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Active shooter drills have become a standard practice in nearly all U.S. schools, yet their potential impact on students and educators has received limited attention. School Active Shooter Drills: Mitigating Risks to Mental, Emotional, and Behavioral Health explores how these drills are conducted and how to reduce potential harm while supporting school safety. Developed by a committee of experts in education, school safety, public health, pediatrics, child and adolescent development, psychiatry, psychology, neuroscience, public policy, and criminology, this report provides an in-depth review of current practices and offers guidance. The report provides suggestions for implementing practices that promote prevention and preparedness while supporting well-being, and foster learning environments where students and staff feel safe, capable, and supported. School Active Shooter Drills finds that while drills aim to enhance preparedness, they often vary dramatically in intensity and design, f

Advances in biomedical science, data science, engineering, and technology are leading to high-pace innovation with potential to transform health and medicine. These innovations simultaneously raise important ethical and social issues, including how to fairly distribute their benefits and risks. The National Academies of Sciences, Engineering, and Medicine, in collaboration with the National Academy of Medicine, established the Committee on Creating a Framework for Emerging Science, Technology, and Innovation in Health and Medicine to provide leadership and engage broad communities in developing a framework for aligning the development and use of transformative technologies with ethical and equitable principles. The committees resulting report describes a governance framework for decisions throughout the innovation life cycle to advance equitable innovation and support an ecosystem that is more responsive to the needs of a broader range of individuals and is better able to recognize and

Racially and ethnically minoritized populations and tribal communities often face preventable inequities in health outcomes due to structural disadvantages and diminished opportunities around health care, employment, education, and more. Federal Policy to Advance Racial, Ethnic, and Tribal Health Equity analyzes how past and current federal policies may create, maintain, and/or amplify racial, ethnic, and tribal health inequities. This report identifies key features of policies that have served to reduce inequities and makes recommendations to help achieve racial, ethnic, and tribal health equity.

The assessment of risk is complex and often controversial. It is derived from the existence of a hazard, and it is characterized by the uncertainty of possible undesirable events and their outcomes. Few outcomes are as undesirable as nuclear war and nuclear terrorism. Over the decades, much has been written about particular situations, policies, and weapons that might affect the risks of nuclear war and nuclear terrorism. The nature of the concerns and the risk analysis methods used to evaluate them have evolved considerably over time. At the request of the Department of Defense, Risk Analysis Methods for Nuclear War and Nuclear Terrorism discusses risks, explores the risk assessment literature, highlights the strengths and weaknesses of risk assessment approaches, and discusses some publicly available assumptions that underpin U.S. security strategies, all in the context of nuclear war and nuclear terrorism.

The COVID-19 pandemic has had an unprecedented impact on the lives of children and their families, who have faced innumerable challenges such as illness and death; school closures; social isolation; financial hardship; food insecurity; deleterious mental health effects; and difficulties accessing health care. In almost every outcome related to social, emotional, behavioral, educational, mental, physical, and economic health and well-being, families identifying as Black, Latino, and Native American, and those with low incomes, have disproportionately borne the brunt of the negative effects of the pandemic. The effects of the COVID-19 pandemic on children and families will be felt for years to come. While these long-term effects are unknown, they are likely to have particularly significant implications for children and families from racially and ethnically minoritized communities and with low incomes. Addressing the Long-Term Effects of the COVID-19 Pandemic on Children and Families iden

Extreme weather and wildfires, intensified by climate change, are damaging the native plant communities of landscapes across the United States. Native plant communities are foundational to thriving ecosystems, delivering goods and services that regulate the environment and support life, provide food and shelter for a wide range of native animals, and embody a wealth of genetic information with many beneficial applications. Restoring impaired ecosystems requires a supply of diverse native plant seeds that are well suited to the climates, soils, and other living species of the system. This report examines the needs for native plant restoration and other activities, provides recommendations for improving the reliability, predictability, and performance of the native seed supply, and presents an ambitious agenda for action. An Assessment of Native Seed Needs and the Capacity for Their Supply considers the various challenges facing our natural landscapes and calls for a coordinated public-p

