The COVID-19 pandemic sparked widespread implementation of wastewater surveillance in communities across the United States to help track the spread of the disease. In contrast to clinical laboratory testing that tracks individual cases of infection, wastewater surveillance provides a way to measure the amount of DNA from pathogens coming from homes, businesses, and other institutions that share a sewer system. To help coordinate and centralize early efforts, the U.S. Centers for Disease Control and Prevention (CDC) launched the National Wastewater Surveillance System (NWSS) in September 2020, with pilot sites in eight states. As of April 2024, the NWSS is receiving data from more than 1,300 active sampling sites, covering a population of 130 million individuals.
A Phase 1 report released in early 2023 examined the usefulness of the NWSS during the COVID-19 pandemic, described the potential value of a robust national wastewater surveillance system beyond COVID-19, and provided recommendations to increase the public health impact of such a system. This Phase 2 report details the technical constraints and opportunities to improve wastewater surveillance for the prevention and control of infectious diseases in the U.S. It recommends improvements in the consistency and quality of national wastewater sampling, testing, and data analysis, and identifies research and technology development needs for a national wastewater surveillance system that can serve ongoing and changing public health needs in the United States.
Topics: Health and Medicine | Environment and Environmental Studies
Rare diseases, such as sickle cell disease and thalassemia, affect up to 30 million people in the United States and at least 300 million across the globe. Congress called on the U.S. Food and Drug Administration (FDA) to sponsor a National Academies study on processes for evaluating the safety and efficacy of drugs for rare diseases or conditions in the United States and the European Union. The resulting report provides recommendations for enhancing and promoting rare disease drug development by improving engagement with people affected by a rare disease, advancing regulatory science, and fostering collaboration between FDA and the European Medicines Agency.
Topics: Health and Medicine
Since its formation more than 60 years ago, the National Aeronautics and Space Administration (NASA) has served as a global leader in science, aeronautics, and exploration, propelled technological innovation, and inspired youth to pursue careers in science and engineering, while often accomplishing the seemingly impossible. However, despite its critical and transformative role, NASA faces an uncertain future due to declining national investment as a percentage of gross domestic product and systemic issues that compromise its infrastructure, workforce, and capacity for technological innovation.
As requested by Congress in the CHIPS and Science Act of 2022, the National Academies of Sciences, Engineering, and Medicine convened an independent expert committee to evaluate whether NASA's current workforce, infrastructure, technological capabilities, and their interfaces can meet its strategic goals. NASA at a Crossroads: Maintaining Workforce, Infrastructure, and Technology Preeminence in the Coming Decades considers the critical facilities and emerging technologies necessary to fulfill NASA's mission, as well as the workforce skills and organizational structure required to perform and support the work of the mission directorates, both now and in the future.
Topics: Space and Aeronautics
At any one time, at least 30,000 people in the U.S. are living with amyotrophic lateral sclerosis (ALS), a rapidly progressive, fatal neurological disease affecting individuals, caregivers, at-risk genetic carriers, and others. In 2022, Congress directed the National Institutes of Health to commission a National Academies committee of experts to recommend key actions public, private, and nonprofit sectors should take to make ALS a livable disease within the next 10 years. The resulting report, Living with ALS, focuses on an integrated ALS multidisciplinary care and research system to help facilitate earlier diagnosis and connections to specialty care.
Topics: Health and Medicine
Since artificial intelligence's (AI) inception, AI and neuroscience have influenced each other to advance models of neural circuitry, analyze large and complex datasets, and inform the development of AI algorithms. This bidirectional relationship also has implications for health care as researchers and clinicians begin to explore the role of AI in clinical diagnosis, disease monitoring, and predicting treatment outcomes of central nervous system disorders. The National Academies Forum on Neuroscience and Nervous System Disorders hosted a public workshop in March 2024 to explore safe, responsible, and equitable use of AI in neuroscience and identify collaborative strategies for increasing AI literacy, building public trust, and creating accessible user interfaces.
Topics: Health and Medicine
The U.S. science, technology, engineering, and mathematics (STEM) workforce plays a vital role in fostering and sustaining innovation, economic competitiveness, and national security. This workforce currently depends, and for the foreseeable future will depend, on both international and domestic talent. Foreign STEM talent contributes to domestic innovation, economic growth, and U.S. leadership in science and technology and also expands perspectives and networks essential to future scientific collaborations and discoveries.
At the request of the U.S. Department of Defense, this report reviews foreign and domestic talent or incentive programs and their corresponding scientific, economic, and national security benefits. International Talent Programs in the Changing Global Environment makes recommendations to improve the effectiveness of U.S. mechanisms for attracting and retaining international students and scholars relative to the programs and incentives other nations use to support national research capabilities, especially in national security and defense-related fields.
Topics: Policy for Science and Technology
Semiconductor chips power practically all electronic devices, from cellphones and vehicles to communications and defense systems essential for national security. The Department of Defense (DoD) uses a wide range of semiconductors for mission systems such as radars, sensors, and high-power-density electronics - but the U.S. is now strongly dependent on other nations for both commercial and defense semiconductor needs.
At the request of Congress, this study addresses the challenges that DoD is experiencing as it engages with the global microelectronics sector and explores ways to engage with public-private partnerships to support assured production and innovation in the semiconductor industry. The recommendations of Strategies to Enable Assured Access to Semiconductors for the Department of Defense focus on long-term strategic coordination, investment in emerging technologies, leveraging of commercial advancements, and a modernization strategy that is nimble enough to incorporate emerging technologies and be responsive to global competition.
Topics: Engineering and Technology
The National Climate Assessment (NCA) is a report produced periodically by the United States Global Change Research Program that takes a comprehensive look at global climate change. Before release, it undergoes intensive review for technical accuracy. What has not been studied in-depth are the users and uses of the NCA, and how the report has informed decision-making. To support evaluation of stakeholder use of the NCA, the National Academies prepared a strategy for creating and implementing an evaluation design that can inform ongoing and future NCAs and related products. This can support a process of continuous improvement.
The NCA serves a large number of audiences, and they vary in their needs and in access to climate information. An evaluation would benefit from understanding how the audiences for the NCA are interconnected through networks and how they use, modify, and transmit information from the report. The evaluation would also benefit by first creating a logic model to describe how the NCA is hypothesized to achieve its intended outcomes. The logic model can then be used to design a set of overarching evaluation questions, and to prioritize which audiences to target in the evaluation. Different research methods will be appropriate depending on the audience and the level of information available about the audience. Such an evaluation, taken in stages, can reveal the impact of federal climate science on decisions across the nation and help the USGCRP address any gaps and frailties in the NCA and related products and how they are communicated in the future.
Topics: Environment and Environmental Studies | Behavioral and Social Sciences
Racial and ethnic inequities in health and health care impact individual well-being, contribute to millions of premature deaths, and cost the United States hundreds of billions of dollars annually. Addressing these inequities is vital to improving the health of the nation’s most disadvantaged communities—and will also help to achieve optimal health for all. In 2003, the Institute of Medicine examined these inequities in Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.
Because disparities persist, the National Academies convened an expert committee with support from the Agency for Healthcare Research and Quality and the National Institutes of Health. The committee’s report reviews the major drivers of health care disparities, provides insight into successful and unsuccessful interventions, identifies gaps in the evidence base, and makes recommendations to advance health equity.
Topics: Health and Medicine
Since the onset of the coronavirus disease 2019 (COVID-19) pandemic in early 2020, many individuals infected with the virus that causes COVID-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have continued to experience lingering symptoms for months or even years following infection. Some symptoms can affect a person's ability to work or attend school for an extended period of time. Consequently, in 2022, the Social Security Administration requested that the National Academies convene a committee of relevant experts to investigate and provide an overview of the current status of diagnosis, treatment, and prognosis of long-term health effects related to Long COVID. This report presents the committee conclusions.
Topics: Health and Medicine
Vaccines are a public health success story, as they have prevented or lessened the effects of many infectious diseases. To address concerns around potential vaccine injuries, the Health Resources and Services Administration (HRSA) administers the Vaccine Injury Compensation Program (VICP) and the Countermeasures Injury Compensation Program (CICP), which provide compensation to those who assert that they were injured by routine vaccines or medical countermeasures, respectively. The National Academies of Sciences, Engineering, and Medicine have contributed to the scientific basis for VICP compensation decisions for decades.
HRSA asked the National Academies to convene an expert committee to review the epidemiological, clinical, and biological evidence about the relationship between COVID-19 vaccines and specific adverse events, as well as intramuscular administration of vaccines and shoulder injuries. This report outlines the committee findings and conclusions.
Topics: Health and Medicine
Engaging the full breadth of talent in the United States is an important component of growing and sustaining dominance in research and development (R&D) and supporting national security into the future. By 2030, one-fifth of Americans will be above age 65 and at or nearing retirement from the workforce. Estimates of race and ethnic demographic changes between 2016 and 2030 show a decrease in the non-Hispanic white population and an increase in terms of both number and share of all other demographic groups, and this trend will continue to increase. These population shifts signal a citizenry and workforce that will be increasingly diverse. For the United States to maintain its global competitiveness and protect its security interests, targeted support is needed to cultivate talent from communities throughout the nation.
The nation's more than 800 Minority-Serving Institutions (MSIs) provide an impactful and cost-effective opportunity to focus on cultivating the current and future U.S. population for careers in science, technology, engineering, and mathematics (STEM), including in fields critical to the U.S. Department of Defense (DOD). At the request of DOD, this report identifies tangible frameworks for increasing the participation of MSIs in defense-related research and development and identifies the necessary mechanisms for elevating minority serving institutions to R1 status (doctoral universities with very high research activity) on the Carnegie Classifications of Institutions of Higher Education scale.
