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"Protecting Earth's environment and other solar system bodies from harmful contamination has been an important principle throughout the history of space exploration. For decades, the scientific, political, and economic conditions of space exploration converged in ways that contributed to effective development and implementation of planetary protection policies at national and international levels. However, the future of space exploration faces serious challenges to the development and implementation of planetary protection policy. The most disruptive changes are associated with (1) sample return from, and human missions to, Mars; and (2) missions to those bodies in the outer solar system possessing water oceans beneath their icy surfaces. Review and Assessment of Planetary Protection Policy Development Processes addresses the implications of changes in the complexion of solar system exploration as they apply to the process of developing planetary protection policy. Specifically, this report examines the history of planetary protection policy, assesses the current policy development process, and recommends actions to improve the policy development process in the future"--

When is it appropriate to return individual research results to participants? The immense interest in this question has been fostered by the growing movement toward greater transparency and participant engagement in the research enterprise. Yet, the risks of returning individual research results--such as results with unknown validity--and the associated burdens on the research enterprise are competing considerations. Returning Individual Research Results to Participants reviews the current evidence on the benefits, harms, and costs of returning individual research results, while also considering the ethical, social, operational, and regulatory aspects of the practice. This report includes 12 recommendations directed to various stakeholders--investigators, sponsors, research institutions, institutional review boards (IRBs), regulators, and participants--and are designed to help (1) support decision making regarding the return of results on a study-by-study basis, (2) promote high-quality individual research results, (3) foster participant understanding of individual research results, and (4) revise and harmonize current regulations.

"The amount of nutrients required by an individual is determined by a number of physiological processes, including absorption, metabolism, stability, and bio-activation. These processes determine nutrient needs and provide variations in requirements in the population. All have modifiers and sensitizers, such as sex, genetics, pregnancy, age, pharmaceuticals, toxins, food matrix, and epigenetics. Disease can also be a major modifier of these processes. In April 2018, the National Academies of Science, Engineering and Medicine convened a workshop in order to explore the evidence for special nutritional requirements in disease states and the medical conditions that cannot be met with a normal diet. Participants explored the impact a disease state can have on nutrient metabolism and nutritional status, and attempted to close informational gaps. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

"The question of whether and under what circumstances terminally ill patients should be able to access life-ending medications with the aid of a physician is receiving increasing attention as a matter of public opinion and of public policy. Ethicists, clinicians, patients, and their families debate whether physician-assisted death ought to be a legal option for patients. While public opinion is divided and public policy debates include moral, ethical, and policy considerations, a demand for physician-assisted death persists among some patients, and the inconsistent legal terrain leaves a number of questions and challenges for health care providers to navigate when presented with patients considering or requesting physician-assisted death. To discuss what is known and not known empirically about the practice of physician-assisted death, the National Academies of Sciences, Engineering, and Medicine convened a 2-day workshop in Washington, DC, on February 12-13, 2018. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

Beginning in October 2017, the National Academies of Sciences, Engineering, and Medicine organized a set of workshops designed to gather information for the Decadal Survey of Social and Behavioral Sciences for Applications to National Security. The fourth workshop focused on the science of cognition and perception, and this publication summarizes the presentations and discussions from this workshop.

Beginning in October 2017, the National Academies of Sciences, Engineering, and Medicine organized a set of workshops designed to gather information for the Decadal Survey of Social and Behavioral Sciences for Applications to National Security. The sixth workshop focused on understanding narratives for national security purposes, and this publication summarizes the presentations and discussions from this workshop.

Beginning in October 2017, the National Academies of Sciences, Engineering, and Medicine organized a set of workshops designed to gather information for the Decadal Survey of Social and Behavioral Sciences for Applications to National Security. The fifth workshop focused on workforce development and intelligence analysis, and this publication summarizes the presentations and discussions from this workshop.

