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Carbon materials pervade many aspects of modern life, from fuels and building materials to consumer goods and commodity chemicals. Reaching net-zero emissions will require replacing existing fossil-carbon-based systems with circular-carbon economies that transform wastes like CO2 into useful materials. This report evaluates market opportunities and infrastructure needs to help decision makers better understand how carbon dioxide utilization can contribute to a net-zero emissions future.

The National Academies Roundtable on Quality Care for People with Serious Illness, National Cancer Policy Forum, and Forum on Aging, Disability and Independence hosted a workshop that examined opportunities to better support family caregiving for people with cancer or other serious illnesses. This workshop built upon previous work, including the 2016 consensus report Families Caring for an Aging America. This Proceedings of a Workshop summarizes the discussions held during the workshop, which focused on: strategies to better capture, understand, and act on family caregiver input and experience; research gaps and opportunities to guide caregiving for patients with serious illnesses; potential policy and practice opportunities to advance family-centered care for serious illness; and opportunities to embed a health equity focus across family caregiving research, policy, and practice.

The United States has deployed commercial nuclear power since the 1950s, and as of 2021, nuclear power accounts for approximately 20 percent of U.S. electricity generation. The current commercial nuclear fleet consists entirely of thermal-spectrum, light water reactors operating with low-enriched uranium dioxide fuel in a once-through fuel cycle. In recent years, the U.S. Congress, U.S. Department of Energy, and private sector have expressed considerable interest in developing and deploying advanced nuclear reactors to augment, and possibly replace, the U.S. operating fleet of reactors, nearly all of which will reach the end of their currently licensed operating lives by 2050. Much of this interest stems from the potential ability of advanced reactors and their associated fuel cycles - as claimed by their designers and developers - to provide a number of advantages, such as improvements in economic competitiveness, reductions in environmental impact via better natural resource utilization and/or lower waste generation, and enhancements in nuclear safety and proliferation resistance. At the request of Congress, this report explores merits and viability of different nuclear fuel cycles, including fuel cycles that may use reprocessing, for both existing and advanced reactor technologies; and waste management (including transportation, storage, and disposal options) for advanced reactors, and in particular, the potential impact of advanced reactors and their fuel cycles on waste generation and disposal.

The U.S. Department of State, through its Bureau of International Narcotics and Law Enforcement Affairs (INL), provides foreign assistance and supports capacity building for criminal justice systems and police organizations in approximately 90 countries around the world. It has a mandate to strengthen fragile states, support democratic transitions, and stabilize conflict-affected societies by helping partner countries develop effective and accountable criminal justice sector institutions and systems. At the request of INL, the National Academies of Sciences, Engineering, and Medicine assembled the Committee on Evidence to Advance Reform in the Global Security and Justice Sectors to review the available research evidence on police and policing practices, with emphasis on how police reform can promote the rule of law and protect the public. The 5 consensus studies that are part of this project provide evidence-driven policy and research recommendations for key stakeholders with the goal of informing capacity-building activities. This report is a compilation of those 5 studies.

Implementation science bridges the gap between research and medical practice, investigating aspects of practice and pedagogy that make the strategies successful for future use. By introducing and training leaders, faculty, and health workforce researchers in implementation science, health professions education institutions can build capacity for evidence-based practices. The National Academies Global Forum on Innovation in Health Professional Education held a workshop series to introduce the concept of implementation science to health professional educators to consider its potential use in the classroom. Speakers provided a foundation for discussion of the role of implementation science in health professions education and provided methods for educators interested in applying these recommendations to scale. This Proceedings of a Workshop highlights the presentations and discussions that occurred at the workshop.

Strategically moving communities and infrastructure--including homes and businesses--away from environmentally high-risk areas, such as vulnerable coastal regions, has been referred to as "managed retreat." Of all the ways humans respond to climate-related disasters, managed retreat has been one of the most controversial due to the difficulty inherent in identifying when, to where, by whom, and the processes by which such movement should take place. In 2021, the Gulf Research Program of the National Academies of Sciences, Engineering, and Medicine sponsored a two-year consensus study, Managed Retreat in the U.S. Gulf Coast Region, to learn about and respond to the unique challenges associated with managed retreat. As part of this study, the committee convened a series of three public workshops in 2022 in the Gulf Coast region to gather information for the consensus report. Each workshop focused on policy and practice considerations, research and data needs, and community engagement strategies. This proceedings recounts the first workshop in Houston and Port Arthur, Texas.