Topics: Education
High magnetic fields are a vital tool in many areas of science and technology that impact our everyday lives. Magnetic resonance imaging enables a wide range of medical diagnostics and research, while nuclear magnetic resonance is critical for drug discovery research and more. High magnetic fields are an essential component to many proposed fusion energy reactors and are necessary to push the boundaries towards the development of new quantum technologies and semiconductors.
At the request of the National Science Foundation, the National Academies organized a study to identify scientific opportunities and key applications for high-magnetic-field science and technology for the next decade and beyond. This report explores the current state and future prospects for high-magnetic-field technologies and recommends actions to support the workforce, facilities, magnet development, and critical materials access necessary to promote U.S. innovation.
Topics: Math, Chemistry, and Physics | Engineering and Technology
Decades of research have shown that disadvantaged communities exist at the intersection of high levels of hazard exposure and poverty. Geospatial environmental justice (EJ) tools, such as the White House Council on Environmental Quality-developed Climate and Economic Justice Screening Tool (CEJST), are designed to integrate different kinds of health, social, environmental, and economic data to identify disadvantaged communities and to aid policy and investment decisions that address the pervasive, persistent, and largely unaddressed problems associated with environmental disparities in the United States.
Constructing Valid Geospatial Tools for Environmental Justice evaluates several EJ tools, including CEJST, and provides a conceptual framework and data strategy recommendations for developing the composite indicators that are the heart of geospatial EJ tools. An EJ tool that is transparent, legitimate, and has the trust of its users and the communities it represents is based on a structured iterative process that includes: a clear statement of tool objectives and definitions for the concepts being measured; the selection and integration of data and indicators; and assessment of robustness of the selected data and integration processes. Decisions regarding the tool should be iteratively informed by meaningful community engagement, validation to ensure tool results reflect real-world experiences, and careful and thorough documentation of all decision and data processes.
Topics: Environment and Environmental Studies | Math, Chemistry, and Physics | Behavioral and Social Sciences
In February 2024, the National Academies Global Forum on Innovation in Health Professional Education co-hosted a public workshop with Penn Dental Medicine to explore value proposition for oral health promotion and disease prevention. Experts from around the globe representing multiple sectors, discussed the value of holistic oral health, particularly for those with disabilities, and the importance of interprofessional education and collaborative practices aimed at whole-person oral health care.
Topics: Health and Medicine
Many federal agencies provide data and statistics on inequality and related aspects of household income, consumption, and wealth (ICW). However, because the information provided by these agencies is often produced using different concepts, underlying data, and methods, the resulting estimates of poverty, inequality, mean and median household income, consumption, and wealth, as well as other statistics, do not always tell a consistent or easily interpretable story. Measures also differ in their accuracy, timeliness, and relevance so that it is difficult to address such questions as the effects of the Great Recession on household finances or of the Covid-19 pandemic and the ensuing relief efforts on household income and consumption. The presence of multiple, sometimes conflicting statistics at best muddies the waters of policy debates and, at worst, enable advocates with different policy perspectives to cherry-pick their preferred set of estimates. Achieving an integrated system of relevant, high-quality, and transparent household ICW data and statistics should go far to reduce disagreement about who has how much, and from what sources. Further, such data are essential to advance research on economic wellbeing and to ensure that policies are well targeted to achieve societal goals.
Creating an Integrated System of Data and Statistics on Household Income, Consumption, and Wealth reviews the major household ICW statistics currently produced by U.S. statistical agencies and provides guidance for modernizing the information to better inform policy and research, such as understanding trends in inequality and mobility. This report provides recommendations for developing an improved 21st century data system for measuring the extent to which economic prosperity is shared by households throughout the population and for understanding how the distribution of resources is affected by government policy and economic events.
Topics: Behavioral and Social Sciences
About 20 percent of all Americans live with a behavioral health condition, but only half of this population receives treatment - with direct consequences that include poor physical health outcomes, increased health care costs, and reduced quality of life and life span.
Barriers to obtaining behavioral health treatment are most evident in populations receiving Medicare, Medicaid, and Marketplace plans. Behavioral health care providers serving individuals enrolled in these plans are more likely to experience challenges around reimbursement and training, which disincentivizes participation.
The Centers for Medicare & Medicaid Services and the Substance Abuse and Mental Health Services Administration asked the National Academies to convene an expert committee to examine current challenges in ensuring broad access to evidence-based behavioral health care services through Medicare, Medicaid, and Marketplace programs and propose strategies to address those challenges.
Topics: Health and Medicine
National and international plans for halting and reversing climate change focus on reducing and eventually ending the largest source of greenhouse gas emissions: carbon dioxide (CO2) released by fossil fuel combustion. However, as the nation moves towards replacing many fossil CO2-emitting processes with zero- or low-carbon-emission alternatives, special attention is needed to eliminate net carbon emissions from the systems that cannot be fully "decarbonized", such as the production of aviation fuel, chemicals, plastics, and construction materials. For these systems, carbon will need to be managed and utilized effectively, in a way that either prevents CO2 from entering the atmosphere or reuses it through circular processes that do not contribute additional emissions.
Carbon Utilization Infrastructure, Markets, and Research and Development: A Final Report is the second report of a two-part study. The study's first report assessed the state of infrastructure for CO2 transportation, use, and storage, highlighting priority opportunities for further investment. This second report identifies potential markets and commercialization opportunities for CO2- and coal waste-derived products, examines economic, environmental, and climate impacts of CO2 utilization infrastructure, and puts forward a comprehensive research agenda for carbon utilization technologies.
Topics: Energy and Energy Conservation | Math, Chemistry, and Physics
Research supported by scientific ocean drilling has fundamentally transformed our understanding of the planet with key contributions to the discovery and theory of plate tectonics; the formation and destruction of ocean crust; the reconstruction of extreme greenhouse and icehouse climates; the identification of major extinctions; and the discovery of a diverse community of microbes living deep ocean seafloor. With the retirement in 2024 of the JOIDES Resolution-- the U.S. dedicated drilling vessel for deep sea research and the workhorse for the international scientific ocean drilling community-- the scientific ocean drilling landscape will change. At this critical juncture, the National Science Foundation (NSF) is looking to identify the most urgent research questions that can only be answered with scientific ocean drilling and what infrastructure is needed to progress those priorities.
This interim report that is the first part of a broader study of decadal survey of ocean science provides a broad perspective of future research and associated infrastructure needs. The report concludes that the rapid pace of climate change, related extreme events, sea level rise, changes in ocean currents, chemistry threatening ocean ecosystems, and devastating natural hazards are among the greatest challenges facing society. By coring the past to inform the future, U.S. based scientific ocean drilling research continues to have unique and essential roles in addressing these vital and urgent challenges.
Topics: Earth Sciences
Engineering advances economic growth, enhances manufacturing capacity, enhances infrastructure resilience, improves healthcare, and strengthens national security. However, the impact of engineering research - and, by extension, engineering education - is often hidden from the public eye. Promoting comprehension of how engineering affects society is thus a crucial aspect of garnering and sustaining public backing of policies aimed at ensuring that technology continues to serve the greater good of humanity. One part of this effort is highlighting the pivotal role of federal support of engineering research. Such support furnishes researchers with the necessary resources to pursue ambitious projects, fostering exploration into fundamental questions, groundbreaking technology and engineered systems developments, and practical applications.
Since its inception in 1950, the National Science Foundation (NSF)—an independent federal agency—has played a critical role in funding cutting-edge research, including in engineering. At the request of NSF, Impacts of National Science Foundation Engineering Research Support on Society explores how investment in engineering research and education has led to positive societal impacts, focusing on the stories of the people responsible for these impacts. This report presents clear, compelling narratives for the public about the sources and effects of engineering innovations and offer recommendations on how to bring this information to the attention of diverse audiences.
Topics: Engineering and Technology
Public-private partnerships (PPPs) are collaborations among public and private entities (e.g., government agencies, research institutions, nonprofit organizations, and industry organizations) that bring together diverse expertise, resources, and perspectives to solve complex challenges. The National Academies National Cancer Policy Forum, in collaboration with the Forum on Drug Discovery, Development, and Translation, hosted a public workshop in October 2023 to examine opportunities to improve the care and outcomes for patients with cancer through PPPs for clinical cancer research.
Topics: Health and Medicine
Infant formula is a primary or supplementary source of nutrition for many infants in the U.S. Consequently, disruptions to the supply of infant formula can have a severe impact on infants' health and well-being. In late 2021 and early 2022, a recall of specific infant formula products, followed by a pause in production, resulted in a widespread, national shortage. The incident demonstrated that additional risk management planning is needed to protect infants from the consequences of potential future supply chain disruptions.
In 2023, the U.S. Food and Drug Administration contracted with the National Academies to convene an expert committee to examine and report on challenges in supply, market competition, and regulation of infant formula. The resulting consensus study report explains policy and marketplace vulnerabilities that were exposed during the shortage, describes the extent to which actions taken by relevant stakeholders addressed these vulnerabilities, identifies remaining gaps in the system, and recommends actions to reduce the risk and lessen the effect of any future disruption to the infant formula supply chain.
Topics: Food and Nutrition
Ocean Acoustics - the study of sound in the ocean, how it travels, interacts with, and is affected by its underwater surroundings - is a growing and critical field. Sound from both natural and human-generated sources can be an effective tool for probing the ocean environment. While the first applications of ocean acoustics began in the military, applications today encompass offshore energy production, national security, environmental monitoring, climate science, exploration and mapping, as well as fundamental ocean science.
Even as demand for ocean acoustics grows, workforce development is challenged by both the multidisciplinary nature of the field and its widely varying career paths. Ocean acoustics may be housed in a diversity of departments in higher education institutions, and career paths and trajectory of formal education can range from the vocational/associates' level through the doctorate level. This report examines the state of ocean acoustics education; assesses expected demand for acoustics expertise over the next decade; identifies competencies required across higher education and professional training programs; and presents strategies to raise the profile of careers in ocean acoustics. The report recommends a number of actions that federal agencies, industry, and academia can take to develop the expertise needed to meet current and future workforce demands.