Coal remains one of the principal sources of energy for the United States, and the nation has been a world leader in coal production for more than 100 years. According to U.S. Energy Information Administration projections to 2050, coal is expected to be an important energy resource for the United States. Additionally, metallurgical coal used in steel production remains an important national commodity. However, coal production, like all other conventional mining activities, creates dust in the workplace. Respirable coal mine dust (RCMD) comprises the size fraction of airborne particles in underground mines that can be inhaled by miners and deposited in the distal airways and gas-exchange region of the lung. Occupational exposure to RCMD has long been associated with lung diseases common to the coal mining industry, including coal workers' pneumoconiosis, also known as "black lung disease." Monitoring and Sampling Approaches to Assess Underground Coal Mine Dust Exposures compares the monitoring technologies and sampling protocols currently used or required by the United States, and in similarly industrialized countries for the control of RCMD exposure in underground coal mines. This report assesses the effects of rock dust mixtures and their application on RCMD measurements, and the efficacy of current monitoring technologies and sampling approaches. It also offers science-based conclusions regarding optimal monitoring and sampling strategies to aid mine operators' decision making related to reducing RCMD exposure to miners in underground coal mines.

The U.S. Gulf Coast provides a valuable setting to study deeply connected natural and human interactions and feedbacks that have led to a complex, interconnected coastal system. The physical landscape in the region has changed significantly due to broad-scale, long-term processes such as coastal subsidence and river sediment deposition as well as short-term episodic events such as hurricanes. Modifications from human activities, including building levees and canals and constructing buildings and roads, have left their own imprint on the natural landscape. This coupled natural-human coastal system and the individual aspects within it (physical, ecological, and human) are under increased pressure from accelerating environmental stressors such as sea level rise, intensifying hurricanes, and continued population increase with its accompanying coastal development. Promoting the resilience and maintaining the habitability of the Gulf Coast into the future will need improved understanding of the coupled natural-human coastal system, as well as effective sharing of this understanding in support of decision-making and policies. Understanding the Long-term Evolution of the Coupled Natural-Human Coastal System presents a research agenda meant to enable a better understanding of the multiple and interconnected factors that influence long-term processes along the Gulf Coast. This report identifies scientific and technical gaps in understanding the interactions and feedbacks between human and natural processes, defines essential components of a research and development program in response to the identified gaps, and develops priorities for critical areas of research.

Almost 25 years have passed since the Demography of Aging (1994) was published by the National Research Council. Future Directions for the Demography of Aging is, in many ways, the successor to that original volume. The Division of Behavioral and Social Research at the National Institute on Aging (NIA) asked the National Academies of Sciences, Engineering, and Medicine to produce an authoritative guide to new directions in demography of aging. The papers published in this report were originally presented and discussed at a public workshop held in Washington, D.C., August 17-18, 2017. The workshop discussion made evident that major new advances had been made in the last two decades, but also that new trends and research directions have emerged that call for innovative conceptual, design, and measurement approaches. The report reviews these recent trends and also discusses future directions for research on a range of topics that are central to current research in the demography of aging. Looking back over the past two decades of demography of aging research shows remarkable advances in our understanding of the health and well-being of the older population. Equally exciting is that this report sets the stage for the next two decades of innovative research-a period of rapid growth in the older American population.

Huanglongbing (HLB) or citrus greening, first observed more than a hundred years ago in Asia, is the most serious disease threat to the citrus-growing industry worldwide due to its complexity, destructiveness, and incalcitrance to management. First detected in Florida in 2005, HLB is now widespread in the state and threatens the survival of the Florida citrus industry despite substantial allocation of research funds by Florida citrus growers and federal and state agencies. As the HLB epidemic raged in 2008, Florida citrus growers began allocating funds for HLB research in hopes of finding short-, medium-, and long-term solutions. This effort created the Citrus Research and Development Foundation (CRDF), an organization with oversight responsibility for HLB research and development efforts in Florida. This report provides an independent review of the portfolio of research projects that have been or continue to be supported by the CRDF. It seeks to identify ways to retool HLB research--which, despite significantly increasing understanding of the factors involved in HLB, has produced no major breakthroughs in controlling the disease--and accelerate the development of durable tools and strategies that could help abate the damage caused by HLB and prevent the possible collapse of the Florida citrus industry.

When discussing the risk of introducing drones into the National Airspace System, it is necessary to consider the increase in risk to people in manned aircraft and on the ground as well as the various ways in which this new technology may reduce risk and save lives, sometimes in ways that cannot readily be accounted for with current safety assessment processes. The Committee on Assessing the Risks of Unmanned Aircraft Systems (UAS) Integration examined the various ways that risk can be defined and applied to integrating UAS into the National Airspace System managed by the Federal Aviation Administration (FAA). The committee looked at recent developments in this field and consulted numerous experts in academia, industry, and government. The committee developed 11 recommendations that are presented in this report.

