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"Opioid prescriptions for acute and chronic pain increased dramatically from the late 1990s into the current decade in both the civilian and the Department of Veterans Affairs and Department of Defense treatment environments. Similarly, prescriptions for benzodiazepines also increased significantly for anxiety and insomnia. Combinations of opioid and benzodiazepines have proben fatal when taken concurrently, with research demonstrating this phenomenon for nearly 40 years. This issue is exacerbated within the veteran population because of higher rates of pain, anxiety and other related health issues due to military life. An evaluation of the relationship between opioid and benzodiazepine medication practices at the VA is necessary to improve treatment for mental health and combat-related trauma for veterans. An Approach to Evaluate the Effects of Concomitant Prescribing of Opioids and Benzodiazepines on Veteran Deaths and Suicides investigates the effects of opioid initiation and tapering strategies in the presence of benzodiazepines in veterans. This report explores neurobiology and the principles of addiction and tolerance, in addition to the current use of opioids and benzodiazepines for treating pain and anxiety in both the veteran and general population. It also provides a protocol to evaluate the relationship between opioid and benzodiazepine medication practices. This framework is a critical foundation for further research to improve concomitant opioid and benzodiazepine medication practices for veterans and the general population"--

"Near Earth objects (NEOs) have the potential to cause significant damage on Earth. In December 2018, an asteroid exploded in the upper atmosphere over the Bering Sea (western Pacific Ocean) with the explosive force of nearly 10 times that of the Hiroshima bomb. While the frequency of NEO impacts rises in inverse proportion to their sizes, it is still critical to monitor NEO activity in order to prepare defenses for these rare but dangerous threats. Currently, NASA funds a network of ground-based telescopes and a single, soon-to-expire space-based asset to detect and track large asteroids that could cause major damage if they struck Earth. This asset is crucial to NEO tracking as thermal-infrared detection and tracking of asteroids can only be accomplished on a space-based platform. Finding Hazardous Asteroids Using Infrared and Visible Wavelength Telescopes explores the advantages and disadvantages of infrared (IR) technology and visible wavelength observations of NEOs. This report reviews the techniques that could be used to obtain NEO sizes from an infrared spectrum and delineate the associated errors in determining the size. It also evaluates the strengths and weaknesses of these techniques and recommends the most valid techniques that give reproducible results with quantifiable errors"--Publisher's description

Every ten years, the Department of Health and Human Service's Healthy People Initiative develops a new set of science-based, national objectives with the goal of improving the health of all Americans. Defining balanced and comprehensive criteria for healthy people enables the public, programs, and policymakers to gauge our progress and reevaluate efforts towards a healthier society. Criteria for Selecting the Leading Health Indicators for Healthy People 2030 makes recommendations for the development of Leading Health Indicators for the initiative's Healthy People 2030 framework. The authoring committee's assessments inform their recommendations for the Healthy People Federal Interagency Workgroup in their endeavor to develop the latest Leading Health Indicators. The finalized Leading Health Indicators will establish the criteria for healthy Americans and help update policies that will guide decision-marking throughout the next decade. This report also reviews and reflects upon current and past Healthy People materials to identify gaps and new objectives.

The Army Research Laboratory (ARL) is the corporate laboratory for the U.S. army, which bridges scientific and military communities. The ARL is critical in maintaining the United States' dominant military power through its advanced research and analysis capabilities. The National Academies of Sciences, Engineering, and Medicine's Army Research Laboratory Technical Assessment Board (ARLTAB) conducts biennial assessments of the scientific and technical quality of the facilities. These assessments are necessary to ensure that the ARL's resources and quality of programs are maximized. 2017-2018 Assessment of the Army Research Laboratory includes findings and recommendations regarding the quality of the ARL's research, development, and analysis programs. The report of the assessment is subdivided by the ARL's Science and Technology campaigns, including Materials Research, Sciences for Lethality and Protection, Information Sciences, Computational Sciences, Sciences for Maneuver, Human Sciences, and Analysis and Assessment. This biennial report summarizes the findings for the 2017-2018 period.