Historically Black Colleges and Universities (HBCUs) and other minority institutions (MIs) represent a valuable resource to expand the Department of Defense's (DoD) government and extramural workforce and science and technology enterprise. The more than 400 public and private HBCUs, Tribal Colleges and Universities, Hispanic-Serving Institutions, and other two- and four-year MIs are positioned to make strong and uniquely important contributions to the defense research enterprise, offering DoD an opportunity to widen its talent pool and diversify STEM research and ultimately strengthen its ability to support national security. Defense Research Capacity at Historically Black Colleges and Universities and Other Minority Institutions examines the status of DoD research at HBCUs and MIs, including the methods and means necessary to advance research capacity at these institutions in order to comprehensively address the national security and defense needs of the United States. This report off

Digital health encompasses a broad array of tools and strategies with the goals of advancing research, increasing health care access and quality, and making care more personalized. It encompasses health content, digital health interventions, and digital applications, such as communication tools connecting patients and clinicians (e.g., secure email in the patient portal, text, chat, video visit), remote monitoring tools, clinical decision support tools, and systems for exchanging health information. Patient-facing tools, tools for clinicians, and systems to facilitate research and care improvement are all part of this diverse landscape, and each raises unique opportunities and potential challenges. To examine key policy issues for the effective and safe development, implementation, and use of digital health technologies in oncology research and care, the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine held a virtual workshop in collaboratio

"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

A report that provides a summary and evaluation of several modeling approaches, and their theoretical and empirical underpinnings, relative to complex land-change dynamics and processes, and identifie

Resnick (health research and policy, U. of Illinois, Chicago) and Siegel (community health sciences, Boston U.) help public health students and practitioners in all levels of government and the privat

High school graduation and dropout rates have long been used as indicators of educational system productivity and effectiveness and of social and economic well being. While determining these rates may

From the National Research Council's Committee on Health, Environmental, and Other External Costs and Benefits of Energy Production and Consumption, this study reports on the external costs and benefi

"The technical and cultural boundaries between modeling, simulation, and games are increasingly blurring, providing broader access to capabilities in modeling and simulation and further credibility to

Modern transportation allows people, animals, and plants--and the pathogens they carry--to travel more easily than ever before. The ease and speed of travel, tourism, and international trade connect o

Behavioral Modeling and Simulation describes and assesses research efforts now underway to answer questions, using fundamental behavioral and social science knowledge and evolving modeling methods. I

Report examines genes, behavior, and the social environment. Topics include the impact of social and cultural environment on health; genetics and health; genetic, environmental, and personality dete

This report presents a framework and implementation strategy for translating public and professional concerns about medical performance and accountability into measures of health care quality, and arg

Policy Implications of International Graduate Students and Postdoctoral Scholars in the United States explores the role and impact of students and scholars on US educational institutions and the US ec

Written for both a lay and professional audience, this report discusses the many traditional cereals of sub-Saharan Africa and assesses their potential for expanding and diversifying African and world

The development of minimally invasive approaches to screen for multiple tumor types at one time could potentially improve health outcomes; however, the clinical utility of multicancer detection (MCD) testing has yet to be established. The National Academies National Cancer Policy Forum held a workshop in October 2024 to explore the current scientific understanding and clinical use of MCD testing, as well as implications for cancer care and outcomes for all patients.

The Scholarship of Teaching and Learning (SOTL) is a systematic and evidence-based approach to examining teaching and improving learning that is openly shared. In the summer and fall of 2024, the National Academies Global Forum on Innovation in Health Professional Education held a public workshop series exploring current and future applications of SOTL to health professional education and elevating its critical value for advancing health professional workforce development across the education to practice continuum. This Proceedings of a Workshop highlights the presentations and discussions that occurred at the workshop.