Since the end of the Second World War, the United States has developed the world's preeminent system for biomedical research, one that has given rise to revolutionary medical advances as well as a dynamic and innovative business sector generating high-quality jobs and powering economic output and exports for the U.S. economy. However, there is a growing concern that the biomedical research enterprise is beset by several core challenges that undercut its vitality, promise, and productivity and that could diminish its critical role in the nation's health and innovation in the biomedical industry. Among the most salient of these challenges is the gulf between the burgeoning number of scientists qualified to participate in this system as academic researchers and the elusive opportunities to establish long-term research careers in academia. The patchwork of measures to address the challenges facing young scientists that has emerged over the years has allowed the U.S. biomedical enterprise to continue to make significant scientific and medical advances. These measures, however, have not resolved the structural vulnerabilities in the system, and in some cases come at a great opportunity cost for young scientists. These unresolved issues could diminish the nation's ability to recruit the best minds from all sectors of the U.S. population to careers in biomedical research and raise concerns about a system that may favor increasingly conservative research proposals over high-risk, innovative ideas. The Next Generation of Biomedical and Behavioral Sciences Researchers: Breaking Through evaluates the factors that influence transitions into independent research careers in the biomedical and behavioral sciences and offers recommendations to improve those transitions. These recommendations chart a path to a biomedical research enterprise that is competitive, rigorous, fair, dynamic, and can attract the best minds from across the country.

"The built environment--the physical world made up of the homes, buildings, streets, and infrastructure within which people live, work, and play--underwent changes during the 20th and 21st centuries that contributed to a sharp decline in physical activity and affected access to healthy foods. Those developments contributed in turn to the weight gain observed among Americans in recent decades. Many believe, therefore, that policies and practices that affect the built environment could affect obesity rates in the United States and improve the health of Americans. The National Academies of Sciences, Engineering, and Medicine convened a workshop in September 2017 to improve understanding of the roles played by the built environment in the prevention and treatment of obesity and to identify promising strategies in multiple sectors that can be scaled up to create more healthful and equitable environments. This publication summarizes the presentations and discussions from the workshop" --Publisher's description.

"Scientific advances over the past several decades have accelerated the ability to engineer existing organisms and to potentially create novel ones not found in nature. Synthetic biology, which collectively refers to concepts, approaches, and tools that enable the modification or creation of biological organisms, is being pursued overwhelmingly for beneficial purposes ranging from reducing the burden of disease to improving agricultural yields to remediating pollution. Although the contributions synthetic biology can make in these and other areas hold great promise, it is also possible to imagine malicious uses that could threaten U.S. citizens and military personnel. Making informed decisions about how to address such concerns requires a realistic assessment of the capabilities that could be misused. To that end, the U.S. Department of Defense, working with other agencies involved in biodefense, asked the National Academies of Sciences, Engineering, and Medicine to develop a framework to guide an assessment of the security concerns related to advances in synthetic biology, to assess the levels of concern warranted for such advances, and to identify options that could help mitigate those concerns"--

"Recommended intake levels for nutrients and other dietary components were designed initially to prevent nutrient deficiency diseases in a given population, and the original methodological approach used to derive intake values did not include consideration for other applications. However, with the increasing globalization of information and the identification of a variety of factors specific to different population subgroups (e.g., young children and women of reproductive age) that influence their nutritional needs, there has been increasing recognition of the need to consider methodological approaches to deriving nutrient reference values (NRVs) that are applicable across countries and that take into account the varying needs of different population subgroups. There is a need for guidance and recommendations about methodological approaches, as well as their potential for application to an international process for the development of NRVs, and particularly for young children and women of reproductive age. Harmonization of Approaches to Nutrient Reference Values: Applications to Young Children and Women of Reproductive Age examines these issues and makes recommendations for a unified approach to developing NRVs that would be acceptable globally"--Publisher's description.

