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

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

Protecting 18 million United States health care workers from infectious agents - known and unknown - involves a range of occupational safety and health measures that include identifying and using appropriate protective equipment. The 2009 H1N1 influenza pandemic and the 2014 Ebola virus outbreak in West Africa have called raised questions about how best to ensure appropriate and effective use of different kinds of personal protective equipment such as respirators, not only to promote occupational safety but also to reduce disease transmission. The Use and Effectiveness of Powered Air Purifying Respirators in Health Care is the summary of a workshop convened by the Institute of Medicine Standing Committee on Personal Protective Equipment for Workplace Safety and Health to explore the current state of practices and research related to powered air purifying respirator (PAPRs) and potential updates to performance requirements. Presentations and discussions highlighted current health care practices using PAPRs and outlined the research to date on the use and effectiveness of PAPRs in health care settings with a focus on the performance requirements. The Use and Effectiveness of Powered Air Purifying Respirators in Health Care focuses on efficacy, current training, maintenance, supplies, and possible enhancements and barriers to use in inpatient, clinic, nursing home, and community (home) settings. This report also explores the strengths and weaknesses of using various approaches to health care PAPR standards. Table of Contents Front Matter 1 Introduction 2 Defining PAPRs and Current Standards 3 Why, Where, and How PAPRs Are Being Used in Health Care 4 Research and Design Perspectives 5 Priorities and Opportunities for Improving PAPRs for Use in Health Care References Appendix A: Agenda Appendix B: Registered Attendees

Review of NASA's Evidence Reports on Human Health Risks 2014 Letter Report is the second in a series of five reports from the Institute of Medicine that will independently review more than 30 evidence reports that the National Aeronautics and Space Administration has compiled on human health risks for long-duration and exploration space flights. This report builds on the 2008 IOM report Review of NASA's Human Research Program Evidence Books: A Letter Report, which provided an initial and brief review of the evidence reports. This letter report reviews seven 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. The report analyzes each evidence report's overall quality, which included readability; internal consistency; the source and breadth of cited evidence; identification of existing knowledge and research gaps; authorship expertise; and, if applicable, response to recommendations from the 2008 IOM letter report. Table of Contents Front Matter Review of NASA's Evidence Reports on Human Health Risks: 2014 Letter Report References Appendix A: Meeting Agendas Appendix B: Committee Biographical Sketches

Since its inception, the U.S. human spaceflight program has grown from launching a single man into orbit to an ongoing space presence involving numerous crewmembers. As the U.S. space program evolves, propelled in part by increasing international and commercial collaborations, long duration or exploration spaceflights - such as extended stays on the International Space Station or missions to Mars - become more realistic. These types of missions will likely expose crews to levels of known risk that are beyond those allowed by current health standards, as well as to a range of risks that are poorly characterized, uncertain, and perhaps unforeseeable. As the National Aeronautics and Space Administration (NASA) and Congress discuss the next generation of NASA's missions and the U.S. role in international space efforts, it is important to understand the ethical factors that drive decision making about health standards and mission design for NASA activities. NASA asked the Institute of Medicine to outline the ethics principles and practices that should guide the agency's decision making for future long duration or exploration missions that fail to meet existing health standards. Health Standards for Long Duration and Exploration Spaceflight identifies an ethics framework, which builds on the work of NASA and others, and presents a set of recommendations for ethically assessing and responding to the challenges associated with health standards for long duration and exploration spaceflight.As technologies improve and longer and more distant spaceflight becomes feasible, NASA and its international and commercial partners will continue to face complex decisions about risk acceptability. This report provides a roadmap for ethically assessing and responding to the challenges associated with NASA's health standards for long duration and exploration missions. Establishing and maintaining a firmly grounded ethics framework for this inherently risky activity is essential to guide NASA's decisions today and to create a strong foundation for decisions about future challenges and opportunities. Table of Contents Front Matter Summary 1 Introduction 2 NASA Risk Management and Health Standards 3 Health Risks 4 Risk Acceptance and Responsibilities in Human Spaceflight and Terrestrial Activities 5 Recommendations for Ethics Principles 6 Recommendations for Ethics Responsibilities and Decision Framework Appendix A: Meeting Agendas Appendix B: Committee Biographical Sketches