Chronic wasting disease (CWD) is a fatal, infectious prion disease affecting the central nervous system of some species of Cervidae-animals such as deer, elk, and moose. Recognized as a disease in the 1980s but suspected to have been present in the United States for decades longer, CWD affects both captive and free-ranging cervids and has been reported in 35 states and five Canadian provinces of North America as of August 1, 2024. The potential ramifications of the increasing spread of CWD are serious, and include negative impacts on ecosystems, and large economic costs for agencies with management responsibilities related to cervids and for industries that depend on cervids or cervid products. Cultural and food security impacts for communities with traditions tied to cervid hunting are also impacted. In 2020, Congress passed America's Conservation Enhancement (ACE) Act (P.L. 116-188), directing the U.S. Fish and Wildlife Service to lead a task force for addressing CWD in the United St

As the largest U.S. employer, the Department of Defense (DoD) is a major provider of training and development. Given the complex and increasingly unpredictable operational landscape within which the military operates across land, sea, air, cyberspace, and space, continuous learning is vital in the military. Military learners must acquire diverse skills, from communication to using advanced technology, and retain those skills for use when necessary. Success in learning - and the ability to retain and transfer what is learned to military missions - is directly linked with military innovation, operational success, and the success of our nation. Adult Learning in the Military Context examines motivations shaping learning, contextual and equity factors, emerging learning technologies, effective approaches to assessment, and provides a research agenda. This report highlights that adult learners are most motivated when learning aligns with personal goals but notes that military structures may

Despite decades of ongoing efforts to improve racial and ethnic diversity in clinical trials, many gaps remain in achieving demographic representation in clinical studies. In May 2024, the National Academies Forum on Drug Discovery, Development, and Translation, in collaboration with the National Cancer Policy Forum, hosted a public workshop to explore system-level changes and initiatives across organizations and sectors to improve representation, data collection, and reporting in clinical trials and progress tracking in the United States.

Engineering advances economic growth, enhances manufacturing capacity, enhances infrastructure resilience, improves healthcare, and strengthens national security. However, the impact of engineering research - and, by extension, engineering education - is often hidden from the public eye. Promoting comprehension of how engineering affects society is thus a crucial aspect of garnering and sustaining public backing of policies aimed at ensuring that technology continues to serve the greater good of humanity. One part of this effort is highlighting the pivotal role of federal support of engineering research. Such support furnishes researchers with the necessary resources to pursue ambitious projects, fostering exploration into fundamental questions, groundbreaking technology and engineered systems developments, and practical applications. Since its inception in 1950, the National Science Foundation (NSF)--an independent federal agency--has played a critical role in funding cutting-edge res

Infant formula is a primary or supplementary source of nutrition for many infants in the U.S. Consequently, disruptions to the supply of infant formula can have a severe impact on infants' health and well-being. In late 2021 and early 2022, a recall of specific infant formula products, followed by a pause in production, resulted in a widespread, national shortage. The incident demonstrated that additional risk management planning is needed to protect infants from the consequences of potential future supply chain disruptions. In 2023, the U.S. Food and Drug Administration contracted with the National Academies to convene an expert committee to examine and report on challenges in supply, market competition, and regulation of infant formula. The resulting consensus study report explains policy and marketplace vulnerabilities that were exposed during the shortage, describes the extent to which actions taken by relevant stakeholders addressed these vulnerabilities, identifies remaining gaps

Ocean Acoustics - the study of sound in the ocean, how it travels, interacts with, and is affected by its underwater surroundings - is a growing and critical field. Sound from both natural and human-generated sources can be an effective tool for probing the ocean environment. While the first applications of ocean acoustics began in the military, applications today encompass offshore energy production, national security, environmental monitoring, climate science, exploration and mapping, as well as fundamental ocean science. Even as demand for ocean acoustics grows, workforce development is challenged by both the multidisciplinary nature of the field and its widely varying career paths. Ocean acoustics may be housed in a diversity of departments in higher education institutions, and career paths and trajectory of formal education can range from the vocational/associates' level through the doctorate level. This report examines the state of ocean acoustics education; assesses expected dem