Over the past decade, resilience has gained significant traction across the nation and innovative programs are showing exciting progress in building resilient communities. For communities to be prepared for future extreme weather and climate events, as well as the chronic daily stressors, the momentum of implementing and taking action to build community resilience should continue to be fostered and expanded. Building on its many efforts dedicated to increasing and enhancing resilience, the Resilient America Roundtable hosted the State of Resilience Leadership Forum and Community Workshop on June 28 and 29, 2016. This activity brought together diverse decision makers, experts, practitioners, and community stakeholders, including representatives from academia, government, the private sector, foundations, and nonprofit organizations, to consider the results of years of investment, experimentation, and research in building resilience, take stock of these many initiatives and efforts, and share their experiences in building more resilient communities. This publication summarizes the presentations and discussions from the workshop.

"The urban built environment is a prime setting for microbial transmission, because just as cities serve as hubs for migration and international travel, components of the urban built environment serve as hubs that drive the transmission of infectious disease pathogens. The risk of infectious diseases for many people living in slums is further compounded by their poverty and their surrounding physical and social environment, which is often overcrowded, is prone to physical hazards, and lacks adequate or secure housing and basic infrastructure, including water, sanitation, or hygiene services. To examine the role of the urban built environment in the emergence and reemergence of infectious diseases that affect human health, the National Academies of Sciences, Engineering, and Medicine planned a public workshop. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

"Precision medicine is focused on the individual and will require the rapid and accurate identification and prioritization of causative factors of disease. To move forward and accelerate the delivery of the anticipated benefits of precision medicine, developing predictable, reproducible, and reliable animal models will be essential. In order to explore the topic of animal-based research and its relevance to precision medicine, the National Academies of Sciences, Engineering, and Medicine convened a 2-day workshop on October 5 and 6, 2017. The workshop was designed to focus on the development, implementation, and interpretation of model organisms to advance and accelerate the field of precision medicine. Participants examined the extent to which next-generation animal models, designed using patient data and phenotyping platforms targeted to reveal and inform disease mechanisms, will be essential to the successful implementation of precision medicine. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

"On September 14, 2017, the Roundtable on Population Health Improvement of the National Academies of Sciences, Engineering, and Medicine convened a workshop to explore the intersection of health and early childhood care and education, two key social determinants of health. This workshop follows a 2014 roundtable workshop that considered the interface between the education and health sectors broadly, from research and metrics to cross-sectoral partnerships and financing. The 2017 workshop continued that discussion, with a deeper focus on early childhood (birth through age 5) as a critical period in human development and an important opportunity for educational and related interventions. This publication summarizes the presentations and discussions from the 2017 workshop"--Publisher's description.

"During the 2016 presidential election, America's election infrastructure was targeted by actors sponsored by the Russian government. Securing the Vote: Protecting American Democracy examines the challenges arising out of the 2016 federal election, assesses current technology and standards for voting, and recommends steps that the federal government, state and local governments, election administrators, and vendors of voting technology should take to improve the security of election infrastructure. In doing so, the report provides a vision of voting that is more secure, accessible, reliable, and verifiable"--Publisher's description.

Improved observations of the atmospheric boundary layer (BL) and its interactions with the ocean, land, and ice surfaces have great potential to advance science on a number of fronts, from improving forecasts of severe storms and air quality to constraining estimates of trace gas emissions and transport. Understanding the BL is a crucial component of model advancements, and increased societal demands for extended weather impact forecasts (from hours to months and beyond) highlight the need to advance Earth system modeling and prediction. New observing technologies and approaches (including in situ and ground-based, airborne, and satellite remote sensing) have the potential to radically increase the density of observations and allow new types of variables to be measured within the BL, which will have broad scientific and societal benefits. In October 2017, the National Academies of Sciences, Engineering, and Medicine convened a workshop to explore the future of BL observations and their role in improving modeling and forecasting capabilities. Workshop participants discussed the science and applications drivers for BL observation, emerging technology to improve observation capabilities, and strategies for the future. This publication summarizes presentations and discussions from the workshop.

"A consensus study report of The National Academies of Sciences, Engineering, Medicine."

