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Both the Food and Drug Administration (FDA) and the National Institute for Occupational Safety and Health (NIOSH) have responsibilities for evaluating and regulating respiratory protective devices ("respirators") for health care workers. Respirators protect the user from respiratory hazards by either removing contaminants from the air (air-purifying respirators) or by supplying clean air from another source (air-supplying respirators). Respirators that are used in workplaces in the United States must be approved by NIOSH and meet standards and test results specified by regulation. Respirators used by health care workers are air-purifying respirators that generally fall into three types: (1) disposable particulate filtering facepiece respirators (also termed N95s); (2) elastomeric respirators, also known as reusable respirators because they use a replaceable filter; or (3) powered air-purifying air respirators. To provide input to NIOSH and FDA and to discuss potential next steps to integrate the two agencies' processes to certify and approve N95 respirators for use in health care settings, a workshop was held by the National Academies of Sciences, Engineering, and Medicine in August 2016. The workshop was focused on exploring the strengths and limitations of several current test methods for N95 respirators as well as identifying ongoing research and research needs. This publication summarizes the presentations and discussions from the workshop.

The United States has long recognized that the nation's prosperity and security depend on how we address challenges of disasters, poverty, famine, and disease around the world. The U.S. Agency for International Development (USAID) has played a vital role in promoting U.S. national and international interests by advancing strategies for employing science, technology, and innovation to respond to global challenges. The focus by USAID on science, technology, and innovation is critical to improve development outcomes. At the core of this progress is the engagement of science institutions and other innovative enterprises and their commitment to work in partnership with USAID to research, test, and scale solutions. The Role of Science, Technology, Innovation, and Partnerships in the Future of USAID provides an assessment and advice on the current and future role for science, technology, and innovation in assistance programs at USAID and on the role of partnerships in the public and private sectors to expand impact. This report examines challenges and opportunities for USAID in expanding the utilization of science, technology, and innovation in development assistance; assesses how USAID has deployed science, technology, and innovation; and recommends priority areas for improvement going forward in partnership with others.

Note: This is the French translation of Recent Fertility Trends in Sub-Saharan Africa. Fertility rates and population growth influence economic development. The marked declines in fertility seen in some developing nations have been accompanied by slowing population growth, which in turn provided a window of opportunity for rapid economic growth. For many sub-Saharan African nations, this window has not yet opened because fertility rates have not declined as rapidly there as elsewhere. Fertility rates in many sub-Saharan African countries are high: the total rate for the region is estimated to be 5.1 births per woman, and rates that had begun to decline in many countries in the region have stalled. High rates of fertility in these countries are likely to contribute to continued rapid population growth: the United Nations projects that the region's population will increase by 1.2 billion by 2050, the highest growth among the regions for which there are projections. In June 2015, the Committee on Population organized a workshop to explore fertility trends and the factors that have influenced them. The workshop committee was asked to explore history and trends related to fertility, proximate determinants and other influences, the status and impact of family planning programs, and prospects for further reducing fertility rates. This study will help donors, researchers, and policy makers better understand the factors that may explain the slow pace of fertility decline in this region, and develop methods to improve family planning in sub-Saharan Africa.

"On June 16, 2016, the Roundtable on Population Health Improvement held a workshop at the Lutheran Church of the Good Shepherd in Brooklyn, New York, to explore the influence of trauma and violence on communities. The workshop highlighted examples of community-based organizations using trauma-informed approaches to treat violence and build safe and healthy communities. Presentations showcased examples that can serve as models in different sectors and communities and shared lessons learned. This publication summarizes the presentation and discussion of the event"--Publisher's description.

"The National Academies of Sciences, Engineering, Medicine."