Topics: Earth Sciences | Industry and Labor
Concerted efforts to deepen understanding of RNA modifications and their role in living systems hold the potential to advance human health, improve crop yields, and address other pressing societal challenges. RNA, which carries the information encoded by DNA to the places where it is needed, is amazingly diverse and dynamic. RNA is processed and modified through natural biological pathways, giving rise to hundreds, in some cases thousands, of distinct RNA molecules for each gene, thereby diversifying genetic information. RNA modifications are known to be pivotal players in nearly all biological processes, and their dysregulation has been implicated in a wide range of human diseases and disorders. Yet, our knowledge of RNA modifications remains incomplete, hindered by current technological limitations. Existing methods cannot discover all RNA modifications, let alone comprehensively sequence them on every RNA molecule. Nonetheless, what is known about RNA modifications has already been leveraged in the development of vaccines that helped saved millions of lives worldwide during the COVID-19 pandemic. RNA modifications also have applications beyond health, for example, enhancing agricultural productivity.
Charting a Future for Sequencing RNA and Its Modifications: A New Era for Biology and Medicine calls for a focused, large-scale effort to accelerate technological innovation to harness the full potential of RNA modifications to address pressing societal challenges in health, agriculture, and beyond. This report assesses the scientific and technological breakthroughs, workforce, and infrastructure needs to sequence RNA and its modifications, and ultimately understand the roles RNA modifications play in biological processes and disease. It proposes a roadmap of innovation that will make it possible for any RNA from any biological system to be sequenced end-to-end with all of its modifications - a capability that could lead to more personalized and targeted treatments and instigate transformative changes across various sectors beyond health and medicine.
Topics: Biology and Life Sciences | Health and Medicine
Experiencing a single disaster - a hurricane, tornado, flood, severe winter storm, or a global pandemic - can wreak havoc on the lives and livelihoods of individuals, families, communities and entire regions. For many people who live in communities in the U.S. Gulf of Mexico region, the reality of disaster is starker. Endemic socioeconomic and health disparities have made many living in Gulf of Mexico communities particularly vulnerable to the effects of weather-climate hazards. Prolonged disaster recovery and increasing disaster risk is an enduring reality for many living in Gulf of Mexico communities. Between 2020 and 2021, seven major hurricanes and a severe winter storm affected communities across the region. As a backdrop to these acute weather events, the global COVID-19 pandemic was unfolding, producing a complex and unprecedented public health and socioeconomic crisis.
Traditionally, the impacts of disasters are quantified individually and often in economic terms of property damage and loss. In this case, each of these major events occurring in the Gulf of Mexico during this time period subsequently earned the moniker of "billion-dollar" disaster. However, this characterization does not reflect the non-financial human toll and disparate effects caused by multiple disruptive events that increase underlying physical and social vulnerabilities, reduce adaptive capacities and ultimately make communities more sensitive to the effects of future disruptive events. This report explores the interconnections, impacts, and lessons learned of compounding disasters that impair resilience, response, and recovery efforts. While Compounding Disasters in Gulf Coast Communities, 2020-2021 focuses on the Gulf of Mexico region, its findings apply to any region that has similar vulnerabilities and that is frequently at risk for disasters.
Topics: Environment and Environmental Studies
With recent medical, technological, and socioeconomic developments, people are living longer. The rising average age of the world's population presents an opportunity to develop health policy that prioritizes functioning as a goal of healthy aging. In February 2024, the National Academies convened a hybrid workshop at the University of Lucerne in Switzerland to host a discussion focused on the World Health Organization's concept of functioning. Speakers paid particular focus to healthy aging and the future of rehabilitation as a health strategy. Experts emphasized that the need for rehabilitation is increasing due to rapid population aging accompanied by a rise in physical and mental health conditions, limitations, and injuries. The associated economic and practical obstacles of optimizing functioning across the life course were also discussed.
Topics: Health and Medicine
2023 marked the 10-year anniversary of the National Academies Institute of Medicine consensus report, "Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis." The National Cancer Policy Forum and the American Society of Clinical Oncology co-hosted a public workshop in October 2023 to provide an opportunity for the cancer community to gauge progress on the implementation of the report recommendations and to discuss persistent challenges in achieving excellent and equitable cancer care. Workshop speakers considered actions that could be taken to improve progress, as well as aspects of cancer care that have changed over the past decade and thus might require new strategies to advance the delivery of high-quality cancer care.
Topics: Health and Medicine
In 2018, the National Academies released Thriving on Our Changing Planet: A Decadal Strategy for Earth Observation from Space. The decadal survey identified key science questions and prioritized observational needs to advance U.S. efforts in Earth science and support critical applications such as climate modeling and weather prediction. In the past few years, the need for actionable data and better scientific information on Earth's interacting systems has increased in urgency, as global climate change accelerates coupled with increasing numbers of extreme weather events.
At the request of NASA, this mid-term assessment evaluates progress and recommends actions to meet decadal survey priorities. This report explores ways that NASA's Earth Science Division can maintain programmatic balance, improve alignment with decadal survey priorities, and prepare for the next decadal survey.
Topics: Space and Aeronautics
Science, technology, engineering, and mathematics (STEM) live in the American imagination as promising tools for solving pressing global challenges and enhancing quality of life. Despite the importance of the STEM disciplines in the landscape of U.S. political, economic, and social priorities, STEM learning opportunities are unevenly distributed, and the experiences an individual has in STEM education are likely to vary tremendously based on their race, ethnicity, socio-economic class, gender, and a myriad of other factors.
Equity in K-12 STEM Education: Framing Decisions for the Future approaches equity in STEM education not as a singular goal but as an ongoing process that requires intentional decision-making and action toward addressing and disrupting existing inequities and envisioning a more just future. Stakeholders at all levels of the education system - including state, district, and school leaders and classroom teachers - have roles as decision-makers who can advance equity. This consensus study report provides five equity frames as a guide to help decision-makers articulate short- and long-term goals for equity and make decisions about policy and practice.
Topics: Education
Women in the United States experience a higher prevalence of many chronic conditions, including Alzheimer's disease, depression, and osteoporosis, than men; they also experience female-specific conditions, such as endometriosis and pelvic floor disorders. A lack of research into both the biological and social factors that influence these conditions greatly hinders diagnosis, treatment, and prevention efforts, thus contributing to poorer health outcomes for women and substantial costs to individuals and for society.
The National Institutes of Health's Office of Research on Women's Health asked the National Academies of Sciences, Engineering, and Medicine to convene an expert committee to identify gaps in the science on chronic conditions that are specific to or predominantly impact women, or affect women differently, and propose a research agenda. The committee's report presents their conclusions and recommendations.
Topics: Health and Medicine
The lack of a clear and consistent definition for Long COVID presents challenges for policymakers, researchers, public health professionals, clinicians, support services, and patients. As such, the Administration for Strategic Preparedness and Response and the Office of the Assistant Secretary for Health asked the National Academies to assemble a committee of experts to produce a consensus definition for Long COVID. The resulting report, A Long COVID Definition: A Chronic, Systemic Disease State with Profound Consequences, presents the 2024 NASEM Long COVID Definition, developed based on findings reported in existing literature, as well as stakeholder and patient input.
Topics: Health and Medicine
This Report of the Treasurer of the National Academy of Sciences presents the financial position and results of operations as well as a review of the endowment and other long-term investments portfolio activities of our Academy for the year ended December 31, 2023.
Topics: Policy for Science and Technology
For more than 75 years, high-hazard structures in the U.S., including dams and nuclear power plants, have been engineered to withstand floods resulting from the most unlikely but possible precipitation, termed Probable Maximum Precipitation (PMP). Failure of any one of the more than 16,000 high-hazard dams and 50 nuclear power plants in the United States could result in the loss of life and impose significant economic losses and widespread environmental damage, especially under the pressures of climate change. While PMP estimates have provided useful guidance for designing critical infrastructure, weaknesses in the scientific foundations of PMP, combined with advances in understanding, observing, and modeling extreme storms, call for fundamental changes to the definition of PMP and the methods used to estimate it.
Modernizing Probable Maximum Precipitation Estimation recommends a new definition of PMP and presents a vision for a methodology relevant for design, operation, and regulation of critical infrastructure. The new definition targets precipitation depths with an extremely low exceedance probability instead of assuming rainfall is bounded, and considers specified climate periods so that PMP estimates can change as the climate changes. Near-term enhancements to PMP include improved data collection, model-based storm reconstructions, and strengthened scientific grounding for PMP methods. Long-term model-based PMP estimation will employ kilometer-scale climate models capable of resolving PMP storms and producing PMP-magnitude precipitation. A Model Evaluation Project will provide scientific grounding for model-based PMP estimation and determine when transition to a model-based PMP estimation should occur. Scientific and modeling advances along this front will contribute to addressing the societal challenges linked to the changes in extreme storms and precipitation in a warming climate, which are critical steps to ensuring the safety of our infrastructure and society.
Topics: Earth Sciences
Domestic and foreign violent extremist organizations, or terrorist groups, have caused a greater amount of harm with chemical agents than with biological or radiological weapons. The United States capacity and capability to identify, prevent, counter, and respond adequately to chemical threats is established by the strategies, policies, and laws enacted across multiple levels of government. While the number of chemical terrorism incidents has risen and fallen over time, there is no empirical or analytical indication that the threat is disappearing. This report comes at a time when the nation’s highest-level strategies have shifted from focusing primarily on violent extremist organizations to focusing more on Great Power Competition. This shift in relative perceived threat and consequent prioritization will impact efforts against chemical terrorism, and in turn, affect funding priorities. Revised risk assessments are needed to reprioritize risks guided by new strategies, so that strategy-aligned budgets can be created. The report recommends weapons of mass destruction budgets be aligned with evolving priorities and incentivize activities that transition promising research to operations.