Electronic Health Records (EHRs) are used across a wide variety of activities in cancer care and cancer research, including communication among health care team members and patients, clinical documentation and treatment planning, patient safety and quality improvement, scheduling and billing, as well as clinical research and disease surveillance activities. On February 28 and March 1, 2022, the National Cancer Policy Forum and the Computer Science and Telecommunications Board of the National Academies of Sciences, Engineering, and Medicine hosted a public workshop to examine opportunities to improve patient care and outcomes through collaborations to enhance innovation in the development, implementation, and use of EHRs in oncology care, research, and surveillance. This Proceedings of a Workshop summarizes the presentations and discussions that took place at the workshop.

In response to a request from Congress, the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine conducted a study comparing the process to develop the Dietary Guidelines for Americans, 2020-2025 (DGA 2020-2025) to recommendations included in the previously published National Academies report, Redesigning the Process for Establishing the Dietary Guidelines for Americans. This report describes the findings of the committee and conclusions related to this assessment. Notably, this report does not evaluate the merits of the DGA 2020-2025 but evaluates the process by which they were created relative to the recommendations made in the previously published National Academies report.

Steel is a common component of U.S. infrastructure, but that steel can corrode when buried in soil, rock, or fill. Steel corrosion is estimated to cost the United States 3-4 percent of its gross domestic product every year, and it can lead to infrastructure failure, loss of lives, property, disruption of energy and transportation systems, and damage to the environment. Although the mechanisms of steel corrosion are well understood, limited data on subsurface corrosion and the inability to measure corrosivity directly make accurate corrosion prediction through modeling a challenge. When hazardous levels of corrosion does occur, it is difficult to determine whether the cause was related to site selection, engineering decisions, changes in subsurface conditions, or a combination of these factors. This report explores the state of knowledge and technical issues regarding the corrosion of steel used for earth applications (e.g., for ground stabilization, pipelines, and infrastructure foundations) in unconsolidated earth or rock in different geologic settings. The report summarizes mechanisms of steel corrosion, assesses the state of practice for characterizing factors in the subsurface environment that influence corrosion and corrosion rates, and assesses the efficacy and uncertainties associated with quantitative, field, and laboratory methods for predicting corrosion. The industries and experts most involved with managing buried steel should collaborate to improve multidisciplinary understanding of the processes that drive buried steel corrosion. Developing a common lexicon related to buried steel corrosion, generating new data on corrosion through collaborative long-term experiments, sharing and managing data, and developing new data analytical techniques to inform infrastructure design, construction, and management decisions are key. Industries, experts, and regulators should collaboratively develop decision support systems that guide site characterization and help manage risk. These systems and new data should undergird a common clearinghouse for data on corrosion of buried steel, which will ultimately inform better and more efficient management of buried steel infrastructure, and protect safety and the environment.

Patients diagnosed with Alzheimer's disease and related dementias (ADRD) rely on family members, their community, and the health care system for progressively increasing support over the course of their disease. These people receive care through a frequently siloed health care system across hospitals, nursing homes, ambulatory care settings, and long-term care settings, as well as community- and home-based care. As the number of people living with a diagnosis of ADRD continues to grow, so does the need to provide better support for these people and their caregivers. The National Institute on Aging (NIA) Division of Behavioral and Social Research suggests that organizational behavior change will be needed for health care systems to integrate all of the services and supports required to provide high-quality care for people with ADRD. NIA sponsored a workshop hosted by the National Academies of Sciences, Engineering, and Medicine to explore mechanisms to improve the quality of care for people living with ADRD and the potential of innovative payment models to incentivize health care systems to make the necessary systemic changes. The workshop convened a diverse array of experts in fields including nursing, geriatrics, health care economics, health care services research, quality measurement, social work, medical ethics, law, health care finance, and health care policy. This publication summarizes the presentation and discussion of the workshop.