Protecting the health and safety of health care workers is vital to the health of each of us. Preparing for and responding to a future influenza pandemic or to a sustained outbreak of an airborne transmissible disease requires a high-level commitment to respiratory protection for health care workers across the wide range of settings in which they work and the jobs that they perform. Keeping health care workers healthy is an ethical commitment both in terms of addressing the occupational risks faced by health care workers and of providing for the continuity of patient care and services needed to maintain the health of individuals and communities. During a public health emergency, challenges will arise concerning the availability of respiratory protective devices (i.e., respirators). Reusable respirators (specifically, reusable half-facepiece elastomeric respirators) are the standard respiratory protection device used in many industries, and they provide an option for use in health care that has to date not been fully explored. The durability and reusability of elastomeric respirators make them desirable for stockpiling for emergencies, where the need for large volumes of respirators can be anticipated. However, they are used infrequently in health care. Reusable Elastomeric Respirators in Health Care explores the potential for the use of elastomeric respirators in the U.S. health care system with a focus on the economic, policy, and implementation challenges and opportunities. This report examines the practicability of elastomeric use in health care on a routine basis and during an influenza pandemic or other large aerosol-transmissible outbreak, when demand for respiratory protective devices by U.S. health care personnel may be larger than domestic supplies. The report also addresses the issues regarding emergency stockpile management of elastomeric respiratory protective devices. Table of Contents Front Matter Summary 1 Introduction 2 Elastomeric Respirators 3 Implementing Reusable Elastomeric Respirators in Health Care Settings: Routine and Surge Use 4 Research and Development 5 Next Steps and Recommendations Appendix A: Meeting Agendas Appendix B: Committee Biographical Sketches

The organ donation and transplantation system strives to honor the gift of donated organs by fully using those organs to save and improve the quality of the lives of their recipients. However, there are not enough donated organs to meet the demand and some donated organs may not be recovered, some recovered organs may not be transplanted, and some transplanted organs may not function adequately. Organ donor intervention research can test and assess interventions (e.g., medications, devices, and donor management protocols) to maintain or improve organ quality prior to, during, and following transplantation. The intervention is administered either while the organ is still in the deceased donor or after it is recovered from the donor but before it is transplanted into a recipient. Organ donor intervention research presents new challenges to the organ donation and transplantation community because of ethical questions about who should be considered a human subject in a research study, whose permission and oversight are needed, and how to ensure that such research does not threaten the equitable distribution of a scarce and valuable resource. Opportunities for Organ Donor Intervention Research focuses on the ethical, legal, regulatory, policy, and organizational issues relevant to the conduct of research in the United States involving deceased organ donors. This report provides recommendations for how to conduct organ donor intervention research in a manner that maintains high ethical standards, that ensures dignity and respect for deceased organ donors and their families, that provides transparency and information for transplant candidates who might receive a research organ, and that supports and sustains the public's trust in the process of organ donation and transplantation. Table of Contents Front Matter Summary 1 Introduction 2 Ethical Framework 3 Legal, Regulatory, and Policy Frameworks for Organ Donation and Research Participation 4 Research Approval, Implementation, and Oversight: Ensuring Quality and Trust Appendix A: Meeting Agendas Appendix B: Committee Biographical Sketches