Topics: Conflict and Security Issues
For nearly eight decades, the world has been navigating the dangers of the nuclear age. Despite Cold War tensions and the rise of global terrorism, nuclear weapons have not been used in conflict since Hiroshima and Nagasaki in 1945. Efforts such as strategic deterrence, arms control and non-proliferation agreements, and the U.S.-led global counterterrorism have helped to keep nuclear incidents at bay. However, the nation's success to date in countering nuclear terrorism does not come with a guarantee, success often carries the risk that other challenges will siphon away attention and resources and can lead to the perception that the threat no longer exists.
This report found that U.S. efforts to counter nuclear or radiological terrorism are not keeping pace with the evolving threat landscape. The U.S. government should maintain a strategic focus and effort on combatting terrorism across the national security community in coordination with international partners, State, Local, Tribal and Territorial authorities, the National Laboratories, universities and colleges, and civil society. Developing and sustaining adequate nuclear incident response and recovery capabilities at the local and state levels will likely require significant new investments in resources and empowerment of local response from Federal Emergency Management Agency (FEMA), working with the Centers for Disease Control and Prevention, Environmental Protection Agency, Department of Energy, and National Institutes of Health.
Topics: Conflict and Security Issues
The United States is an important food producer globally, in part because of its abundance of agriculturally productive soils. However, management practices that maximize yields have caused losses in soil organic matter, poor soil structure and water-holding capacity, and increased salinity on millions of acres of land - and have adversely affected the microbial communities that are the drivers of many soil processes. At the same time, recent scientific advances have spurred interest in how microbial communities can support soil health, food quality, and human health.
It is in this context that the U.S. Department of Agriculture National Institute of Food and Agriculture asked the National Academies to explore the linkages between soil health and human health. The report finds that to improve soil health, federal agencies need to promote the importance of soil health, support translational research, and develop a coordinated national approach to monitor soil health over time and space. Given the potential that microbiomes have in modulating soil, plant, and human health, there is also a pressing need to determine which microbial features, if any, contribute to quantifying or fortifying health in both human and soil systems and to understand the direct and indirect roles of soil, alongside other environmental factors, in influencing human microbial colonization and subsequent health outcomes. Such investigation involves delving into the relatively sparse or disconnected research regarding the microbiome continuum that links soil and human systems.
Topics: Earth Sciences | Food and Nutrition | Agriculture | Health and Medicine
Research in biological and physical sciences in space provides the critical scientific and technological foundations that make space exploration possible. This booklet summarizes recent advances in the biological and physical sciences that have changed our understanding of the factors important to human, plant, animal, and microbial health, and then highlights research needs to make transformative advances in space.
Topics: Space and Aeronautics
Family caregiving is not simply an outside obligation that has no bearing on the workings of academic science, technology, engineering, mathematics, and medicine (STEMM) as it affects the lives of so many people working and studying in colleges and universities around the country. Caregiving responsibilities often clash with ingrained norms in academic STEMM environments, which demand that STEMM students and workers demonstrate immense devotion to their fields and are always available and visibly working.
Supporting Family Caregivers in STEMM describes the ways in which the labor and contributions of caregivers are often invisible and undervalued, with a specific focus on the academic STEMM ecosystem, including undergraduate and graduate students, postdoctoral scholars, resident physicians and other trainees, tenure-track and non-tenure-track faculty, staff, and researchers. This report reviews policies and practices that support caregivers, locally and nationally, and describes best practices in policy implementation and design. Supporting Family Caregivers in STEMM also highlights innovative practices and offers actionable recommendations to higher education institutions, public and private funders, and the federal government.
Topics: Industry and Labor
Seafood--including marine and freshwater fish, mollusks, and crustaceans--is a healthy food choice, but it can also contain contaminants. It is currently unclear how much seafood children or pregnant and lactating women are consuming, and what impact seafood consumption is having on children's growth and development.
The U.S. Department of Health and Human Services, the U.S. Department of Agriculture, the U.S. Environmental Protection Agency, and the National Oceanic and Atmospheric Administration tasked the National Academies of Sciences, Engineering, and Medicine with convening an expert committee to examine associations between seafood intake for children, adolescents, and pregnant and lactating women and child growth and development. The committee also evaluated when to conduct risk-benefit analyses (RBAs), while considering contextual factors such as equity, diversity, inclusion, and access to health care, and explored how these factors might impact RBAs.
Topics: Health and Medicine | Food and Nutrition
Congress called on the National Academies to convene a committee to examine the real and perceived risks of liability arising from research conducted with pregnant and lactating women. The resulting report, Clinical Research with Pregnant and Lactating Populations: Overcoming Real and Perceived Liability Risks, explores and finds limited evidence of legal liability for inclusion of pregnant and lactating women in clinical research, contradicting perceptions of heightened liability. The committee also makes recommendations that could lead to a more robust evidence base about the safety and efficacy of medications for pregnant and lactating women that would facilitate more informed decision making regarding care while mitigating liability.
Topics: Health and Medicine
Climate change is increasing the frequency and severity of floods, posing serious threats to lives, livelihoods, and the future of affected communities. To explore opportunities to prevent and mitigate inequitable health impacts from flooding, the National Academies Environmental Health Matters Initiative (EHMI) organized a workshop on March 13 and 18, 2024, titled Communities, Climate Change, and Health Equity: Exploring Flood Adaptation Strategies to Support Health Equity. The workshop was the fourth in a series of EHMI events exploring the state of knowledge on climate-related health disparities. Through presentations, shared stories, and interactive discussions, participants explored health risks posed by flooding events, effective adaptation strategies for community resilience and climate adaptation, and ways to foster partnerships among government, academia, and the private sector to implement these strategies both locally and regionally.
Topics: Health and Medicine
This concise and beautifully illustrated booklet expresses the Academy's view on the teaching of creationism alongside evolution in the science classroom—"The tenets of 'creation science' are not supported by scientific evidence....Creationism has no place in a science curriculum at any level...." This is an essential tool for educators, school administrators, students, and parents—anyone with an interest in the quality of science education. This booklet is a reissue that updates the 1984 edition.
Topics: Biology and Life Sciences
Addressing climate change is essential and possible, and it offers a host of benefits - from better public health to new economic opportunities. The United States has a historic opportunity to lead the way in decarbonization by transforming its current energy system to one with net-zero emissions of carbon dioxide. Recent legislation has set the nation on the path to reach its goal of net zero by 2050 in order to avoid the worst consequences of climate change. However, even if implemented as designed, current policy will get the United States only part of the way to its net-zero goal.
Accelerating Decarbonization in the United States provides a comprehensive set of actionable recommendations to help policymakers achieve a just and equitable energy transition over the next decade and beyond, including policy, technology, and societal dimensions. This report addresses federal and subnational policy needs to overcome implementation barriers and gaps with a focus on energy justice, workforce development, public health, and public engagement. The report also presents a suite of recommendations for the electricity, transportation, built environment, industrial, fossil fuels, land use, and finance sectors.
Topics: Environment and Environmental Studies | Earth Sciences
At the request of the Administration for Strategic Preparedness and Response, the National Academies convened a committee to examine lessons learned from the COVID-19 pandemic and mpox multi-country outbreak to inform an evaluation of the state of smallpox research, development, and stockpiling of medical countermeasures (MCM). In the resulting report, the committee presents findings and conclusions that may inform U.S. Government investment decisions in smallpox MCM readiness, as well as the official U.S. position on the disposition of live viral collections at future World Health Assembly meetings.
Topics: Health and Medicine
A National Academies committee was tasked with identifying essential health care services for women related to intimate partner violence (IPV) during steady state conditions, determining whether the essential health care services related to IPV differ during public health emergencies (PHEs), and identifying strategies to sustain access to those essential health care services during PHEs. This report, Essential Health Care Services Addressing Intimate Partner Violence, presents findings from research and deliberations and lays out recommendations for leaders of health care systems, federal agencies, health care providers, emergency planners, and those involved in IPV research.
Topics: Health and Medicine
Between 1980 and mid-2023, 232 billion-dollar disasters occurred in the U.S. Gulf Coast region, with the number of disasters doubling annually since 2018. The variety and frequency of storms have exacerbated historic inequalities and led to cycles of displacement and chronic stress for communities across the region. While disaster displacement is not a new phenomenon, the rapid escalation of climate-related disasters in the Gulf increases the urgency to develop pre-disaster policies to mitigate displacement and decrease suffering. Yet, neither the region nor the nation has a consistent and inclusionary process to address risks, raise awareness, or explore options for relocating communities away from environmental risks while seeking out and honoring their values and priorities.
Community-Driven Relocation: Recommendations for the U.S. Gulf Coast Region and Beyond examines how people and infrastructure relocate and why community input should drive the planning process. This report provides recommendations to guide a path for federal, state, and local policies and programs to improve on and expand existing systems to better serve those most likely to be displaced by climate change.
Topics: Behavioral and Social Sciences
Experiencing poverty during childhood can lead to lasting harmful effects that compromise not only children’s health and welfare but can also hinder future opportunities for economic mobility, which may be passed on to future generations. This cycle of economic disadvantage weighs heavily not only on children and families experiencing poverty but also the nation, reducing overall economic output and placing increased burden on the educational, criminal justice, and health care systems.
Reducing Intergenerational Poverty examines key drivers of long- term, intergenerational poverty, including the racial disparities and structural factors that contribute to this cycle. The report assesses existing research on the effects on intergenerational poverty of income assistance, education, health, and other intervention programs and identifies evidence-based programs and policies that have the potential to significantly reduce the effects of the key drivers of intergenerational poverty. The report also examines the disproportionate effect of disadvantage to different racial/ethnic groups. In addition, the report identifies high-priority gaps in the data and research needed to help develop effective policies for reducing intergenerational poverty in the United States.