The US Department of State, Bureau of International Narcotics and Law Enforcement (INL) provides assistance and supports capacity building for criminal justice systems and police organizations in approximately 90 countries. In order to support and inform that work, this report explores high-level corruption and its effects on police organizations, as well as strategies that police can use to effectively contribute to efforts to combat that corruption.

The Hanford Nuclear Reservation in Washington state, which produced plutonium for nuclear weapons from 1944-1987, is the site of the largest and most complex nuclear cleanup challenge in the United States. The U.S. Department of Energy's Office of Environmental Management (DOE-EM) is responsible for managing the cleanup of the radioactive and other hazardous wastes stored in 177 underground tanks at the site. DOE plans to use vitrification, or immobilization in glass waste forms, for all of the high-level radioactive waste at Hanford. However, because the volume of "low-activity waste" exceeds DOEs capacity limits for vitrification, DOE must decide how to treat the remaining "supplemental low-activity waste" (SLAW) so that it can be safely disposed in a near-surface disposal site. To help inform its decision, DOE contracted with a Federally Funded Research and Development Center (FFRDC), led by Savannah River National Laboratory, to analyze and report its findings about three potential alternative technologies. At the request of Congress, the National Academies reviewed the FFRDC report in terms of its value for decision making and how well it meets various Congressional requirements related to Hanford cleanup. The review concludes that the FFRDC report is overall very strong, provides a useful framework for evaluating the technology options, and is responsive to guidance from the first National Academies review. The framework provides for structured side-by-side comparisons, using relevant criteria, of a limited number of alternatives for managing SLAW. Recommendations for strengthening the report include estimating a lifecycle cost profile for constructing and operating each alternative, and providing more in-depth discussion on potential challenges that may need to be addressed in obtaining the necessary various regulatory approvals.

The Materials Genome Initiative (MGI) was launched in 2011 by the White House Office of Science and Technology Policy to help accelerate the design, discovery, development and deployment of advanced materials and to reduce costs through the integration of advanced computation and data management with experimental synthesis and characterization. A broad range of federal agencies - including the National Science Foundation (NSF), the Department of Energy, and the Department of Defense - are part of the MGI effort and have invested more than $1 billion in resources and infrastructure accumulative since the start. The efforts of NSF have been focused largely within the Designing Materials to Revolutionize and Engineer Our Future (DMREF) program, which supports the development of fundamental science, computational and experimental tools for generating and managing data, and workforce that enable industry and other government agencies to develop and deploy materials that meet societal needs and national priorities. At the request of NSF, this report evaluates the goals, progress, and scientific accomplishments of the DMREF program within the context of similar efforts both within the United States and abroad. The recommendations of this report will assist NSF as it continues to increase its engagement with industry and federal agencies to transition the results from fundamental science efforts to reach the MGI goal of deploying advanced materials at least twice as fast as possible today, at a fraction of the cost that meet national priorities.

Dietary assessment in older adults presents many unique problems due to the diversity of health states and capabilities that span the population group. Little is known about dietary intakes, body composition, and nutritional status among individuals 75 and older. The National Academies Food and Nutrition Board hosted a virtual workshop series in spring 2022 intended to provide guidance to researchers and clinicians. The workshops aimed to outline considerations relating to different methods of assessing intakes of food and dietary supplements in older adults. The covered topics included current status of dietary and nutrition assessment of older adults and advances and key issues in this topic; nutritional screening of older adults; and nutritional practices, challenges, and policies that affect older adults. This Proceedings highlights presentations and discussions from the workshops.

Virginia was one of the first major gold-producing states in the U.S., but it has seen only limited and intermittent gold mining activity in the last 70 years. Recent increase in gold prices and other factors have brought renewed attention to mining gold at both new and historical sites in Virginia. This report provides an evaluation of the gold deposits in Virginia, the probable modern mining techniques that could be used at such deposits, and whether existing regulations in the Commonwealth are sufficient to protect air and water quality and human health from potential impacts of gold mining activities. The report concludes that the regulatory framework of Virginia appears to have been designed for operations like crushed stone quarrying and sand and gravel operations, not gold mining. Thus, the current regulatory framework is not adequate to address the potential impacts of commercial gold mining and lacks an adequate financial assurance system, which poses a fiscal and environmental risk to the Commonwealth. Additionally, Virginia lacks opportunities for the public to be engaged in permitting processes and a modern system for review of environmental impacts from potential gold mining projects.