2023 marked the 10-year anniversary of the National Academies Institute of Medicine consensus report, "Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis." The National Cancer Policy Forum and the American Society of Clinical Oncology co-hosted a public workshop in October 2023 to provide an opportunity for the cancer community to gauge progress on the implementation of the report recommendations and to discuss persistent challenges in achieving excellent and equitable cancer care. Workshop speakers considered actions that could be taken to improve progress, as well as aspects of cancer care that have changed over the past decade and thus might require new strategies to advance the delivery of high-quality cancer care.

In 2018, the National Academies released Thriving on Our Changing Planet: A Decadal Strategy for Earth Observation from Space. The decadal survey identified key science questions and prioritized observational needs to advance U.S. efforts in Earth science and support critical applications such as climate modeling and weather prediction. In the past few years, the need for actionable data and better scientific information on Earth's interacting systems has increased in urgency, as global climate change accelerates coupled with increasing numbers of extreme weather events. At the request of NASA, this mid-term assessment evaluates progress and recommends actions to meet decadal survey priorities. This report explores ways that NASA's Earth Science Division can maintain programmatic balance, improve alignment with decadal survey priorities, and prepare for the next decadal survey.

Racial and ethnic inequities in health and health care impact individual well-being, contribute to millions of premature deaths, and cost the United States hundreds of billions of dollars annually. Addressing these inequities is vital to improving the health of the nation's most disadvantaged communities?and will also help to achieve optimal health for all. In 2003, the Institute of Medicine examined these inequities in Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Because disparities persist, the National Academies convened an expert committee with support from the Agency for Healthcare Research and Quality and the National Institutes of Health. The committee's report reviews the major drivers of health care disparities, provides insight into successful and unsuccessful interventions, identifies gaps in the evidence base, and makes recommendations to advance health equity.

On March 20 and 21, 2023, the Board on Science Education at the National Academies of Sciences, Engineering, and Medicine hosted a workshop titled Effective Health Communication within the Current Information Environment and the Role of the Federal Government. Workshop speakers and participants, a majority of whom were working in government agencies in federal health communication or leadership positions, joined both in person in Washington, D.C. as well as virtually to explore the current health information environment as it pertains to public trust and behavior change, explore how federal health agencies can communicate effectively within the current information environment and what is needed to support effective health communication moving forward. This publication summarizes the presentations and discussion of the workshop.

Population surveys collect information from participants by asking questions. Today, many surveys also collect biologic specimens that can be used to analyze a respondents DNA and other biomarkers. The National Health and Nutrition Examination Survey (NHANES) is a population survey that also administers a physical examination, collects biospecimens, and reports some test results (e.g., cholesterol levels) to the participant. While visiting communities large and small throughout the country, NHANES collects health and nutrition data from a representative sample of individuals through in-person interviews and health examinations that take place at special mobile examination centers. The examination component consists of medical, dental, and physiological examinations, as well as laboratory tests. On December 2, 7, and 8, 2022, a workshop was convened to focus on anticipated future collections of genomic data by NHANES. The 2022 workshop explored ethical considerations and current practic

While there is a limited data on safety-sensitive professionals, substance use disorders potentially affect pilots and flight attendants at the same rate as the general population - around 15 percent - but due to the high-risk nature of their jobs, aircraft operators are held to a higher standard for substance misuse on the job. To protect the safety of the public and the aviation workforce, the Human Intervention Motivation Study (HIMS) and the Flight Attendant Drug and Alcohol Program (FADAP) were launched to help treat critical aviation workers - pilots and flight attendants, respectively - who misuse substances. In response to a congressional mandate, this new report reviews available evidence on the effectiveness of HIMS and FADAP and offers recommendations for improving these programs.