Topics: Behavioral and Social Sciences
As the United States devotes extensive resources to health care, evaluating how successfully the U.S. system delivers high-quality, high-value care in an equitable manner is essential. At the request of Congress, the Agency for Healthcare Research and Quality (AHRQ) annually produces the National Healthcare Quality Report (NHQR) and the National Healthcare Disparities Report (NHDR). The reports have revealed areas in which health care performance has improved over time, but they also have identified major shortcomings. After five years of producing the NHQR and NHDR, AHRQ asked the IOM for guidance on how to improve the next generation of reports.
The IOM concludes that the NHQR and NHDR can be improved in ways that would make them more influential in promoting change in the health care system. In addition to being sources of data on past trends, the national healthcare reports can provide more detailed insights into current performance, establish the value of closing gaps in quality and equity, and project the time required to bridge those gaps at the current pace of improvement.
Topics: Health and Medicine
A high-quality preschool education can foster critical development and learning that promotes joyful, affirming, and enriching learning opportunities that prepare children for success in school and life. While preschool programs generally provide emotionally supportive environments, their curricula often fall short in advancing learning in math, early literacy, and science, and lack the necessary support for multilingual learners emerging bilingualism. Additionally, access to high-quality, effective early learning experiences may be limited and inadequate based on factors such as a childs race, location, gender, language, identified disability, and socioeconomic status.
A New Vision for High-Quality Preschool Curriculum examines preschool curriculum quality for children from ages three to five, with special attention to the needs of Black and Latine children, multilingual learners, children with disabilities and children experiencing poverty in the United States. The report articulates a vision for high-quality preschool curricula for all children, grounded in an equity and justice-oriented principles from inception to implementation and evaluation.
Topics: Education
What is genius? Define it. Now think of scientists who embody the concept of genius. Does the name John Bardeen spring to mind? Indeed, have you ever heard of him?
Like so much in modern life, immediate name recognition often rests on a cult of personality. We know Einstein, for example, not just for his tremendous contributions to science, but also because he was a character, who loved to mug for the camera. And our continuing fascination with Richard Feynman is not exclusively based on his body of work; it is in large measure tied to his flamboyant nature and offbeat sense of humor.
These men, and their outsize personalities, have come to erroneously symbolize the true nature of genius and creativity. We picture them born brilliant, instantly larger than life. But is that an accurate picture of genius? What of others who are equal in stature to these icons of science, but whom history has awarded only a nod because they did not readily engage the public? Could a person qualify as a bona fide genius if he was a regular Joe?
The answer may rest in the story of John Bardeen.
John Bardeen was the first person to have been awarded two Nobel Prizes in the same field. He shared one with William Shockley and Walter Brattain for the invention of the transistor. But it was the charismatic Shockley who garnered all the attention, primarily for his Hollywood ways and notorious views on race and intelligence.
Bardeen's second Nobel Prize was awarded for the development of a theory of superconductivity, a feat that had eluded the best efforts of leading theorists—including Albert Einstein, Neils Bohr, Werner Heisenberg, and Richard Feynman. Arguably, Bardeen's work changed the world in more ways than that of any other scientific genius of his time. Yet while every school child knows of Einstein, few people have heard of John Bardeen. Why is this the case?
Perhaps because Bardeen differs radically from the popular stereotype of genius. He was a modest, mumbling Midwesterner, an ordinary person who worked hard and had a knack for physics and mathematics. He liked to picnic with his family, collaborate quietly with colleagues, or play a round of golf. None of that was newsworthy, so the media, and consequently the public, ignored him.
John Bardeen simply fits a new profile of genius. Through an exploration of his science as well as his life, a fresh and thoroughly engaging portrait of genius and the nature of creativity emerges. This perspective will have readers looking anew at what it truly means to be a genius.
Topics: Explore Science | Biography and Autobiography
Data are at the forefront of efforts to solve many of today's greatest problems, including climate change, misinformation and disinformation, the threat of future global pandemics, and the quest by people everywhere to lead better lives. But if researchers are going to use data to contribute to the solutions of problems, data need to be available for them to use. Over time, data have become increasingly voluminous, complex, and heterogeneous. Massive volumes of data are being generated by new devices and methods, and many of these data are not easy to analyze, interpret, or share. Groups that generate data may be reluctant to share them for a variety of professional, personal, financial, regulatory, and statutory reasons.
These issues were addressed during the US-UK Scientific Forum on Researcher Access to Data held in Washington, DC, on September 12–13, 2023. Organized by the National Academy of Sciences and the Royal Society, the forum examined the constellation of issues surrounding researchers' access to data, best practices and lessons learned from exemplary research disciplines, and new ideas and techniques that could drive research forward. This publication summarizes the presentations and discussions of the forum.
Topics: Policy for Science and Technology
Across multiple domains of science, engineering, and medicine, excitement is growing about the potential of digital twins to transform scientific research, industrial practices, and many aspects of daily life. A digital twin couples computational models with a physical counterpart to create a system that is dynamically updated through bidirectional data flows as conditions change. Going beyond traditional simulation and modeling, digital twins could enable improved medical decision-making at the individual patient level, predictions of future weather and climate conditions over longer timescales, and safer, more efficient engineering processes. However, many challenges remain before these applications can be realized.
This report identifies the foundational research and resources needed to support the development of digital twin technologies. The report presents critical future research priorities and an interdisciplinary research agenda for the field, including how federal agencies and researchers across domains can best collaborate.
Topics: Computers and Information Technology | Math, Chemistry, and Physics
Social media has been fully integrated into the lives of most adolescents in the U.S., raising concerns among parents, physicians, public health officials, and others about its effect on mental and physical health. Over the past year, an ad hoc committee of the National Academies of Sciences, Engineering, and Medicine examined the research and produced this detailed report exploring that effect and laying out recommendations for policymakers, regulators, industry, and others in an effort to maximize the good and minimize the bad. Focus areas include platform design, transparency and accountability, digital media literacy among young people and adults, online harassment, and supporting researchers.
Topics: Health and Medicine
Protecting privacy and ensuring confidentiality in data is a critical component of modernizing our national data infrastructure. The use of blended data - combining previously collected data sources - presents new considerations for responsible data stewardship. Toward a 21st Century National Data Infrastructure: Managing Privacy and Confidentiality Risks with Blended Data provides a framework for managing disclosure risks that accounts for the unique attributes of blended data and poses a series of questions to guide considered decision-making.
Technical approaches to manage disclosure risk have advanced. Recent federal legislation, regulation and guidance has described broadly the roles and responsibilities for stewardship of blended data. The report, drawing from the panel review of both technical and policy approaches, addresses these emerging opportunities and the new challenges and responsibilities they present. The report underscores that trade-offs in disclosure risks, disclosure harms, and data usefulness are unavoidable and are central considerations when planning data-release strategies, particularly for blended data.
Topics: Behavioral and Social Sciences
Facial recognition technology is increasingly used for identity verification and identification, from aiding law enforcement investigations to identifying potential security threats at large venues. However, advances in this technology have outpaced laws and regulations, raising significant concerns related to equity, privacy, and civil liberties.
This report explores the current capabilities, future possibilities, and necessary governance for facial recognition technology. Facial Recognition Technology discusses legal, societal, and ethical implications of the technology, and recommends ways that federal agencies and others developing and deploying the technology can mitigate potential harms and enact more comprehensive safeguards.
Topics: Computers and Information Technology | Behavioral and Social Sciences | Engineering and Technology
Fisheries are essential to the global economy and feed billions around the world; they, support individuals and communities, and sustain cultural heritages and livelihoods. Although U.S. fisheries have been managed for commercial fishing historically, there has been an interest more recently in better accounting for and meeting the needs of the diverse individuals, groups, and communities that rely on and participate in fisheries, or aspire to do so.
At the request of the National Marine Fisheries Service, this report considers information needs and data collection for assessing the distribution of fisheries management benefits. Assessing Equity in the Distribution of Fisheries Management Benefits identifies information needs, obstacles to collecting information, and potential methodologies for assessing where and to whom the primary benefits of commercial and for-hire fishery management accrue.
Topics: Agriculture | Environment and Environmental Studies
To consider how an Earth system science approach can inform research on climate intervention, The National Academies of Sciences, Engineering, and Medicine held a virtual workshop on June 20-22, 2023 titled Climate Intervention in an Earth Systems Science Framework. Individuals with a wide range of physical, ecological, and social sciences expertise explored climate interventions within the context of convergent research and the capacities of the National Science Foundation (NSF). The workshop drew on the National Academies report Next Generation Earth Systems Science at the National Science Foundation, which called upon NSF to pursue an Earth systems science initiative that emphasizes research on interconnections and feedback between natural and social processes; focuses on real-world problems; enhances the participation of social, engineering, and data scientists; and strengthens efforts to include diverse perspectives in research.
Topics: Environment and Environmental Studies | Earth Sciences
In the United States, 54% of nurses and physicians, 60% of medical students and residents, and 61% of pharmacists have symptoms of burnout. Burnout is a long-standing issue and a fundamental barrier to professional well-being. It was further exacerbated by the COVID-19 pandemic. Health workers who find joy, fulfillment, and meaning in their work can engage on a deeper level with their patients, who are at the heart of health care. Thus, a thriving workforce is essential for delivering safe, high-quality, patient-centered care.
The National Plan for Health Workforce Well-Being is intended to inspire collective action that focuses on changes needed across the health system and at the organizational level to improve the well-being of the health workforce. As a nation, we must redesign how health is delivered so that human connection is strengthened, health equity is achieved, and trust is restored. The National Plan’s vision is that patients are cared for by a health workforce that is thriving in an environment that fosters their well-being as they improve population health, enhance the care experience, reduce costs, and advance health equity; therefore, achieving the “quintuple aim.”
Together, we can create a health system in which care is delivered joyfully and with meaning, by a committed team of all who work to advance health, in partnership with engaged patients and communities.