Land-grant colleges and universities play a crucial role in addressing the complex challenges facing the U.S. agricultural system and global food security. Multidisciplinary collaboration involving a diversity of land-grant institutions has the potential to accelerate scientific progress on those challenges. However, historical and current funding disparities have prevented Historically Black Colleges and Universities and Tribal Colleges and Universities from being full partners in multi-institutional collaborations. This report, produced by request of the U.S. Department of Agriculture National Institute of Food and Agriculture acting on a congressional directive, examines how enhanced cooperation across the land-grant system could deepen and expand the impact of its agricultural work, which is critical to address evolving industry and environmental challenges, as well as demands from consumers. The report concludes that many investigators are unaware of potential partners with complementary expertise across the system. The report states that adopting a culture of collaboration could improve the coordination in the land-grant system. Key report recommendations include improving systems and incentives for facilitating academic partnerships, providing dedicated support for collaboration across the land-grant system, and enhancing outreach strategies for communicating about the beneficial outcomes of collaborative research.

While significant progress has been seen in fields such as cardiovascular medicine and cancer in improving patient stratification and developing targeted drugs based on genetic findings, progress continues to lag for neuropsychiatric disorders. To address this issue, the National Academies of Sciences, Engineering, and Medicine's Forum on Neuroscience and Nervous System Disorders convened a workshop in October 2021. The workshop brought together government, philanthropic foundations, and disease-focused non--profit organizations to discuss new genetic and neuroscience technologies and explore how they can be used to elucidate disease mechanisms and to advance the development of biomarkers and targeted therapies for people with neurological and psychiatric disorders. This Proceedings of a Workshop summarizes the presentations and discussions of the workshop.

Emerging real-time data sources, together with innovative data science techniques and methods - including artificial intelligence and machine learning - can help inform upstream suicide prevention efforts. Select social media platforms have proactively deployed these methods to identify individual platform users at high risk for suicide, and in some cases may activate local law enforcement, if needed, to prevent imminent suicide. To explore the current scope of activities, benefits, and risks of leveraging innovative data science techniques to help inform upstream suicide prevention at the individual and population level, the Forum on Mental Health and Substance Use Disorders of the National Academies of Sciences, Engineering, and Medicine convened a virtual workshop series consisting of three webinars held on April 28, May 12, and June 30, 2022. This Proceedings highlights presentations and discussions from the workshop.

Patient-centered outcomes research (PCOR) studies consider the questions and outcomes that are meaningful to patients to compare the effectiveness of different prevention, diagnostic, and treatment options. PCOR also increases patient involvement in their care by providing them an opportunity to evaluate the quality, outcomes, and effectiveness of health care treatments and intervention, especially in areas where there is poor existing clinical evidence. The National Academies of Sciences, Engineering, and Medicine Board on Healthcare Services hosted a series of public workshops to explore ways of accelerating the use of PCOR findings in clinical practice to improve health and health care. Workshop discussions touched on the role of community health workers in helping care providers see and understand the whole picture of patient lives, the need for community engagement to ensure research is conducted and applied to practice equitably, and ways of measuring the impact of efforts to disseminate and implement new practices based on PCOR. This report summarizes the discussions that took place at these workshops.

Scholars, policymakers, and the public view police legitimacy and community trust in the police alike as essential components of an effective police organization. An extensive network of international and regional organizations, bilateral donors, international financial institutions, and civil society organizations aims to work with governments to improve policing practices and enhance police legitimacy. As a part of that network, the U.S. Department of State, through its Bureau of International Narcotics and Law Enforcement Affairs (INL), provides foreign assistance to and supports capacity building for criminal justice systems and police organizations in approximately 90 countries. Like many donors, it strives to direct its resources to the most effective approaches to achieve its mission. At the request of INL, the Committee on Law and Justice of the National Academies of Sciences, Engineering, and Medicine convened an ad hoc committee to review, assess, and reach consensus on existing evidence on policing institutions, police practices and capacities, and police legitimacy in the international context. The committee produced five reports, addressing questions of interest to INL and the State Department. Developing Policing Practices that Build Legitimacy, the fourth in this series, responds to the question: What policing practices build community trust and legitimacy in countries with low-to-moderate criminal justice sector capacity? This report focuses on the concept of legitimacy and ways of building legitimacy to foster this kind of trust and expectations.