The social cost of carbon (SC-CO2) is an economic metric intended to provide a comprehensive estimate of the net damages - that is, the monetized value of the net impacts, both negative and positive - from the global climate change that results from a small (1-metric ton) increase in carbon-dioxide (CO2) emissions. Under Executive Orders regarding regulatory impact analysis and as required by a court ruling, the U.S. government has since 2008 used estimates of the SC-CO2 in federal rulemakings to value the costs and benefits associated with changes in CO2 emissions. In 2010, the Interagency Working Group on the Social Cost of Greenhouse Gases (IWG) developed a methodology for estimating the SC-CO2 across a range of assumptions about future socioeconomic and physical earth systems. Valuing Climate Changes examines potential approaches, along with their relative merits and challenges, for a comprehensive update to the current methodology. This publication also recommends near- and longer-term research priorities to ensure that the SC- CO2 estimates reflect the best available science.

Federal government statistics provide critical information to the country and serve a key role in a democracy. For decades, sample surveys with instruments carefully designed for particular data needs have been one of the primary methods for collecting data for federal statistics. However, the costs of conducting such surveys have been increasing while response rates have been declining, and many surveys are not able to fulfill growing demands for more timely information and for more detailed information at state and local levels. Innovations in Federal Statistics examines the opportunities and risks of using government administrative and private sector data sources to foster a paradigm shift in federal statistical programs that would combine diverse data sources in a secure manner to enhance federal statistics. This first publication of a two-part series discusses the challenges faced by the federal statistical system and the foundational elements needed for a new paradigm.

"Recent health care payment reforms aim to improve the alignment of Medicare payment strategies with goals to improve the quality of care provided, patient experiences with health care, and health outcomes, while also controlling costs. These efforts move Medicare away from the volume-based payment of traditional fee-for-service models and toward value-based purchasing, in which cost control is an explicit goal in addition to clinical and quality goals. Specific payment strategies include pay-for-performance and other quality incentive programs that tie financial rewards and sanctions to the quality and efficiency of care provided and accountable care organizations in which health care providers are held accountable for both the quality and cost of the care they deliver. Accounting For Social Risk Factors in Medicare Payment is the fifth and final report in a series of brief reports that aim to inform ASPE analyses that account for social risk factors in Medicare payment programs mandated through the IMPACT Act. This report aims to put the entire series in context and offers additional thoughts about how to best consider the various methods for accounting for social risk factors, as well as next steps"--

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

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) began 40 years ago as a pilot program and has since grown to serve over 8 million pregnant women, and mothers of and their infants and young children. Today the program serves more than a quarter of the pregnant women and half of the infants in the United States, at an annual cost of about $6.2 billion. Through its contribution to the nutritional needs of pregnant, breastfeeding, and post-partum women; infants; and children under 5 years of age; this federally supported nutrition assistance program is integral to meeting national nutrition policy goals for a significant portion of the U.S. population. To assure the continued success of the WIC, Congress mandated that the Food and Nutrition Service of the U.S. Department of Agriculture (USDA) reevaluate the program's food packages every 10 years. In 2014, the USDA asked the Institute of Medicine to undertake this reevaluation to ensure continued alignment with the goals of the Dietary Guidelines for Americans. In this third report, the committee provides its final analyses, recommendations, and the supporting rationale.

This is the fourth in a series of five letter reports that provide an independent review of the more than 30 evidence reports that NASA has compiled on human health risks for long-duration and exploration spaceflights.This letter report reviews eight evidence reports and examines the quality of the evidence, analysis, and overall construction of each report; identifies existing gaps in report content; and provides suggestions for additional sources of expert input.

Over the last decade, several large-scale United States and international programs have been initiated to incorporate advances in molecular and cellular biology, -omics technologies, analytical methods, bioinformatics, and computational tools and methods into the field of toxicology. Similar efforts are being pursued in the field of exposure science with the goals of obtaining more accurate and complete exposure data on individuals and populations for thousands of chemicals over the lifespan; predicting exposures from use data and chemical-property information; and translating exposures between test systems and humans. Using 21st Century Science to Improve Risk-Related Evaluations makes recommendations for integrating new scientific approaches into risk-based evaluations. This study considers the scientific advances that have occurred following the publication of the NRC reports Toxicity Testing in the 21st Century: A Vision and a Strategy and Exposure Science in the 21st Century: A Vision and a Strategy. Given the various ongoing lines of investigation and new data streams that have emerged, this publication proposes how best to integrate and use the emerging results in evaluating chemical risk. Using 21st Century Science to Improve Risk-Related Evaluations considers whether a new paradigm is needed for data validation, how to integrate the divergent data streams, how uncertainty might need to be characterized, and how best to communicate the new approaches so that they are understandable to various stakeholders.