Topics: Health and Medicine
Smart manufacturing technologies - from advanced sensors to new computing capabilities - have the potential to greatly improve the productivity, energy efficiency, and sustainability of the U.S. manufacturing sector. Successfully implementing these technologies is essential for ensuring U.S. competitiveness and providing new job opportunities for the U.S. workforce.
Options for a National Plan for Smart Manufacturing explores promising technologies transforming the manufacturing sector and identifies the research and resources needed to accelerate smart manufacturing adoption industry wide. This report also identifies critical needs for education and workforce development for smart manufacturing and makes actionable recommendations to support and train the next-generation manufacturing workforce.
Topics: Industry and Labor | Engineering and Technology
The Survey of Income and Program Participation (SIPP) is one of the U.S. Census Bureau’s major surveys with features making it a uniquely valuable resource for researchers and policy analysts. However, the Census Bureau faces the challenge of protecting the confidentiality of survey respondents which has become increasingly difficult because numerous databases exist with personal identifying information that collectively contain data on household finances, home values, purchasing behavior, and other SIPP-relevant characteristics.
A Roadmap for Disclosure Avoidance in the Survey of Income and Program Participation addresses these issues and how to make data from SIPP available to researchers and policymakers while protecting the confidentiality of survey respondents. The report considers factors such as evolving privacy risks, development of new methods for protecting privacy, the nature of the data collected through SIPP, the practice of linking SIPP data with administrative data, the types of data products produced, and the desire to provide timely access to SIPP data. The report seeks to balance minimizing the risk of disclosure against allowing researchers and policymakers to have timely access to data that support valid inferences.
Topics: Behavioral and Social Sciences
Approximately 3.6 million live births occur every year in the United States. Between 8 and 9 percent of infants are born with low birth weight (LBW), defined by the medical community as less than 2,500 grams or 5.5 pounds at birth. While most infants born with LBW are not impacted by severe developmental disabilities or major or multiple health conditions, research indicates that these infants often do experience elevated rates of mild to moderate chronic health conditions that have meaningful functional impacts throughout an individuals life course.
The Social Security Administration (SSA) asked the National Academies of Sciences, Engineering, and Medicine to convene an expert committee to provide an overview of the current status of the identification, treatment, and prognosis of LBW babies, including trends in survivability, in the U.S. population under age 1 year. SSA also asked the committee to provide information on the short- and long-term functional outcomes associated with and the most common conditions related to LBW, available treatments and services, and other considerations. The resulting report, Low Birth Weight Babies and Disability, presents the committees conclusions.
Topics: Health and Medicine
Antarctica hosts some of the harshest and most remote environments on Earth - and it is a region of vital importance for scientific research. The environment and position of Antarctica on the globe mean that research conducted there can offer unique insights on important Earth processes, including rising sea level, the carbon cycle, ecosystem structure. As the climate warms, data gathered from Antarctic research will be essential to understanding how Earth processes are changing and the potential social, economic, and health impacts on both U.S. and global populations.
This report identifies the highest priorities for research in the Southern Ocean and nearshore and coastal Antarctica, as well as gaps in current capabilities to support this research. Global sea level rise, heat and carbon budgets, and changing ecosystems are the three highest-priority science drivers for research in the region. To address those drivers and maintain a robust U.S. research presence in this vitally important region, investments are needed in the U.S. Antarctic program and its research platforms, including the development of new technologies and the replacement of aging icebreaking research vessels. Additionally, the U.S. should strengthen relationships with other nations’ Antarctic programs that can help support these essential science drivers.
Topics: Earth Sciences
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.
Topics: Health and Medicine
Member agencies of the intelligence community (IC) collect, maintain, and store large amounts of data. There is a profusion of sensors and communications options that has led to a dramatic escalation in the amount of data readily available for a wide variety of purposes. Much more data are being created than are being deleted. But a large fraction, as much as 30 to 35 percent of enterprise data, is data that are rarely accessed (with weeks to years elapsing between uses) and may sit for a long period of time. This poses a challenge because it means that, worldwide, a massive number of exabytes of data need to be securely maintained, managed, and administered in some sort of way. Additionally, the amount of data that will need to be archived for short- and long-term use will continue to rise. In particular, the IC has the potential to be one of the largest customers for cold data storage because of its wide-ranging need for information.
At the request of the Office of the Director of National Intelligence (ODNI), this Rapid Expert Consultation (REC) explores options for technologies for archival data storage, focusing primarily on current data storage technologies, particularly magnetic storage, Flash, MRAM, and optical storage. While not all of these technologies are well suited to archival storage applications, the ODNI indicated a desire to hear about all possible options. Brief overviews of emerging technologies are included. Finally, the REC offers comments on the importance of non-technological aspects of archiving, including policies and personnel, which should be considered in the design and acquisition of long-term data storage systems.
Topics: Computers and Information Technology | Conflict and Security Issues
Research shows that that children learn science and engineering subjects best by engaging from an early age in the kinds of practices used by real scientists and engineers. By doing science and engineering, children not only develop and refine their understanding of the core ideas and crosscutting concepts of these disciplines, but can also be empowered to use their growing understanding to make sense of questions and problems relevant to them. This approach can make learning more meaningful, equitable, and lasting.
Using cases and shorter examples, Rise and Thrive with Science shows what high-quality teaching and learning in science and engineering can look like for preschool and elementary school children. Through analyses of these examples and summaries of research findings, the guide points out the key elements of a coherent, research-grounded approach to teaching and learning in science and engineering. This guide also discusses the kinds of support that educators need to implement effective and equitable instruction for all children. This book will provide inspiration for practitioners at the preschool and elementary levels to try new strategies for science and engineering education, whatever their level of experience.
Rise and Thrive with Science will be an essential guide for teachers as they organize instruction to enable young children to carry out their own science investigations and engineering design projects, determine the kinds of instruction that lead to meaningful learning, and try to engage every one of their students.
Topics: Education
Critical Issues in Transportation for 2024 and Beyond calls for reassessing the role of transportation in addressing major societal challenges and the research that informs the choices that society will need to make in 2024 and coming years. This reassessment is driven by large-scale environmental, public health, and socioeconomic forces, including:
For the latest edition of Critical Issues in Transportation, the Transportation Research Board’s Executive Committee chose to focus on five societal goals to address these and other dynamic forces and the challenges in accentuating transportation’s role in achieving them.
Topics: Transportation and Infrastructure
Advances in biomedical science, data science, engineering, and technology are leading to high-pace innovation with potential to transform health and medicine. These innovations simultaneously raise important ethical and social issues, including how to fairly distribute their benefits and risks. The National Academies of Sciences, Engineering, and Medicine, in collaboration with the National Academy of Medicine, established the Committee on Creating a Framework for Emerging Science, Technology, and Innovation in Health and Medicine to provide leadership and engage broad communities in developing a framework for aligning the development and use of transformative technologies with ethical and equitable principles. The committees resulting report describes a governance framework for decisions throughout the innovation life cycle to advance equitable innovation and support an ecosystem that is more responsive to the needs of a broader range of individuals and is better able to recognize and address inequities as they arise.
Topics: Health and Medicine
Research in biological and physical sciences in space provides the critical scientific and technological foundations that make space exploration possible. As humanity looks towards the Moon and Mars for future missions, this work is needed to help astronauts adapt and live in the harsh environments of space. Thriving in Space provides a roadmap for increasing national investment in biological and physical science research, from experiments to infrastructure to education. This report identifies key scientific questions, priorities, and ambitious research campaigns that will enable human space exploration and transform our understanding of how the universe works.
Thriving in Space reviews the state of knowledge in the current and emerging areas of space-related biological and physical sciences research and generates recommendations for a comprehensive vision and strategy for a decade of transformative science at the frontiers of biological and physical sciences research in space. This report will help NASA define and align biological and physical sciences research to uniquely advance scientific knowledge, meet human and robotic exploration mission needs, and provide terrestrial benefits.
Topics: Space and Aeronautics
This booklet provides key insights from Oil in the Sea IV: Inputs, Fates, and Effects, published in 2022, which benefited from significant advancements in scientific methods to detect the input and fates of oil in the sea, and from lessons learned from the Deepwater Horizon explosion and oil spill in 2010. Going beyond previous reports, Oil in the Sea IV includes analysis of human health impacts of oil in the sea, oil in the Arctic marine environment, and prevention and response efforts that can help to both reduce the amount of oil reaching the sea and minimize its effects. The booklet is meant to serve as a reference guide to all those involved in oil spill research and response.
Topics: Environment and Environmental Studies | Earth Sciences
Pediatric subspecialists are critical to ensuring quality care and pursuing research to improve prevention, diagnosis, and treatment for children. However, there are substantial disincentives to pursuing a career as a pediatric subspecialist, which are often heightened for individuals from groups underrepresented in medicine, and more effective collaboration with primary care clinicians is needed. Changing health care needs, increasing care complexity, and access barriers to pediatric subspecialty care have raised concerns about the current and future availability of pediatric subspecialty care and research.
In response, the National Academies, with support from a coalition of sponsors, formed the Committee on the Pediatric Subspecialty Workforce and Its Impact on Child Health and Well-Being to recommend strategies and actions to ensure an adequate pediatric subspecialty physician workforce to support broad access to high quality subspecialty care and a robust research portfolio to advance the health and health care of infants, children, and adolescents. This report outlines recommendations that, if fully implemented, can improve the quality of pediatric medical subspecialty care through a well-supported, superbly trained, and appropriately used primary care, subspecialty, and physician-scientist workforce.
Topics: Behavioral and Social Sciences | Health and Medicine
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.
Topics: Health and Medicine | Transportation and Infrastructure
The predominant way of making steel in the United Sates is by using an electric arc furnace (EAF) to melt scrap steel, which results in the formation of a rock-like material called slag. Among its various applications, EAF slag is used in a loose or unencapsulated form as ground cover material for residential landscaping. However, the slag generated from the EAF process can contain toxic metals, which can be hazardous to human and environmental health.