Accidents and terrorist attacks that lead to the release of radioactive materials can cause deaths, injuries, and a range of psychosocial effects in the surrounding community and team of emergency responders. In the United States, federal, state, and local agencies respond with the necessary resources to address the consequences of nuclear and radiological incidents and monitor the affected population. Following the 2011 Fukushima Daiichi Nuclear Power Plant accident and the 2017 Gotham Shield National Level Exercise, the CDC recognized an opportunity to improve their practices by establishing a more efficient and timely health effect surveillance system before another incident occurs. On March 12-13th, 2019, the National Academies convened a workshop to discuss the process for preparing a radiation registry for monitoring long-term health effects of populations affected by a nuclear or radiological incident. Participants assessed existing information, useful practices, and tools for planning a radiation registry that will enhance incident monitoring and response methods. This publication summarizes the discussions and presentations from the workshop.

"Oral health care and medical health care both seek to maintain and enhance human health and well-being. Yet, dentistry and primary care in the United States are largely separated and isolated from each other. Each has its own siloed systems for education, service delivery, financing, and policy oversight. The result has been duplication of effort, a cultural gap between the two professions, and lost opportunities for productive collaboration and better health. On December 6, 2018, in Washington, DC, the National Academies of Sciences, Engineering, and Medicine held a workshop titled Integrating Oral and General Health Through Health Literacy Practices. This publication summarizes the presentations and discussions from the workshop"--

Education and health care significantly influence well-being and health outcomes, especially throughout adolescence. In fact, doctors note that performance in school is highly reflective of a child's current and future health. Despite knowledge of this connection, pediatricians are rarely aware of their patients' school performance and have a limited understanding of the education system. Fostering collaboration and aligning efforts within the health and education sectors is a critical step towards building stronger and healthier communities. On June 14, 2018, the National Academies convened a workshop to discuss how efforts within the health sector can support children's education from pre-kindergarten through 12th grade and to explore the barriers between these sectors. The committee also examined case examples of health-education collaboration and opportunities in policy. This publication summarizes the presentations and discussions from the workshop.

These are proceedings of the second of a two-workshop series. This workshop took place in October 2018. The first workshop took place in February 2018 and was entitled: Improving Cancer Diagnosis and Care: Patient Access to Oncologic Imaging and Pathology Expertise and Technologies.

The National Institutes of Health (NIH) is the primary agency of the United States government responsible for biomedical and public health research. Founded in the late 1870s, NIH has produced extraordinary advances in the treatment of common and rare diseases and leads the world in biomedical research. It is a critical national resource that plays an important role in supporting national security. The 310-acre Bethesda campus supports some 20,000 employees and contractors, and it contains more than 12 million square feet of facilities divided amongst nearly 100 buildings, including the largest dedicated research hospital in the world. The Bethesda campus supports some of the most sophisticated and groundbreaking biomedical research in the world. However, while some new state-of-the-art buildings have been constructed in recent years, essential maintenance for many facilities and the campus overall has been consistently deferred for many years. The deteriorating condition of NIH's built environment is now putting its ability to fulfill its mission at substantial risk. Managing the NIH Bethesda Campus' Capital Assets for Success in a Highly Competitive Global Biomedical Research Environment identifies the facilities in greatest need of repair on the Bethesda campus and evaluates cost estimates to determine what investment is needed for the NIH to successfully accomplish its mission going forward.--

In 1943, as part of the Manhattan Project, the Hanford Nuclear Reservation was established with the mission to produce plutonium for nuclear weapons. During 45 years of operations, the Hanford Site produced about 67 metric tonnes of plutonium--approximately two-thirds of the nation's stockpile. Production processes generated radioactive and other hazardous wastes and resulted in airborne, surface, subsurface, and groundwater contamination. Presently, 177 underground tanks contain collectively about 210 million liters (about 56 million gallons) of waste. The chemically complex and diverse waste is difficult to manage and dispose of safely. Section 3134 of the National Defense Authorization Act for Fiscal Year 2017 calls for a Federally Funded Research and Development Center (FFRDC) to conduct an analysis of approaches for treating the portion of low-activity waste at the Hanford Nuclear Reservation intended for supplemental treatment. The third of four, this report provides an overall assessment of the FFRDC team's final draft report, dated April 5, 2019.