Beginning with the 1990-1991 Gulf War, more than 3.7 million U.S. service members have been deployed to Southwest Asia, where they have been exposed to a number of airborne hazards, including oil-well fire smoke, emissions from open burn pits, dust and sand, diesel exhaust, and poor-quality ambient air. Many service members, particularly those who served in Iraq and Afghanistan, have reported health problems they attribute to their exposure to emissions from open-air burn pits on military installations. In 2013, Congress directed the Department of Veterans Affairs (VA) to establish and maintain the Airborne Hazards and Open Burn Pit (AH&OBP) Registry to "ascertain and monitor" the health effects of such exposures. This report serves as a follow-up to an initial assessment of the AH&OBP Registry completed by an independent committee of the National Academies in 2017. This reassessment does not include any strength-of-the-evidence assessments of potential relationships between exposures to burn pits or airborne hazards and health effects. Rather, this report assesses the ability of the registry to fulfill the intended purposes that Congress and VA have specified for it.

As part of its responsibilities under the Clean Air Act, the U.S. Environmental Protection Agency sets National Ambient Air Quality Standards (NAAQS) for the air pollutants carbon monoxide, lead, oxides of nitrogen, particulate matter, ozone, and sulfur dioxide. EPA uses a "weight of evidence approach" to evaluate evidence from scientific studies and describe the causal relationships between these "criteria pollutants" and any adverse impacts on human health and on public welfare - including impacts on wildlife, water, forests, agriculture, and climate. The evaluation, called an Integrated Science Assessment, is used to inform standards setting associated with the criteria pollutants. This report, produced at the request of EPA, describes EPAs and several other frameworks for inferring causality of health or welfare effects and the characteristics of evidence useful for forming a causal determination. The report concludes that EPAs causal framework is effective, reliable, and scientifically defensible, provided that key scientific questions are identified and a range of necessary expertise is engaged. More transparency in how EPA integrates evidence could improve confidence in their determinations, and more guidance is needed in the framework on how evidence should be examined for vulnerable groups (e.g., human sub-populations) and sensitive ecosystems or species.

"Transportation is the largest source of greenhouse gas emissions in the United States, with petroleum accounting for 90 percent of transportation fuels. Policymakers encounter a range of questions as they consider low-carbon fuel standards to reduce emissions, including total emissions released from production to use of a fuel or the potential consequences of a policy. Life-cycle assessment is an essential tool for addressing these questions. This report provides researchers and practitioners with a toolkit for applying life-cycle assessment to estimate greenhouse gas emissions, including identification of the best approach to use for a stated policy goal, how to reduce uncertainty and variability through verification and certification, and the core assumptions that can be applied to various fuel types. Policymakers should still use a tailored approach for each fuel type, given that petroleum-based ground, air, and marine transportation fuels necessitate different considerations than alternative fuels including biofuels, hydrogen, and electricity. Ultimately, life-cycle assessments should clearly document what assumptions and methods are used to ensure transparency."--

The staggering number of deaths and emergency department visits caused by firearm injuries has only grown with time. Costs associated with firearm related injuries amount to over a billion dollars annually in the United States alone, not including physician charges and postdischarge costs. To address this epidemic, in April of 2022, the National Academies of Sciences, Engineering, and Medicine's Board on Population Health and Public Health Practice, in collaboration with Northwell Heath and the PEACE Initiative, brought together firearm injury prevention thought leaders to explore how health systems can integrate interventions for firearm injury prevention into routine care for the purpose of improving the health of patients and communities. The workshop speakers discussed strategies for firearm injury and mortality prevention and its integration into routine care. Speakers also explored facilitators and barriers to implementation strategies, and how health systems might work to overcome those barriers.