This report, conducted at the request of the U.S. EPA, discusses the relative hazard of key EAF slag constituents, the extent to which they may be released into the environment, and important aspects in assessing human exposures and risk. Due to uncertainties in the current evidence stream, the report was unable to make an overall characterization of risk related to unencapsulated EAF slag use in the United States and cautions against making generalizations from conclusions in published risk assessments. The report also identifies research needs to better understand factors considered to have the potential to contribute to the highest risks from the use of unencapsulated EAF slag, such as human exposure to dust particles that may be released over time from applied slag.
Topics: Environment and Environmental Studies
Complementary feeding refers to the introduction of foods other than human milk or formula to an infants diet. In response to a request from the Centers for Disease Control and Prevention, the National Academies Health and Medicine Division convened the Committee on Complementary Feeding Interventions for Infants and Young Children under Age 2 to conduct a consensus study scoping review of peer-reviewed literature and other publicly available information on interventions addressing complementary feeding of infants and young children. The interventions studied took place in the U.S. and other high-income country health care systems; early care and education settings; university cooperative extension programs; the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); home visiting programs; and other settings. This consensus study report summarizes evidence and provides information on interventions that could be scaled up or implemented at a community or state level.
Topics: Food and Nutrition | Health and Medicine
The next decade of planetary science and astrobiology holds tremendous promise. This booklet highlights key science questions, identifies priority missions, and presents a research strategy that includes both planetary defense and human exploration.
Topics: Space and Aeronautics
Since 1790, the U.S. census has been a recurring, essential civic ceremony in which everyone counts; it reaffirms a commitment to equality among all, as political representation is explicitly tied to population counts. Assessing the 2020 Census looks at the quality of the 2020 Census and its constituent operations, drawing appropriate comparisons with prior censuses. The report acknowledges the extraordinary challenges the Census Bureau faced in conducting the census and provides guidance as it plans for the 2030 Census. In addition, the report encourages research and development as the goals and designs for the 2030 Census are developed, urging the Census Bureau to establish a true partnership with census data users and government partners at the state, local, tribal, and federal levels.
Topics: Behavioral and Social Sciences
We live in a time of extraordinary discovery and progress in astronomy and astrophysics. The next decade will transform our understanding of the universe and humanity's place in it. Every decade the U.S. agencies that provide primary federal funding for astronomy and astrophysics request a survey to assess the status of, and opportunities for the Nation's efforts to forward our understanding of the cosmos. Pathways to Discovery in Astronomy and Astrophysics for the 2020s identifies the most compelling science goals and presents an ambitious program of ground- and space-based activities for future investment in the next decade and beyond. The decadal survey identifies three important science themes for the next decade aimed at investigating Earth-like extrasolar planets, the most energetic processes in the universe, and the evolution of galaxies. The Astro2020 report also recommends critical near-term actions to support the foundations of the profession as well as the technologies and tools needed to carry out the science.
Topics: Space and Aeronautics
Formaldehyde is widely present in the environment and is one of the highest production chemicals by volume, used in manufactured goods including wood products, permanent press fabrics, and household products. It is also formed by combustion sources and is present in smoke from cigarettes and other tobacco products, and in emissions from gas stoves and open fireplaces. In carrying out its mission to protect human health, the U.S. Environmental Protection Agency (EPA) identifies and characterizes the health hazards of chemicals found in the environment through its Integrated Risk Information System (IRIS) Program, which has reviewed the human health hazards resulting from formaldehyde exposure in several assessments.
This report is a continuation of guidance from the National Academies on draft IRIS assessments of formaldehyde and other aspects of the IRIS program. This report reviews the 2022 Draft Assessment with regard to its adequacy and transparency in evaluating the scientific literature, use of appropriate methods to synthesize the current state-of-the science, and presentations of conclusions that are supported by the scientific evidence. The report concludes that the 2022 Draft Assessment follows the advice of prior National Academies reports and that its findings on hazard and quantitative risk are supported by the evidence identified. However, revisions are needed to ensure that users can find and follow the methods used in each step of the assessment for each health outcome.
Topics: Environment and Environmental Studies
The next decade of planetary science and astrobiology holds tremendous promise. New research will expand our understanding of our solar system's origins, how planets form and evolve, under what conditions life can survive, and where to find potentially habitable environments in our solar system and beyond. Origins, Worlds, and Life: A Decadal Strategy for Planetary Science and Astrobiology 2023-2032 highlights key science questions, identifies priority missions, and presents a comprehensive research strategy that includes both planetary defense and human exploration. This report also recommends ways to support the profession as well as the technologies and infrastructure needed to carry out the science.
Topics: Space and Aeronautics
The field of quantum information science (QIS) has witnessed a dramatic rise in scientific research activities in the 21st century as excitement has grown about its potential to revolutionize communications and computing, strengthen encryption, and enhance quantum sensing, among other applications. While, historically, QIS research has been dominated by the field of physics and computer engineering, this report explores how chemistry - in particular the use of molecular qubits - could advance QIS. In turn, researchers are also examining how QIS could be used to solve problems in chemistry, for example, to facilitate new drug and material designs, health and environmental monitoring tools, and more sustainable energy production.
Recognizing that QIS could be a disruptive technology with the potential to create groundbreaking products and new industries, Advancing Chemistry and Quantum Information Science calls for U.S. leadership to build a robust enterprise to facilitate and support research at the intersection of chemistry and QIS. This report identifies three key research areas: design and synthesis of molecular qubit systems, measurement and control of molecular quantum systems, and experimental and computational approaches for scaling qubit design and function. Advancing Chemistry and Quantum Information Science recommends that the Department of Energy, National Science Foundation, and other funding agencies should support multidisciplinary and collaborative research in QIS, the development of new instrumentation, and facilities, centralized and open-access databases, and efforts to create a more diverse and inclusive chemical workforce.
Topics: Math, Chemistry, and Physics
The world confronts an existential challenge in responding to climate change, resulting in an urgent need to reduce greenhouse gas emissions from all sectors of the economy. What will it take for new and advanced nuclear reactors to play a role in decarbonization? Nuclear power provides a significant portion of the worlds low-carbon electricity, and advanced nuclear technologies have the potential to be smaller, safer, less expensive to build, and better integrated with the modern grid. However, if the United States wants advanced nuclear reactors to play a role in its plans for decarbonization, there are many key challenges that must be overcome at the technical, economic, and regulatory levels.
Laying the Foundation for New and Advanced Nuclear Reactors in the United States discusses how the United States could support the successful commercialization of advanced nuclear reactors with a set of near-term policies and practices. The recommendations of this report address the need to close technology research gaps, explore new business use cases, improve project management and construction, update regulations and security requirements, prioritize community engagement, strengthen the skilled workforce, and develop competitive financing options.
Topics: Environment and Environmental Studies | Energy and Energy Conservation
Many young children in the United States are thriving and have access to the conditions and resources they need to grow up healthy. However, a substantial number of young children face more challenging conditions such as: poverty; food insecurity; exposure to violence; and inadequate access to health care, well-funded quality schools, and mental health care. In many cases, the historical origins of unequal access to crucial supports for children's physical, emotional, and cognitive development are rooted in policies that intentionally segregated and limited various populations' access to resources and create opportunity gaps that intertwine and compound to affect academic, health, and economic outcomes over an individual's life course and across generations.
Closing the Opportunity Gap for Young Children, identifies and describes the causes, costs, and effects of the opportunity gap in young children and explores how disparities in access to quality educational experiences, health care, and positive developmental experiences from birth through age eight intersect with key academic, health, and economic outcomes. The report identifies drivers of these gaps in three key domains—education, mental health, and physical health—and offers recommendations for policy makers for addressing these gaps so that all children in the United States have the opportunity to thrive. In addition, the report offers a detailed set of recommendations for policy makers, practitioners, community organizations, and philanthropic organizations to reduce opportunity gaps in education, health, and social-emotional development.
Topics: Behavioral and Social Sciences
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.
Topics: Health and Medicine
Much of the statistical information currently produced by federal statistical agencies - information about economic, social, and physical well-being that is essential for the functioning of modern society - comes from sample surveys. In recent years, there has been a proliferation of data from other sources, including data collected by government agencies while administering programs, satellite and sensor data, private-sector data such as electronic health records and credit card transaction data, and massive amounts of data available on the internet. How can these data sources be used to enhance the information currently collected on surveys, and to provide new frontiers for producing information and statistics to benefit American society?
Toward a 21st Century National Data Infrastructure: Enhancing Survey Programs by Using Multiple Data Sources, the second report in a series funded by the National Science Foundation, discusses how use of multiple data sources can improve the quality of national and subnational statistics while promoting data equity. This report explores implications of combining survey data with other data sources through examples relating to the areas of income, health, crime, and agriculture.
Topics: Behavioral and Social Sciences
This new publication presents highlights of a June 2023 workshop that focused on a new geospatial tool developed by the White House Council on Environmental Quality to identify communities experiencing climate and economic burdens. The tool, called the Climate and Economic Justice Screening Tool, will be used to guide federal investments to further the White House’s Justice40 Initiative. The workshop explored how well data in the tool represents the lived experiences of historically marginalized and overburdened communities in the United States.
Participants included researchers, policy makers and community members from a wide range of regional, cultural, ethnic, and socioeconomic backgrounds. Topics discussed included potential data gaps, the impact of climate and economic burdens, regional differences in data, historical factors that affect community health and wellbeing, and other inputs to the tool that might help it accurately identify disadvantaged communities.This publication summarizes the presentation and discussion of the workshop.