With U.S. health care costs projected to grow at an average rate of 5.5 percent per year from 2018 to 2027, or 0.8 percentage points faster than the gross domestic product, and reach nearly $6.0 trillion per year by 2027, policy makers and a wide range of stakeholders are searching for plausible actions the nation can take to slow this rise and keep health expenditures from consuming an ever greater portion of U.S. economic output. While health care services are essential to heath, there is growing recognition that social determinants of health are important influences on population health. Supporting this idea are estimates that while health care accounts for some 10 to 20 percent of the determinants of health, socioeconomic factors and factors related to the physical environment are estimated to account for up to 50 percent of the determinants of health. Challenges related to the social determinants of health at the individual level include housing insecurity and poor housing quality, food insecurity, limitations in access to transportation, and lack of social support. These social needs affect access to care and health care utilization as well as health outcomes. Health care systems have begun exploring ways to address non-medical, health-related social needs as a way to reduce health care costs. To explore the potential effect of addressing non-medical health-related social needs on improving population health and reducing health care spending in a value-driven health care delivery system, the National Academies of Science, Engineering, and Medicine held a full-day public workshop titled Investing in Interventions that Address Non-Medical, Health-Related Social Needs on April 26, 2019, in Washington, DC. The objectives of the workshop were to explore effective practices and the supporting evidence base for addressing the non-medical health-related social needs of individuals, such as housing and food insecurities; review assessments of return on investment (ROI) for payers, healthy systems, and communities; and identify gaps and opportunities for research and steps that could help to further the understanding of the ROI on addressing non-medical health-related social needs. This publication summarizes the presentations and discussions from the workshop.

On November 29-30, 2018, in Washington, D.C., the National Academies of Sciences, Engineering, and Medicine held the Workshop on the Continuous Improvement of NASA's Innovation Ecosystem. The workshop was requested by the National Aeronautics and Space Administration (NASA) Office of the Chief Technologist with the goal of identifying actionable and implementable initiatives that could build on NASA's current innovation culture to reach a future state that will ensure the agency's continued success in the evolving aerospace environment. This publication summarizes the presentations and discussions from the workshop.

Successful drug development relies on accurate and efficient clinical trials to deliver the best and most effective pharmaceuticals and clinical care to patients. However, the current model for clinical trials is outdated, inefficient and costly. Clinical trials are limited by small sample sizes that do not reflect variations among patients in the real world, financial burdens on participants, and slow processes, and these factors contribute to the disconnect between clinical research and clinical practice. On November 28-29, the National Academies of Sciences, Engineering, and Medicine convened a workshop to investigate the current clinical trials system and explore the potential benefits and challenges of implementing virtual clinical trials as an enhanced alternative for the future. This publication summarizes the presentations and discussions from the workshop.--Publishers website

In recent years, significant progress has been made in the clinical development and use of various types of cancer immunotherapy, all of which rely on the immune system to fight cancer. The majority of new cancer drug applications submitted to the Food and Drug Administration (FDA) are for immunotherapies or combinations involving immunotherapies. One type of immunotherapy is an immune checkpoint inhibitor. Cells in the human body have proteins that regulate the immune system response to foreign invaders (e.g., cancer cells, microorganisms). However, cancer cells can coopt these "checkpoint" proteins and thwart the immune system's ability to recognize and attack cancer cells. To help promote an immune response to cancer, researchers have developed immune checkpoint inhibitors that enable T-cells to recognize cancer cells as foreign and to prevent deactivation of an immune system response. To examine the challenges and opportunities to develop combination cancer therapies that include immune checkpoint inhibitors, the National Cancer Policy Forum held a workshop on July 16-17, 2018, in Washington, DC. This workshop convened stakeholders with a broad range of expertise, including cancer researchers, clinicians, patient advocates, and representatives from industry, academia, and government. This publication summarizes the presentations and discussions from the workshop.