Indigenous communities experience higher risks for suicide compared to the general U.S. population, with suicide as the second-leading cause of death among Indigenous children and young adults in North America. To reduce this trend, it is essential for prevention and intervention efforts to build on scientific evidence; cultural and local knowledge; and the best community, family, and institutional practices to reduce risk and increase protection. The Forum on Mental Health and Substance Use Disorders and the Forum for Children's Well-Being at the National Academies of Sciences, Engineering, and Medicine convened a three-part virtual public workshop on April 26, 2022, May 13, 2022, and June 10, 2022, to examine suicide risk and protective factors in Indigenous populations, discuss culturally appropriate and effective suicide prevention policies and programs, explore existing data systems and how data can be used for tracking suicide rates, and consider opportunities for action. This Proceedings highlights presentations and discussions from the workshop.

An estimated 10 percent of children in the United States are living with disabilities, including a disproportionate number of children living in poverty and children of marginalized racial and ethnic groups. During the pandemic, children with disabilities suffered disproportionately compared to their peers without disabilities. To learn more about what policies and practices might be sustained or implemented beyond the pandemic to support children with disabilities and their families, the Board on Children, Youth, and Families hosted a workshop on June 13-15, 2022. Workshop presenters included service providers, researchers, government leaders, youth with disabilities, and caregivers of children and youth with disabilities. In this workshop, practices were identified that could improve the system of care for children with disabilities as well as improve access to services for underserved and marginalized populations.

Adolescence is a crucial period of life for the prevention of substance use disorders. Research has shown that early intervention can significantly reduce rates of substance use disorder in adulthood. To learn more about effective family-focused interventions in primary care settings for preventing substance use disorder, the National Academies of Sciences, Engineering, and Medicine hosted a workshop on May 5-6, 2022. The proceedings from that workshop explores existing efforts to incorporate family-focused interventions into state health care policies. It also examines barriers to implementing such interventions as well as lessons learned from successful efforts to scale up these interventions.

The onset of COVID-19 pandemic and inundation of the U.S. health care system emphasized infrastructural and health professional education vulnerabilities. A planning committee of the National Academies of Sciences, Engineering, and Medicine Global Forum on Innovation in Health Professional Education conducted a series of public workshops in the fall of 2021 to explore whether students and trainees should be viewed as members of the health workforce, particular in times of emergency as was experienced during the COVID-19 public health crisis. The planning committee gathered educators, students, administrators, and health professionals to share ideas, experiences, and data to strategize expansion of learning opportunities for medical trainees and enhancement of medical preparedness to unforeseen crises without compromising the quality of patient care. The workshops explored issues such as identifying evidence on value-added roles for students to serve in the delivery of care and in a public health capacity, and balancing the role of learners as consumers (tuition payers) and not licensed providers versus members of the health workforce. This Proceedings highlights presentations and discussions from the workshop.

The Intelligence Community Studies Board of the National Academies of Sciences, Engineering, and Medicine convened a 2-day virtual workshop on December 17 and 21, 2021, to explore insights from world-class experts and technologists familiar with the extensive range of issues associated with anticipating rare events--those characterized by a very low probability of occurring--of major significance. Over the course of the 2-day workshop, the speakers discussed analytical methods, computational advances, data sources, and risk assessment approaches for anticipating rare events, including natural disasters, pandemics, anthropogenic threats, and widespread technological change. This proceedings is a factual summary of the presentations and discussion of the workshop.

"Climate change, driven by increases in human-produced greenhouse gases and particles (collectively referred to as GHGs), is the most serious environmental issue facing society. The need to reduce GHGs has become urgent as heat waves, heavy rain events, and other impacts of climate change have become more frequent and severe. Since the Paris Agreement was adopted in 2015, more than 136 countries, accounting for about 80% of total global GHG emissions, have committed to achieving net-zero emissions by 2050. A growing number of cities, regional governments, and industries have also made pledges to reduce emissions. Providing decision makers with useful, accurate, and trusted GHG emissions information is a crucial part of this effort. This report examines existing and emerging approaches used to generate and evaluate GHG emissions information at global to local scales. The report develops a framework for evaluating GHG emissions information to support and guide policy makers about its use in decision making. The framework identifies six criteria or pillars that can be used to evaluate and improve GHG emissions information: usability and timeliness, information transparency, evaluation and validation, completeness, inclusivity, and communication. The report recommends creating a coordinated repository or clearinghouse to operationalize the six pillars, for example, by providing timely, transparent, traceable information; standardized data formats; and governance mechanisms that are coordinated, trusted, and inclusive of the global community."--Publisher's website.