The world confronts an existential challenge in responding to climate change, resulting in an urgent need to reduce greenhouse gas emissions from all sectors of the economy. What will it take for new and advanced nuclear reactors to play a role in decarbonization? Nuclear power provides a significant portion of the worlds low-carbon electricity, and advanced nuclear technologies have the potential to be smaller, safer, less expensive to build, and better integrated with the modern grid. However, if the United States wants advanced nuclear reactors to play a role in its plans for decarbonization, there are many key challenges that must be overcome at the technical, economic, and regulatory levels. Laying the Foundation for New and Advanced Nuclear Reactors in the United States discusses how the United States could support the successful commercialization of advanced nuclear reactors with a set of near-term policies and practices. The recommendations of this report address the need to cl

Much of the statistical information currently produced by federal statistical agencies - information about economic, social, and physical well-being that is essential for the functioning of modern society - comes from sample surveys. In recent years, there has been a proliferation of data from other sources, including data collected by government agencies while administering programs, satellite and sensor data, private-sector data such as electronic health records and credit card transaction data, and massive amounts of data available on the internet. How can these data sources be used to enhance the information currently collected on surveys, and to provide new frontiers for producing information and statistics to benefit American society? Toward a 21st Century National Data Infrastructure: Enhancing Survey Programs by Using Multiple Data Sources, the second report in a series funded by the National Science Foundation, discusses how use of multiple data sources can improve the quality

COVID-19 has proven among the worst public health crises in a generation. Public health emergencies (PHE) have always been anticipated. Despite the growing field of PHE preparedness and planning since the turn of the twenty-first century and the preparedness plans and exercises developed, the U.S. experienced a suboptimal national response to the emergence of COVID-19 in early 2020 compared to other countries. To explore the U.S. PHE preparedness enterprise, the National Academies Forum on Medical and Public Health Preparedness for Disasters and Emergencies convened a workshop in May 2022. They invited participants from government, NGO, and private sector organizations to consider key components, success stories, and failure points in order to identify opportunities for more effective catastrophic disaster, pandemic, and other large scale PHEs planning at the federal, state, local, tribal, and territorial levels. This Proceedings of a Workshop summarizes the discussions held during the

Over the past century, the Everglades has been dramatically altered by drainage and water management infrastructure intended to improve flood management, urban water supply, and agricultural production. Less than half of the original Everglades remain, and these remnants compete for water with urban and agricultural interests, all the while being impaired by contaminated runoff. The Comprehensive Everglades Restoration Plan (CERP) was established in 2000 as a joint effort by the state and federal government to reverse the decline of the ecosystem. The multibillion project aims to restore the ecosystem over the course of 30 to 40 years by reestablishing the natural hydrological characteristics of the Everglades where feasible and ultimately creating a water system that serves both the natural and human needs of South Florida. Since 2004, a National Academies committee has provided a series of independent, peer-reviewed assessments of CERP progress. Implementation of CERP projects has oc

The United States has a complex system of laws and policies that attempt to regulate the distribution, manufacture, and use of a variety of non-legal drug substances as part of its overall criminal justice system. Laws regarding drug use have disproportionately impacted individuals and communities of color at every step of the journey through the criminal justice system, including arrest, conviction, sentencing, and incarceration. These disparities have clear outcomes for both individual and community health. To examine the effects of drug control policies on the health of individuals and communities of color, the Roundtable on the Promotion of Health Equity held a workshop on October 8, 2018, in Washington, DC. This publication summarizes the presentations and discussions of the workshop.

To examine the potential role of companion animals as sentinels of relevant, shared environmental exposures that may affect human aging and cancer, the National Cancer Policy Forum held a workshop in collaboration with the Forum on Aging, Disability, and Independence and the Standing Committee on the Use of Emerging Science for Environmental Health Decisions to explore this promising and underutilized pathway for research. Presentations and panel discussions covered the current state of the science and pathways for accelerating research, along with opportunities and challenges for using this novel translational approach to exposure science to advance human health. This Proceedings of a Workshop outlines the presentations and discussions that occurred during the workshop.