Topics: Environment and Environmental Studies
The COVID-19 pandemic has had an unprecedented impact on the lives of children and their families, who have faced innumerable challenges such as illness and death; school closures; social isolation; financial hardship; food insecurity; deleterious mental health effects; and difficulties accessing health care. In almost every outcome related to social, emotional, behavioral, educational, mental, physical, and economic health and well-being, families identifying as Black, Latino, and Native American, and those with low incomes, have disproportionately borne the brunt of the negative effects of the pandemic.
The effects of the COVID-19 pandemic on children and families will be felt for years to come. While these long-term effects are unknown, they are likely to have particularly significant implications for children and families from racially and ethnically minoritized communities and with low incomes.
Addressing the Long-Term Effects of the COVID-19 Pandemic on Children and Families identifies social, emotional, behavioral, educational, mental, physical, and economic effects of the COVID-19 pandemic and looks at strategies for addressing the challenges and obstacles that the pandemic introduced for children and families in marginalized communities. This report provides recommendations for programs, supports, and interventions to counteract the negative effects of the pandemic on child and family well-being and offers a path forward to recover from the harms of the pandemic, address inequities, and prepare for the future.
Topics: Behavioral and Social Sciences
What can be more vital to each of us than our health? Yet, despite unprecedented health care spending, the U.S. health system is substantially underperforming, especially with respect to what should be possible, given current knowledge. Although the United States is currently devoting 18% of its Gross Domestic Product to delivering medical care—more than $3 trillion annually and nearly double the expenditure of other advanced industrialized countries—the U.S. health system ranked only 37 in performance in a World Health Organization assessment of member nations. In Vital Directions for Health & Health Care: An Initiative of the National Academy of Medicine, the National Academy of Medicine (NAM), which has long stood as the nation’s most trusted independent source of guidance in health, health care, and biomedical science, has marshaled the wisdom of more than 150 of the nation’s best researchers and health policy experts to assess opportunities for substantially improving the health and well-being of Americans, the quality of care delivered, and the contributions of science and technology. This publication identifies practical and affordable steps that can and must be taken across eight action and infrastructure priorities, ranging from paying for value and connecting care, to measuring what matters most and accelerating the capture of real-world evidence. Without obscuring the difficulty of the changes needed, in Vital Directions, the NAM offers an important blueprint and resource for health, policy, and leaders at all levels to achieve much better health outcomes at much lower cost.
Topics: Health and Medicine
In 2016, the National Academy of Medicine (NAM) hosted a series of meetings, which was sponsored by the Patient-Centered Outcomes Research Institute, with support from NAM's Executive Leadership Network. The series underscored the importance of partnerships between researchers and health system leadership and considered opportunities to build institutional capacity, cross-institutional synergy, and system-wide learning. During these meetings, health system executives, researchers, and others discussed building infrastructure that simultaneously facilitates care delivery, care improvement and evidence development. The vision is a digital system-wide progress toward continuous and seamless learning and improvement throughout health and health care. This publication aims to answer the following questions:
Topics: Health and Medicine
As a result of a collaboration between the National Academy of Medicine (NAM) and the Office of the National Coordinator for Health Information Technology, this NAM Special Publication summarizes and builds on a meeting series in which a multi-stakeholder group of experts discussed the potential of clinical decision support (CDS) to transform care delivery by ameliorating the burden that expanding clinical knowledge and care and choice complexity place on the finite time and attention of clinicians, patients, and members of the care team. This summary also includes highlights from discussions to address the barriers to realizing the full benefits of CDS-facilitated value improvement. Optimizing Strategies for Clinical Decision Support identifies the need for a continuously learning health system driven by the seamless and rapid generation, processing, and practical application of the best available evidence for clinical decision making and lays out a series of actionable collaborative next steps to optimize strategies for adoption and use of CDS.
Topics: Health and Medicine
Social factors, signals, and biases shape the health of our nation. Racism and poverty manifest in unequal social, environmental, and economic conditions, resulting in deep-rooted health disparities that carry over from generation to generation. In Perspectives on Health Equity and Social Determinants of Health, authors call for collective action across sectors to reverse the debilitating and often lethal consequences of health inequity. This edited volume of discussion papers provides recommendations to advance the agenda to promote health equity for all. Organized by research approaches and policy implications, systems that perpetuate or ameliorate health disparities, and specific examples of ways in which health disparities manifest in communities of color, this Special Publication provides a stark look at how health and well-being are nurtured, protected, and preserved where people live, learn, work, and play. All of our nation’s institutions have important roles to play even if they do not think of their purpose as fundamentally linked to health and well-being. The rich discussions found throughout Perspectives on Health Equity and Social Determinants of Health make way for the translation of policies and actions to improve health and health equity for all citizens of our society. The major health problems of our time cannot be solved by health care alone. They cannot be solved by public health alone. Collective action is needed, and it is needed now.
Topics: Health and Medicine
There is no question that opioid use disorder has become the fastest growing, serious, and far-reaching public health crisis facing our nation today. The growing and unprecedented opioid epidemic is a critical issue for public health and medical care throughout the country. Provisional estimates suggest that nearly 65,000 Americans died from a drug overdose in 2016, a 21% increase from the previous year and at a level higher than occurred during the peak years for deaths from HIV infection and automobile fatalities.
Nearly half of opioid overdose deaths are related to medications obtained legally by prescription, sparking deep concern among leaders in the health care sector. The need is clear for clinicians, as the "gatekeepers" of opioid prescriptions, and as the front line in facilitating access to treatment for addiction, to work together with state and community leaders to reduce the impact of opioid misuse on American communities.
At the request of the National Governors Association, the National Academy of Medicine convened a group of experts and field leaders to explore clinicians' roles in addressing opioid misuse and addiction. The resulting Special Publication is informed by, and builds on, initiatives and guidelines that have been stewarded by various stakeholder organizations providing leadership in addressing these issues. In the midst of evolving understanding of and experience in pain management and substance abuse, the authors offer to clinicians a set of axioms applicable both to responsible, appropriate opioid prescribing practices, and to recognition and treatment of substance use disorder. Also underscored are actions that clinicians can take to improve their skills and effectiveness in the face of the growing need, including leadership engagement to ensure that communities have the resources and tools that clinicians require to fulfill their responsibilities.
Topics: Health and Medicine
To advance insights and perspectives on how to better manage the care of the high-need patient population, the National Academy of Medicine, with guidance from an expert planning committee, was tasked with convening three workshops held between July 2015 and October 2016. The resulting special publication, Effective Care for High-Need Patients: Opportunities for Improving Outcomes, Value, and Health, summarizes the presentations, discussions, and relevant literature.
Topics: Health and Medicine
Health services research is "the multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to health care and the quality and cost of health care." Since the 1960s, health services research has provided the foundation for progress, effectiveness, and value in health care. Ironically, at a time in which appreciation has never been higher for both the need and potential from health services research, the political and financial support for sustenance and growth appear to be weakening.
With funding support from AcademyHealth, the American Association of Colleges of Nursing, the American Board of Family Medicine, the American Society of Anesthesiologists, the Association of American Medical Colleges, the Federation of American Hospitals, and the Robert Wood Johnson Foundation, this National Academy of Medicine Special Publication identifies the range of issues that health services research must consider, address, and potentially overcome to transform the field to meet the needs of a 21st-century health care system. These issues are broad, multidisciplinary, and will require a coordinated effort to address—as well as dedicated and sustainable funding. Federal support for health services research has never been more critical. Now is a critical time for the field to articulate its priorities, demonstrate its utility, and transform to meet the needs of a 21st-century health care system. The physical and financial health of the nation is at stake.
Topics: Health and Medicine
Realizing the promise of digital technology will depend on the ability to share information across time and space from multiple devices, sources, systems, and organizations. The major barrier to progress is not technical; rather, it is in the failure of organizational demand and purchasing requirements. In contrast to many other industries, the purchasers of health care technologies have not marshaled their purchasing power to drive interoperability as a key requirement. Better procurement practices, supported by compatible interoperability platforms and architecture, will allow for better, safer patient care; reduced administrative workload for clinicians; protection from cybersecurity attacks; and significant financial savings across multiple markets.
With funding support from the Gordon and Betty Moore Foundation, this National Academy of Medicine Special Publication represents a multi-stakeholder exploration of the path toward achieving large-scale interoperability through strategic acquisition of health information technology solutions and devices. In this publication, data exchanges over three environments are identified as critical to achieving interoperability: facility-to-facility (macro-tier); intra-facility (meso-tier); and at point-of-care (micro-tier). The publication further identifies the key characteristics of information exchange involved in health and health care, the nature of the requirements for functional interoperability in care processes, the mapping of those requirements into prevailing contracting practices, the specification of the steps necessary to achieve system-wide interoperability, and the proposal of a roadmap for using procurement specifications to engage those steps. The publication concludes with a series of checklists to be used by health care organizations and other stakeholders to accelerate progress in achieving system-wide interoperability.
Topics: Health and Medicine
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.
Topics: Health and Medicine
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.
Topics: Health and Medicine | Computers and Information Technology
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.
Topics: Health and Medicine | Computers and Information Technology
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.
Topics: Health and Medicine
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:
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.
Topics: Health and Medicine
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.
Topics: Health and Medicine | Computers and Information Technology
An accurate measure of poverty is necessary to fully understand how the economy is performing across all segments of the population and to assess the effects of government policies on communities and families. In addition, poverty statistics are essential in determining the size and composition of the population whose basic needs are going unmet and to help society target resources to address those needs.
An Updated Measure of Poverty: (Re)Drawing the Line recommends updating the methodology used by the Census Bureau to calculate the Supplemental Poverty Measure (SPM) to reflect household basic needs. This report recommends that the more comprehensive SPM replace the current Official Poverty Measure as the primary statistical measure of poverty the Census Bureau uses. The report assesses the strengths and weaknesses of the SPM and provides recommendations for updating its methodology and expanding its use in recognition of the needs of most American families such as medical care, childcare, and housing costs.
Topics: Behavioral and Social Sciences