Produced water--water from underground formations that is brought to the surface during oil and gas production--is the greatest volume byproduct associated with oil and gas production. It is managed by some combination of underground injection, treatment and subsequent use, treatment and discharge, or evaporation, subject to compliance with state and federal regulations. Management of these waters is challenging not only for industry and regulators, but also for landowners and the public because of differences in the quality and quantity of produced water, varying infrastructure needs, costs, and environmental considerations associated with produced water disposal, storage, and transport. Unconventional oil and gas development involves technologies that combine horizontal drilling with the practice of hydraulic fracturing. Hydraulic fracturing is a controlled, high-pressure injection of fluid and proppant into a well to generate fractures in the rock formation containing the oil or gas. After the hydraulic fracture procedure is completed, the injected fluid is allowed to flow back into the well, leaving the proppant in the newly created fractures. As a result, a portion of the injected water returns to the surface and this water is called "flowback water" which initially may mix with the naturally occurring produced water from the formation. The chemistry and volume of water returning to the surface from unconventional oil and gas operations thus changes during the lifetime of the well due to the amount of fluid used in the initial stage of well development, the amount of water naturally occurring in the geologic formation, the original water and rock chemistry, the type of hydrocarbon being produced, and the way in which production is conducted. The volume and composition of flowback and produced waters vary with geography, time, and site-specific factors. A workshop was conducted by the National Academies of Sciences, Engineering, and Medicine to highlight the challenges and opportunities associated in managing produced water from unconventional hydrocarbon development, and particularly in the area of potential beneficial uses for these waters. This publication summarizes the presentations and discussions from the workshop.

The term "service-learning" generally refers to projects planned as components of academic coursework in which students use knowledge and skills taught in the course to address real needs in their communities. This kind of learning experience, which allows students to focus on critical, reflective thinking and civic responsibility, has become an increasingly popular component of undergraduate science education. In April 2016, the National Academies of Sciences, Engineering, and Medicine planned a workshop to explore the current and potential role of service-learning in undergraduate geosciences education. Participants explored how service learning is being used in geoscience education, its potential benefits, and the strength of the evidence base regarding the nature and benefits of these experiences. This publication summarizes the presentations and discussions from the workshop.

"Workshop on Improving Collection of Indicators of Criminal Justice System Involvement in Population Health Data Programs, March 29-30, 2016 ... Washington, DC"--Page 75.

"Cyber-physical systems (CPS) are 'engineered systems that are built from, and depend upon, the seamless integration of computational algorithms and physical components.' CPS can be small and closed, such as an artificial pancreas, or very large, complex, and interconnected, such as a regional energy grid. CPS engineering focuses on managing inter- dependencies and impact of physical aspects on cyber aspects, and vice versa. With the development of low-cost sensing, powerful embedded system hardware, and widely deployed communication networks, the reliance on CPS for system functionality has dramatically increased. These technical developments in combination with the creation of a workforce skilled in engineering CPS will allow the deployment of increasingly capable, adaptable, and trustworthy systems"--

Cardiac arrest often strikes seemingly healthy individuals without warning and without regard to age, gender, race, or health status. Representing the third leading cause of death in the United States, cardiac arrest is defined as "a severe malfunction or cessation of the electrical and mechanical activity of the heart ... [which] results in almost instantaneous loss of consciousness and collapse". Although the exact number of cardiac arrests is unknown, conservative estimates suggest that approximately 600,000 individuals experience a cardiac arrest in the United States each year. In June 2015, the Institute of Medicine (IOM) released its consensus report Strategies to Improve Cardiac Arrest Survival: A Time to Act, which evaluated the factors affecting resuscitation research and outcomes in the United States. Following the release of this report, the National Academies of Sciences, Engineering, and Medicine was asked to hold a workshop to explore the barriers and opportunities for advancing the IOM recommendations. This publication summarizes the presentations and discussions from the workshop.