The loss of hearing - be it gradual or acute, mild or severe, present since birth or acquired in older age - can have significant effects on one's communication abilities, quality of life, social participation, and health. Despite this, many people with hearing loss do not seek or receive hearing health care. The reasons are numerous, complex, and often interconnected. For some, hearing health care is not affordable. For others, the appropriate services are difficult to access, or individuals do not know how or where to access them. Others may not want to deal with the stigma that they and society may associate with needing hearing health care and obtaining that care. Still others do not recognize they need hearing health care, as hearing loss is an invisible health condition that often worsens gradually over time. In the United States, an estimated 30 million individuals (12.7 percent of Americans ages 12 years or older) have hearing loss. Globally, hearing loss has been identified as the fifth leading cause of years lived with disability. Successful hearing health care enables individuals with hearing loss to have the freedom to communicate in their environments in ways that are culturally appropriate and that preserve their dignity and function. Hearing Health Care for Adults focuses on improving the accessibility and affordability of hearing health care for adults of all ages. This study examines the hearing health care system, with a focus on non-surgical technologies and services, and offers recommendations for improving access to, the affordability of, and the quality of hearing health care for adults of all ages. Table of Contents Front Matter Summary 1 Introduction 2 Hearing Loss: Extent, Impact, and Research Needs 3 Hearing Health Care Services: Improving Access and Quality 4 Hearing Technologies: Expanding Options 5 Improving Affordability of Services and Technologies 6 Engaging a Wider Community: Awareness, Education, and Support 7 Opportunities for Action Appendix A: Meeting Agendas Appendix B: Committee Biographies

Review of NASA's Evidence Reports on Human Health Risks 2015 Letter Report is the third in a series of five reports from the Institute of Medicine that will independently review more than 30 evidence reports that the National Aeronautics and Space Administration has compiled on human health risks for long-duration and exploration space flights. This report builds on the 2008 IOM report Review of NASA's Human Research Program Evidence Books: A Letter Report, which provided an initial and brief review of the evidence reports. This letter report reviews seven 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. The report analyzes each evidence report's overall quality, which included readability; internal consistency; the source and breadth of cited evidence; identification of existing knowledge and research gaps; authorship expertise; and, if applicable, response to recommendations from the 2008 IOM letter report. Table of Contents Front Matter 2015 Letter Report References Appendix A: Meeting Agendas Appendix B: Committee Biographical Sketches

The question of whether and under what circumstances terminally ill patients should be able to access life-ending medications with the aid of a physician is receiving increasing attention as a matter of public opinion and of public policy. Ethicists, clinicians, patients, and their families debate whether physician-assisted death ought to be a legal option for patients. While public opinion is divided and public policy debates include moral, ethical, and policy considerations, a demand for physician-assisted death persists among some patients, and the inconsistent legal terrain leaves a number of questions and challenges for health care providers to navigate when presented with patients considering or requesting physician-assisted death. To discuss what is known and not known empirically about the practice of physician-assisted death, the National Academies of Sciences, Engineering, and Medicine convened a 2-day workshop in Washington, DC, on February 12?13, 2018. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 Conceptual, Legal, and Ethical Considerations in Physician-Assisted Death 3 Experiences with and Reflections on Physician-Assisted Death in the United States 4 Experiences with and Reflections on Physician-Assisted Death Internationally 5 Implementation and Practice of Physician-Assisted Death 6 Physician-Assisted Death in the Context of Long-Term Services and Supports, Palliative Care, and Hospice 7 Reflections on the Workshop and Evidentiary Gaps Appendix A: Workshop Agenda Appendix B: Biographical Sketches of Workshop Speakers and Planning Committee Members

