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. Table of Contents Front Matter 1 Introduction 2 Perspectives from Users, Manufacturers, and Distributors 3 Exploring the State of the Science and Potential Priorities for Research and Standards Development 4 Options for Post-Market Surveillance 5 Potential Next Steps and Priorities References Appendix A: Workshop Agenda Appendix B: Workshop Participants

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. Table of Contents Front Matter 2016 Letter Report Appendix A: Meeting Agendas Appendix B: Committee Biographical Sketches

The medical research landscape in the United States is supported by a variety of organizations that spend billions of dollars in government and private funds each year to seek answers to complex medical and public health problems. The largest government funder is the National Institutes of Health (NIH), followed by the Department of Defense (DoD). Almost half of DoD's medical research funding is administered by the Congressionally Directed Medical Research Programs (CDMRP). The mission of CDMRP is to foster innovative approaches to medical research in response to the needs of its stakeholders?the U.S. military, their families, the American public, and Congress. CDMRP funds medical research to be performed by other government and nongovernmental organizations, but it does not conduct research itself. The major focus of CDMRP funded research is the improved prevention, diagnosis, and treatment of diseases, injuries, or conditions that affect service members and their families, and the general public. The hallmarks of CDMRP include reviewing applications for research funding using a two-tiered review process, and involving consumers throughout the process. Evaluation of the Congressionally Directed Medical Research Programs Review Process evaluates the CDMRP two-tiered peer review process, its coordination of research priorities with NIH and the Department of Veterans Affairs, and provides recommendations on how the process for reviewing and selecting studies can be improved. Table of Contents Front Matter Summary 1 Introduction 2 Overview of the Congressionally Directed Medical Research Programs 3 Participants in the Review Process 4 Vision Setting and the Pre-Application Process 5 Peer Review 6 Programmatic Review 7 Coordination of Research Priorities 8 Findings and Recommendations References Appendix A: Committee Biographical Sketches Appendix B: Open Session Agendas

The decay product of the medical isotope molybdenum-99 (Mo-99), technetium-99m (Tc-99m), and associated medical isotopes iodine-131 (I-131) and xenon-133 (Xe-133) are used worldwide for medical diagnostic imaging or therapy. The United States consumes about half of the world's supply of Mo-99, but there has been no domestic (i.e., U.S.-based) production of this isotope since the late 1980s. The United States imports Mo-99 for domestic use from Australia, Canada, Europe, and South Africa. Mo-99 and Tc-99m cannot be stockpiled for use because of their short half-lives. Consequently, they must be routinely produced and delivered to medical imaging centers. Almost all Mo-99 for medical use is produced by irradiating highly enriched uranium (HEU) targets in research reactors, several of which are over 50 years old and are approaching the end of their operating lives. Unanticipated and extended shutdowns of some of these old reactors have resulted in severe Mo-99 supply shortages in the United States and other countries. Some of these shortages have disrupted the delivery of medical care. Molybdenum-99 for Medical Imaging examines the production and utilization of Mo-99 and associated medical isotopes, and provides recommendations for medical use. Table of Contents Front Matter Executive Summary Summary 1 Background and Study Task 2 Medical Isotope Production and Utilization 3 Global Production of Molybdenum-99 and Future Prospects 4 Progress Toward Establishing Domestic Production of Molybdenum-99 and Associated Medical Isotopes 5 Progress in Eliminating Highly Enriched Uranium and Remaining Obstacles 6 Molybdenum-99/Technetium-99m Historic and Projected Demand 7 Molybdenum-99/Technetium-99m Supply References Appendix A: The American Medical Isotopes Production Act of 2012 Appendix B: Committee and Staff Biographies Appendix C: Presentations and Site Visits Appendix D: List of Radiopharmaceuticals and Associated Codes Used in the Committee's Medicare Data and Nuclear Pharmacy Data Analyses Appendix E: Acronyms

On March 10-11, 2016, the National Academies of Sciences, Engineering, and Medicine held a public symposium on potential U.S. government policies for the oversight of gain-of- function (GOF) research. This was the Academies' second meeting held at the request of the U.S. government to provide a mechanism to engage the life sciences community and the broader public and solicit feedback on optimal approaches to ensure effective federal oversight of GOF research as part of a broader U.S. government deliberative process. The first symposium, held in December 2014, examined the underlying scientific and technical questions surrounding the potential risks and benefits of GOF research involving pathogens with pandemic potential. The second symposium focused on discussion of the draft recommendations regarding GOF research of a Working Group of the National Science Advisory Board for Biosecurity. This report summarizes the key issues and ideas identified during the second symposium. Table of Contents Front Matter 1 Introduction 2 The Draft National Science Advisory Board for Biosecurity Policy Framework, the Risk and Benefit Assessment, and Insights for the Policy Process 3 Issues for U.S. Policy 4 International Policy 5 Summing Up Bibliography Appendix A: Board and Committee Members of Collaborating Units Appendix B: Committee Biographies Appendix C: Symposium Agenda Appendix D: Speaker and Panelist Biographies Appendix E: List of Attendees

This book describes the many diverse experiences of a very active pediatrician from 1943 to 1988. This story begins when he started to medical school in 1943 and ends with his retirement thirty-seven years later in 1988. It includes post retirement stints as a Medical Director for a medical software company and being the Medical Director of a commercial plasma collecting center. He vividly describes many different and unusual medical cases including two true Miracles. One occurred in 1952 during the horrendous polio epidemic, "Connie" and the other one in the 1970's, "Thumbelina." These Miracles are described in detail with all of their agonizing twists and turns. Neither patient should have survived with their many complications and circumstances; but with God's grace they did. This book contains unusual and different exotic medical encounters when the author was in Japan in the Army Medical Corps in 1949-50. This book details why and how that he had to become a pseudo-specialist in his early and middle practice years. These fields included such as Neonatology, Endocrinology, Hematology, Nephrology Kidneys], Family Counseling, and fledgling field of Psychiatry. There were no trained specialist in these fields during those early years. Dr. Oberst portrays a full and productive professional life in many ways which are to describe. This book is an pleasant and interesting read for anyone to enjoy. It contains humor, vivid descriptions, happiness, agonies, and pathos.

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