"The penetration of solid-state lighting (SSL) has increased dramatically since the publication of the National Research Council (NRC) report Assessment of Advanced Solid-State Lighting in 2013. The Committee on Assessment of Solid-State Lighting, Phase 2 has been surprised by this rapid adoption and the accompanying diversity of applications of SSL, which has been driven largely by the dramatic decline in the retail price of lamps and luminaires, and recognition of the unique qualities of the light emitting diode (LED) light source. Improvements in lamp performance, the introduction of innovative applications, improved compatibility of lamps with controls, and the integration of LED lamps in systems have all contributed to this rapid acceptance. Examples of exploiting the special characteristics of SSL are the introduction to steerable headlamps in cars, the use of spectral control to prevent lighting-induced damage to artwork, and more efficient and controllable street lighting. Accompanying this growth in the SSL market has been the rapid decline of compact fluorescent lamps (CFLs) from retail shelves"--Preface, page vii.

"The Small Business Innovation Research (SBIR) program is one of the largest examples of U.S. public-private partnerships, and was established in 1982 to encourage small businesses to develop new processes and products and to provide quality research in support of the U.S. government's many missions. The Small Business Technology Transfer (STTR) Program was created in 1992 by the Small Business Research and Development Enhancement Act to expand joint venture opportunities for small businesses and nonprofit research institutions by requiring small business recipients to collaborate formally with a research institution. The U.S. Congress tasked the National Research Council with undertaking a comprehensive study of how the SBIR and STTR programs have stimulated technological innovation and used small businesses to meet federal research and development needs, and with recommending further improvements to the programs. In the first round of this study, an ad hoc committee prepared a series of reports from 2004 to 2009 on the SBIR and STTR programs at the five agencies responsible for 96 percent of the programs' operations -- including the Department of Energy (DoE). Building on the outcomes from the first round, this second round presents the committee's second review of the DoE SBIR program's operations. Public-private partnerships like SBIR and STTR are particularly important since today's knowledge economy is driven in large part by the nation's capacity to innovate. One of the defining features of the U.S. economy is a high level of entrepreneurial activity. Entrepreneurs in the United States see opportunities and are willing and able to assume risk to bring new welfare-enhancing, wealth-generating technologies to the market. Yet, although discoveries in areas such as genomics, bioinformatics, and nanotechnology present new opportunities, converting these discoveries into innovations for the market involves substantial challenges. The American capacity for innovation can be strengthened by addressing the challenges faced by entrepreneurs"--Publisher's description.

The Everglades ecosystem is vast, stretching more than 200 miles from Orlando to Florida Bay, and Everglades National Park is but a part located at the southern end. During the 19th and 20th centuries, the historical Everglades has been reduced to half of its original size, and what remains is not the pristine ecosystem many image it to be, but one that has been highly engineered and otherwise heavily influenced, and is intensely managed by humans. Rather than slowly flowing southward in a broad river of grass, water moves through a maze of canals, levees, pump stations, and hydraulic control structures, and a substantial fraction is diverted from the natural system to meet water supply and flood control needs. The water that remains is polluted by phosphorus and other contaminants originating from agriculture and other human activities. Many components of the natural system are highly degraded and continue to degrade. Progress Toward Restoring the Everglades is the sixth biennial review of progress made in meeting the goals of the Comprehensive Everglades Restoration Plan (CERP). This complex, multibillion-dollar project to protect and restore the remaining Everglades has a 30-40 year timeline. This report assesses progress made in the various separate project components and discusses specific scientific and engineering issues that may impact further progress. According to Progress Toward Restoring the Everglades, a dedicated source of funding could provide ongoing long-term system-wide monitoring and assessment that is critical to meeting restoration objectives. This report examines the implications of knowledge gained and changes in widely accepted scientific understanding regarding pre-drainage hydrology, climate change, and the feasibility of water storage since the CERP was developed.