In January 2019, the National Academies of Sciences, Engineering, and Medicine convened the 2-day Workshop on Resourcing, Workforce Modeling, and Staffing. This workshop is one of several data-gathering sessions to support the committee's iterative study. The overarching goal of the study is to help the Veterans Health Administration (VHA) assess the overall resource needs of its Facilities Management Program and to develop budget and staffing methodologies. Such methodologies can provide better justification for ensuring that local VHA programs are adequately and consistently staffed to accomplish the mission and meet all requirements. This publication summarizes the presentations and discussions from the workshop.

In September 2015, the National Academies of Sciences, Engineering, and Medicine convened a two-day workshop on evolving paradigms for design and manufacturing. Participants discussed ways to lower costs and shorten production time in defense systems while bringing materials and manufacturing alternatives into the tradespace. This publication summarizes the presentations and discussions from the workshop. --

The U.S. military has been continuously engaged in foreign conflicts for over two decades. The strains that these deployments, the associated increases in operational tempo, and the general challenges of military life affect not only service members but also the people who depend on them and who support them as they support the nation and their families. Family members provide support to service members while they serve or when they have difficulties; family problems can interfere with the ability of service members to deploy or remain in theater; and family members are central influences on whether members continue to serve. In addition, rising family diversity and complexity will likely increase the difficulty of creating military policies, programs and practices that adequately support families in the performance of military duties. Strengthening the Military Family Readiness System for a Changing American Society examines the challenges and opportunities facing military families and what is known about effective strategies for supporting and protecting military children and families, as well as lessons to be learned from these experiences. This report offers recommendations regarding what is needed to strengthen the support system for military families.

"The U.S. Department of Defense (DoD) Manufacturing USA Institutes aim to protect national security and increase U.S. competitiveness in manufacturing. The domestic industrial base is critical to supporting and sustaining both military advantage and economic competitiveness. Through these institutes, the DoD is committed to domestically designing and manufacturing the most innovative defense systems. Intended as intensely collaborative applied research and development endeavors among government, industry, and academia, the institutes are envisioned to become lasting, self-sustaining national assets. A long-term strategy is needed to achieve this goal. The National Academies of Sciences, Engineering, and Medicine recently convened a workshop [January 28-29, 2019] to discuss the long-term sustainability of the Manufacturing USA Institutes. Participants explored different perspectives across multiple disciplines, discussed public-private partnership models, and considered international programs in advanced manufacturing to inform their recommendations regarding the future of the institutes. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

High-performance electronics are key to the U.S. Air Force's (USAF's) ability to deliver lethal effects at the time and location of their choosing. Additionally, these electronic systems must be able to withstand not only the rigors of the battlefield but be able to perform the needed mission while under cyber and electronic warfare (EW) attack. This requires a high degree of assurance that they are both physically reliable and resistant to adversary actions throughout their life cycle from design to sustainment. In 2016, the National Academies of Sciences, Engineering, and Medicine convened a workshop titled Optimizing the Air Force Acquisition Strategy of Secure and Reliable Electronic Components, and released a summary of the workshop. This publication serves as a follow-on to provide recommendations to the USAF acquisition community. --

Throughout history, perhaps no other disease has generated the level of social, scientific, and political discourse or has had the degree of cultural significance as cancer. A collective in the truest sense of the word, "cancer" is a clustering of different diseases that afflict individuals in different ways. Its burdens are equally broad and diverse, from the physical, financial, and psychological tolls it imposes on individuals to the costs it inflicts upon the nation's clinical care and public health systems, and despite decades of concerted efforts often referred to as the "war on cancer", those costs have only continued to grow over time. The causes and effects of cancer are complex--in part preventable and treatable, but also in part unknown, and perhaps even unknowable. Guiding Cancer Control defines the key principles, attributes, methods, and tools needed to achieve the goal of implementing an effective national cancer control plan. This report describes the current structure of cancer control from a local to global scale, identifies necessary goals for the system, and formulates the path towards integrated disease control systems and a cancer-free future. This framework is a crucial step in establishing an effective, efficient, and accountable system for controlling cancer and other diseases. --