The U.S. system of graduate education in science, technology, engineering, and mathematics (STEM) has served the nation and its science and engineering enterprise extremely well. In many ways, it is the "gold standard" for graduate STEM education in the world as evidenced by, among other measures, the substantial number of international students coming to the United States to study. Over the course of their education, graduate students become involved in advancing the frontiers of discovery, as well as in making significant contributions to the growth of the U.S. economy, its national security, and the health and well-being of its people. However, continuous, dramatic innovations in research methods and technologies, changes in the nature and availability of work, shifts in demographics, and expansions in the scope of occupations needing STEM expertise raise questions about how well the current STEM graduate education system is meeting the full array of 21st-century needs. Indeed, recent surveys of employers and graduates and studies of graduate education suggest that many graduate programs do not adequately prepare students to translate their knowledge into impact in multiple careers.

Delivering high-quality cancer care to all patients presents numerous challenges, including difficulties with care coordination and access. Patient navigation is a community-based service delivery intervention designed to promote access to timely diagnosis and treatment of cancer and other chronic diseases by eliminating barriers to care, and has often been proposed and implemented to address these challenges. However, unresolved questions include where patient navigation programs should be deployed, and which patients should be prioritized to receive navigation services when resources are limited. To address these issues and facilitate discussion on how to improve navigation services for patients with cancer, the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine held a workshop on November 13 and 14, 2017. At this workshop, a broad range of experts and stakeholders, including clinicians, navigators, researchers, and patients, explored which patients need navigation and who should serve as navigators, and the benefits of navigation and current gaps in the evidence base.

Understanding, quantifying, and tracking atmospheric methane and emissions is essential for addressing concerns and informing decisions that affect the climate, economy, and human health and safety. Atmospheric methane is a potent greenhouse gas (GHG) that contributes to global warming. While carbon dioxide is by far the dominant cause of the rise in global average temperatures, methane also plays a significant role because it absorbs more energy per unit mass than carbon dioxide does, giving it a disproportionately large effect on global radiative forcing. In addition to contributing to climate change, methane also affects human health as a precursor to ozone pollution in the lower atmosphere. Improving Characterization of Anthropogenic Methane Emissions in the United States summarizes the current state of understanding of methane emissions sources and the measurement approaches and evaluates opportunities for methodological and inventory development improvements. This report will inform future research agendas of various U.S. agencies, including NOAA, the EPA, the DOE, NASA, the U.S. Department of Agriculture (USDA), and the National Science Foundation (NSF).

"Black men are increasingly underrepresented in medical schools and in the medical profession. A diverse workforce is a key attribute of quality healthcare and research suggests that a diverse workforce may help to advance cultural competency and increase access to high-quality health care, especially for underserved populations. Conversely, lack of diversity in the health workforce threatens health care quality and access and contributes to health disparities. In this way, the growing absence of Black men in medicine is especially troubling, because their absence in medicine may have adverse consequences for health care access, quality, and outcomes among Black Americans and Americans overall. To better understand the factors that contribute to the low participation of Black men in the medical profession, facilitate discussion of current strategies used to increase their participation in medical education, and explore new strategies along the educational and professional pipeline that may have potential to increase participation in medicine, the National Academies of Sciences, Engineering, and Medicine and the Cobb Institute jointly convened a 2-day workshop in November 2017, in Washington, DC. This publication summarizes the presentations and discussions from the workshop"--

"The review of this proceedings was overseen by Gary LaFree"--Page ix.

Workshop held at the Keck Center, Washington, DC on October 11, 2017.

"Millions of people in the United States live with serious illnesses such as cancer, heart disease, chronic obstructive pulmonary disorder (COPD), amyotrophic lateral sclerosis, Parkinson's disease, and dementia--often for many years. Those facing serious illness have a range of interconnected medical and non-medical needs, and the way their care is financed has a large impact on the care they receive. Medicare is the predominant payer, but both Medicaid and private payers also play significant roles in financing care for serious illness. In an effort to address the complex needs of people with serious illness, public and private health care payers are testing innovative financing strategies and alternative payment models. These innovative approaches signal a gradual transition from the traditional-fee-for-service system that pays providers based on the quantity of services to a system based on the value of care provided and a heightened focus on improved quality of care at lower cost. To explore this evolving financing and payment landscape for serious illness care within public- and private-sector programs, the Roundtable on Quality Care for People with Serious Illness developed a workshop, Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness. The workshop convened clinicians, researchers, policy analysts, and patient advocates, as well as representatives from academia, government and private health care plans, and insurers to discuss challenges and opportunities in financing high-quality care for people with serious illness. This publication summarizes the presentations and discussions from the workshop"--