"A report of the National Academies of Sciences, Engineering, Medicine."

Using science to improve science communication -- The complexities of communicating science -- The nature of science-related public controversies -- Communicating science in a complex, competitive communication environment -- Building the knowledge base for effective science communication -- References -- Appendix A: Agendas of public meetings -- Appendix B: Biographical sketches of Committee members and staff.

The Department of Homeland Security's (DHS's) BioWatch program aims to provide an early indication of an aerosolized biological weapon attack. The first generation of BioWatch air samplers were deployed in 2003. The current version of this technology, referred to as Generation 2 (Gen-2), uses daily manual collection and testing of air filters from each monitor, a process that can take 12 to 36 hours to detect the presence of biological pathogens. Until April 2014, DHS pursued a next-generation autonomous detection technology that aimed to shorten the time from sample collection to detection to less than 6 hours, reduce the cost of analysis, and increase the number of detectable biological pathogens. Because of concerns about the cost and effectiveness of the proposed Generation 3 system (Gen-3), DHS cancelled its acquisition plans for the next-generation surveillance system. In response to the cancellation announcement, Congress asked the Government Accountability Office (GAO) to conduct a review of the program and the proposed system enhancements that would have been incorporated in BioWatch Gen-3. However, Mike Walter, BioWatch Program manager, Office of Health Affairs, DHS, said that DHS did not agree with all of GAO's characterizations of the BioWatch program efforts described in this review. In response to this, DHS requested that the National Academies of Sciences, Engineering, and Medicine conduct a workshop to further explore the findings of the 2015 GAO report and discuss the impact these findings may have with regard to the future development of the technical capabilities of the BioWatch program. Workshop participants also discussed existing and possible collaborations between BioWatch, public health laboratories, and other stakeholders that could contribute to the enhancement of biosurveillance capabilities at the federal, state, and local levels. This publication summarizes the presentations and discussions from the workshop.

"With the amount of data in the world exploding, big data could generate significant value in the field of infectious disease. The increased use of social media provides an opportunity to improve public health surveillance systems and to develop predictive models. Advances in machine learning and crowdsourcing may also offer the possibility to gather information about disease dynamics, such as contact patterns and the impact of the social environment. New, rapid, point-of-care diagnostics may make it possible to capture not only diagnostic information but also other potentially epidemiologically relevant information in real time. With a wide range of data available for analysis, decision-making and policy-making processes could be improved. While there are many opportunities for big data to be used for infectious disease research, operations, and policy, many challenges remain before it is possible to capture the full potential of big data. In order to explore some of the opportunities and issues associated with the scientific, policy, and operational aspects of big data in relation to microbial threats and public health, the National Academies of Sciences, Engineering, and Medicine convened a workshop in May 2016. Participants discussed a range of topics including preventing, detecting, and responding to infectious disease threats using big data and related analytics; varieties of data (including demographic, geospatial, behavioral, syndromic, and laboratory) and their broader applications; means to improve their collection, processing, utility, and validation; and approaches that can be learned from other sectors to inform big data strategies for infectious disease research, operations, and policy. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

"As the demographics of the United States shift toward a population that is made up of an increasing percentage of older adults and people with disabilities, the workforce that supports and enables these individuals is also shifting to meet the demands of this population. For many older adults and people with disabilities, their priorities include maximizing their independence, living in their own homes, and participating in their communities. In order to meet this population's demands, the workforce is adapting by modifying its training, by determining how to coordinate among the range of different professionals who might play a role in supporting any one older adult or individual with disabilities, and by identifying the ways in which technology might be helpful. To better understand how the increasing demand for supports and services will affect the nation's workforce, the National Academies of Sciences, Engineering, and Medicine convened a public workshop in June 2016, in Washington, DC. Participants aimed to identify how the health care workforce can be strengthened to support both community living and community participation for adults with disabilities and older adults. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

