alabama, Florida, Louisiana, Mississippi, and Texas and evaluates recent progress. The report also makes recommendations for closing critical gaps and implementing transformative approaches that focus on the diverse needs and experiences of people who live and work in the Gulf region.

The South Asia region presents a confluence of major climate impacts and key security issues. From a weather and climate standpoint, the region experiences a wide range of hazards, such as the recent heatwaves, droughts, storms, and floods that have upended the lives and livelihoods of millions of people. From a demographic and socioeconomic standpoint, the region is experiencing rapid transformations and progress, even as fundamental challenges such as poverty and inequality persist. From a security standpoint, the region is the setting for a range of social and political dynamics that impact U.S. interests, including conflict at national and subnational levels; regional rivalries; and the imprint of global geopolitics. On October 26-27, 2022, the National Academies of Sciences, Engineering, and Medicine, under the auspices of the National Academies Climate Security Roundtable, convened a workshop to explore climate security in South Asia. Over two days, workshop participants considered some of the underlying climate, development, and geopolitical dynamics at play in the South Asia region; explored a set of historical case studies and future scenarios for climate change and security in South Asia; and they considered the available tools for analysis and forecasting climate-related risks. This publication summarizes the presentations and discussion of the workshop.

In 2016, the National Science Foundation (NSF) established a five-year program on Understanding the Rules of Life (URoL) to identify generalizable rules that govern biological systems at micro and macro levels. At the request of NSF, the National Academies of Sciences, Engineering, and Medicine convened a series of workshops to explore the achievements of the URoL program. Presenters and participants discussed integration of multi-disciplinary, systems-level approaches, broader implications for studying highly complex systems, future scientific questions and future societal needs, and the production of generalizable rules that apply to different fields and scales. This publication summarizes the presentation and discussion of the workshop.

As part of its core mission, the U.S. Environmental Protection Agency (EPA) is tasked with assessing the hazards and risks to human health from exposure to pollutants. While some pollutants are well studied, there are little or no data on the potential health effects for many thousands of chemicals that can make their way into the environment, such as PFAS. EPA still relies on laboratory mammalian studies as the foundation of most human health risk assessments, which are limited by high costs, long timelines, and other concerns. New approach methods (NAMs) in toxicology, for example new in vivo and in vitro strategies and computational systems biology, offer opportunities to inform timely decision-making when no data are available from laboratory mammalian toxicity tests or epidemiological studies. NAMs may also help inform efforts to protect susceptible and vulnerable populations by characterizing subtle health perturbations, better encompassing genetic diversity, and accounting for nonchemical stressors. While the promise and need for NAMs is clear, many barriers to their use remain. This report aims to bridge the gap between the potential of NAMs and their practical application in human health risk assessment. Building Confidence in New Evidence Streams for Human Health Risk Assessment draws lessons learned from laboratory mammalian toxicity tests to help inform approaches for building scientific confidence in NAMs and for incorporating such data into risk assessment and decision-making. Overall, the report recommendations aim to ensure a seamless handoff from the evaluation of NAM-based testing strategies in the laboratory to the incorporation of NAM data into modern, systematic-review-based risk assessments.