The challenge of monitoring disparities in educational achievement and opportunities shares some characteristics with other complex regulatory problems. For example, when Congress adopted the Clean Air Act (1970) nearly 50 years ago, it emphasized the importance of public health but provided no clear line for distinguishing clean air from dirty air. Most fundamentally, regulating pollution has required choices about what indicates that air is "polluted" for regulatory purposes, how to measure and monitor those indicators, and when the measured level of an indicator should trigger enforcement or other intervention. The statute provided few answers, or even a definitive list of "pollutants" to be regulated. Nor were there definitive answers in the Constitution, economics, the biological sciences, or epidemiology. Instead, definitions and decisions have been a continuous enterprise involving interpretations of vague statutory language, promulgation of hundreds of federal and state regulations, enforcement experience, research in multiple disciplines, and the turbulence of politics.

Separation science plays a critical role in maintaining our standard of living and quality of life. Many industrial processes and general necessities such as chemicals, medicines, clean water, safe food, and energy sources rely on chemical separations. However, the process of chemical separations is often overlooked during product development and this has led to inefficiency, unnecessary waste, and lack of consensus among chemists and engineers. A reevaluation of system design, establishment of standards, and an increased focus on the advancement of separation science are imperative in supporting increased efficiency, continued U.S. manufacturing competitiveness, and public welfare. A Research Agenda for Transforming Separation Science explores developments in the industry since the 1987 National Academies report, Separation and Purification: Critical Needs and Opportunities. Many needs stated in the original report remain today, in addition to a variety of new challenges due to improved detection limits, advances in medicine, and a recent emphasis on sustainability and environmental stewardship. This report examines emerging chemical separation technologies, relevant developments in intersecting disciplines, and gaps in existing research, and provides recommendations for the application of improved separation science technologies and processes. This research serves as a foundation for transforming separation science, which could reduce global energy use, improve human and environmental health, and advance more efficient practices in various industries.--

"Quantum mechanics, the subfield of physics that describes the behavior of very small (quantum) particles, provides the basis for a new paradigm of computing. First proposed in the 1980s as a way to improve computational modeling of quantum systems, the field of quantum computing has recently garnered significant attention due to progress in building small-scale devices. However, significant technical advances will be required before a large-scale, practical quantum computer can be achieved. Quantum Computing: Progress and Prospects provides an introduction to the field, including the unique characteristics and constraints of the technology, and assesses the feasibility and implications of creating a functional quantum computer capable of addressing real-world problems. This report considers hardware and software requirements, quantum algorithms, drivers of advances in quantum computing and quantum devices, benchmarks associated with relevant use cases, the time and resources required, and how to assess the probability of success"--Publisher's description.

"Protecting the health and safety of health care workers is vital to the health of each of us. Preparing for and responding to a future influenza pandemic or to a sustained outbreak of an airborne transmissible disease requires a high-level commitment to respiratory protection for health care workers across the wide range of settings in which they work and the jobs that they perform. Keeping health care workers healthy is an ethical commitment both in terms of addressing the occupational risks faced by health care workers and of providing for the continuity of patient care and services needed to maintain the health of individuals and communities. During a public health emergency, challenges will arise concerning the availability of respiratory protective devices (i.e., respirators). Reusable respirators (specifically, reusable half-facepiece elastomeric respirators) are the standard respiratory protection device used in many industries, and they provide an option for use in health care that has to date not been fully explored. The durability and reusability of elastomeric respirators make them desirable for stockpiling for emergencies, where the need for large volumes of respirators can be anticipated. However, they are used infrequently in health care. Reusable Elastomeric Respirators in Health Care explores the potential for the use of elastomeric respirators in the U.S. health care system with a focus on the economic, policy, and implementation challenges and opportunities. This report examines the practicability of elastomeric use in health care on a routine basis and during an influenza pandemic or other large aerosol-transmissible outbreak, when demand for respiratory protective devices by U.S. health care personnel may be larger than domestic supplies. The report also addresses the issues regarding emergency stockpile management of elastomeric respiratory protective devices"--Publisher's description.

On March 22, 2018, the National Academies of Sciences, Engineering, and Medicine convened a workshop to examine the collaboration between the faith and health sectors, and to highlight the unique opportunities these collaborations offer to help improve population health outcomes. This publication summarizes the presentations and discussions from the workshop.