Over the past 20 years, public concerns have grown in response to the apparent rising prevalence of food allergy and related atopic conditions, such as eczema. Although evidence on the true prevalence of food allergy is complicated by insufficient or inconsistent data and studies with variable methodologies, many health care experts who care for patients agree that a real increase in food allergy has occurred and that it is unlikely to be due simply to an increase in awareness and better tools for diagnosis. Many stakeholders are concerned about these increases, including the general public, policy makers, regulatory agencies, the food industry, scientists, clinicians, and especially families of children and young people suffering from food allergy. At the present time, however, despite a mounting body of data on the prevalence, health consequences, and associated costs of food allergy, this chronic disease has not garnered the level of societal attention that it warrants. Moreover, for patients and families at risk, recommendations and guidelines have not been clear about preventing exposure or the onset of reactions or for managing this disease. Finding a Path to Safety in Food Allergy examines critical issues related to food allergy, including the prevalence and severity of food allergy and its impact on affected individuals, families, and communities; and current understanding of food allergy as a disease, and in diagnostics, treatments, prevention, and public policy. This report seeks to: clarify the nature of the disease, its causes, and its current management; highlight gaps in knowledge; encourage the implementation of management tools at many levels and among many stakeholders; and delineate a roadmap to safety for those who have, or are at risk of developing, food allergy, as well as for others in society who are responsible for public health.

"The most recent Ebola epidemic that began in late 2013 alerted the entire world to the gaps in infectious disease emergency preparedness and response. The regional outbreak that progressed to a significant public health emergency of international concern (PHEIC) in a matter of months killed 11,310 and infected more than 28,616. While this outbreak bears some unique distinctions to past outbreaks, many characteristics remain the same and contributed to tragic loss of human life and unnecessary expenditure of capital: insufficient knowledge of the disease, its reservoirs, and its transmission; delayed prevention efforts and treatment; poor control of the disease in hospital settings; and inadequate community and international responses. Recognizing the opportunity to learn from the countless lessons of this epidemic, the National Academies of Sciences, Engineering, and Medicine convened a workshop in March 2015 to discuss the challenges to successful outbreak responses at the scientific, clinical, and global health levels. Workshop participants explored the epidemic from multiple perspectives, identified important questions about Ebola that remained unanswered, and sought to apply this understanding to the broad challenges posed by Ebola and other emerging pathogens, to prevent the international community from being taken by surprise once again in the face of these threats. This publication summarizes the presentations and discussions from the workshop"--

"Multimodal therapy approaches that combine interventions aimed at different aspects of disease are emerging as potential--and perhaps essential--ways to enhance clinical outcomes for patients with psychiatric and neurological disorders. In order to examine the general principles underlying multimodal therapies and to explore challenges, potential barriers, and opportunities for their development, the National Academies of Sciences, Engineering, and Medicine convened a workshop in June 2016. Participants explored scientific, clinical, regulatory, and reimbursement issues related to multimodal approaches and potential opportunities to enhance clinical outcomes for individuals with nervous system disorders. This publication summarizes the presentations and discussions from the workshop"--Publisher's description.

"The public health burden from lung cancer is substantial: it is the second most commonly diagnosed cancer and the leading cause of cancer-related deaths in the United States. Given the individual and population health burden of lung cancer, especially when it is diagnosed at later stages, there has been a push to develop and implement screening strategies for early detection. However, many factors need to be considered for broad implementation of lung cancer screening in clinical practice. Effective implementation will entail understanding the balance of potential benefits and harms of lung cancer screening, defining and reaching eligible populations, addressing health disparities, and many more considerations. In recognition of the substantial challenges to developing effective lung cancer screening programs in clinical practice, the National Academies of Sciences, Engineering, and Medicine held a workshop in June 2016. At the workshop, experts described the current evidence base for lung cancer screening, the current challenges of implementation, and opportunities to overcome them. Workshop participants also explored capacity and access issues; best practices for screening programs; assessment of patient outcomes, quality, and value in lung cancer screening; and research needs that could improve implementation efforts. This publication summarizes the presentations and discussions from the workshop"--