"Coral reefs are critical to ocean and human life because they provide food, living area, storm protection, tourism income, and more. However, human-induced stressors, such as overfishing, sediment, pollution, and habitat destruction have threatened ocean ecosystems globally for decades. In the face of climate change, these ecosystems now face an array of unfamiliar challenges due to destructive rises in ocean temperature, acidity and sea level. These factors lead to an increased frequency of bleaching events, hindered growth, and a decreasing rate of calcification. Research on interventions to combat these relatively new stressors and a reevaluation of longstanding interventions is necessary to understand and protect coral reefs in this changing climate. Previous research on these methods prompts further questions regarding the decision making process for site-specific interventions. A Decision Framework for Interventions to Increase the Persistence and Resilience of Coral Reefs builds upon a previous report that reviews the state of research on methods that have been used, tested, or proposed to increase the resilience of coral reefs. This new report aims to help coral managers evaluate the specific needs of their site and navigate the 23 different interventions described in the previous report. A case study of the Caribbean, a region with low coral population plagued by disease, serves as an example for coral intervention decision making. This report provides complex coral management decision making tools, identifies gaps in coral biology and conservation research, and provides examples to help individuals and communities tailor a decision strategy to a local area."--

"Convergence-based research approaches are critical in solving many scientific challenges, which frequently draw on large teams of collaborators from multiple disciplines. The 2014 report Convergence: Facilitating Transdisciplinary Integration of Life Sciences, Physical Sciences, Engineering, and Beyond describes the term "convergence" as a multidisciplinary approach that melds divergent areas of expertise to form conclusions that are inaccessible otherwise. However, a convergence-based approach involves hybrid systems of people, buildings, and instruments, which pose complex structural and managerial challenges. In October 23-24, 2018, the National Academies of Sciences, Engineering, and Medicine convened a workshop to explore efforts to promote cultures that support convergence-based approaches to research. The 2014 report served as a foundation for this workshop, allowing participants to further explore convergence as a valuable and adaptable approach to organizing research. This publication summarizes the presentations and discussions from the workshop"--Publisher's description

"The National Academies of Sciences, Engineering, and Medicine's Roundtable on Population Health Improvement has been focused on the subject of dependable resources for population health since its inception in 2013. On December 7, 2017, the roundtable convened a workshop to explore tax policy as it relates to advancing population health, health equity, and economic prosperity. This publication summarizes the presentations and discussions from the workshop."--Publisher's description.

"In the 1970s, flame retardants began to be added to synthetic materials to meet strict flammability standards. Over the years, diverse flame retardants have been manufactured and used in various products. Some flame retardants have migrated out of the products, and this has led to widespread human exposure and environmental contamination. There also is mounting evidence that many flame retardants are associated with adverse human health effects. As a result, some flame retardants have been banned, restricted, or voluntarily phased out of production and use. This publication develops a scientifically based scoping plan to assess additive, nonpolymeric organohalogen flame retardants as a class for potential chronic health hazards under the Federal Hazardous Substances Act, including cancer, birth defects, and gene mutations"--

"The Manufacturing USA initiative seeks to reinforce U.S.-based advanced manufacturing through partnerships among industry, academia, and government. Started in 2012 and established with bipartisan support by the Revitalize American Manufacturing and Innovation Act of 2014, the initiative envisages a nationwide network of research centers for manufacturing innovation. Some 14 manufacturing innovation institutes have been established to facilitate the movement of early-stage research into proven capabilities ready for adoption by U.S. manufacturers. To better understand the role and experiences of the Manufacturing USA institutes, a committee of the National Academies of Sciences, Engineering, and Medicine convened a workshop on May 23, 2017 drawing together institute directors and manufacturing policy experts along with leaders from industry, academia, and government. Given the continued prominence of enhancing domestic manufacturing and international competitiveness in public policy discussions, the National Academies convened a second workshop on November 14, 2018, to monitor the progress of the Manufacturing USA institutes. This publication summarizes the presentations and discussions from this second workshop"--Publisher's description