For most Americans, staying "mentally sharp" as they age is a very high priority. Declines in memory and decision-making abilities may trigger fears of Alzheimer's disease or other neurodegenerative diseases. However, cognitive aging is a natural process that can have both positive and negative effects on cognitive function in older adults - effects that vary widely among individuals. At this point in time, when the older population is rapidly growing in the United States and across the globe, it is important to examine what is known about cognitive aging and to identify and promote actions that individuals, organizations, communities, and society can take to help older adults maintain and improve their cognitive health. Cognitive Aging assesses the public health dimensions of cognitive aging with an emphasis on definitions and terminology, epidemiology and surveillance, prevention and intervention, education of health professionals, and public awareness and education. This report makes specific recommendations for individuals to reduce the risks of cognitive decline with aging. Aging is inevitable, but there are actions that can be taken by individuals, families, communities, and society that may help to prevent or ameliorate the impact of aging on the brain, understand more about its impact, and help older adults live more fully and independent lives. Cognitive aging is not just an individual or a family or a health care system challenge. It is an issue that affects the fabric of society and requires actions by many and varied stakeholders. Cognitive Aging offers clear steps that individuals, families, communities, health care providers and systems, financial organizations, community groups, public health agencies, and others can take to promote cognitive health and to help older adults live fuller and more independent lives. Ultimately, this report calls for a societal commitment to cognitive aging as a public health issue that requires prompt action across many sectors. Table of Contents Front Matter Summary 1 Introduction 2 Characterizing and Assessing Cognitive Aging 3 Population-Based Information About Cognitive Aging 4A Risk and Protective Factors and Interventions: Lifestyle and Physical Environment 4B Risk and Protective Factors and Interventions: Health and Medical Factors 4C Risk and Protective Factors and Interventions: General Cognitive Aging Interventions and Next Steps 5 Health Care Response to Cognitive Aging 6 Community Action: Health, Financial Management, Driving, Technology, and Consumer Decisions 7 Public Education and Key Messages 8 Opportunities for Action Appendix A: Meeting Agendas Appendix B: U.S. Surveys and Studies That Include One or More Items to Measure Cognition Appendix C: Committee Biographies

The men and women who served in the Gulf War theater were potentially exposed to a wide range of biological and chemical agents. Gulf War and Health: Volume 1 assesses the scientific literature concerning the association between these agents and the adverse health effects currently experienced by a large number of veterans. Table of Contents Front Matter Executive Summary 1 Introduction 2 Illnesses in Gulf War Veterans 3 Methodology 4 Depleted Uranium 5 Sarin 6 Pyridostigmine Bromide 7 Vaccines 8 Research Recommendations Appendix A: Scientific Workshop Agenda Appendix B: Public Meeting Agendas Appendix C: Methods of Identifying and Collecting the Literature Appendix D: Gulf War Illnesses and Recognizing New Diseases Appendix E: Effects of Long-Term Exposure to Organophosphate Pesticides in Humans Appendix F: Acronyms and Abbreviations Index

The remarkable increase in the prevalence of obesity among children and youth in the United States over a relatively short timespan represents one of the defining public health challenges of the 21st century. The country is beginning to recognize childhood obesity as a major public health epidemic that will incur substantial costs to the nation. However, the current level of investment by the public and private sectors still does not match the extent of the problem. There is a substantial underinvestment of resources to adequately address the scope of this obesity crisis. At this early phase in addressing the epidemic, actions have begun on a number of levels to improve the dietary patterns and to increase the physical activity levels of young people. Schools, corporations, youth-related organizations, families, communities, foundations, and government agencies are working to implement a variety of policy changes, new programs, and other interventions. These efforts, however, generally remain fragmented and small in scale. Moreover, the lack of systematic monitoring and evaluation of interventions have hindered the development of an evidence base to identify, apply, and disseminate lessons learned and to support promising efforts to prevent childhood obesity. Progress in Preventing Childhood Obesity: How Do We Measure Up? examines the progress made by obesity prevention initiatives in the United States from 2004 to 2006. This book emphasizes a call to action for key stakeholders and sectors to commit to and demonstrate leadership in childhood obesity prevention, evaluates all policies and programs, monitors their progress, and encourages stakeholders to widely disseminate promising practices. This book will be of interest to federal, state, and local government agencies; educators and schools; public health and health care professionals; private-sector companies and industry trade groups; media; parents; and those involved in implementing community-based programs and consumer advocacy. Table of Contents Front Matter Summary 1 Introduction 2 Framework for Evaluating Progress 3 Diverse Populations 4 Government 5 Industry 6 Communities 7 Schools 8 Home 9 Assessing the Nation\'s Progress in Preventing Childhood Obesity Appendix A Acronyms Appendix B Glossary Appendix C Surveillance and Monitoring Activities Appendix D Examples of Recent Federal Agency Programs, Initiatives, and Surveillance Systems for Supporting and Monitoring the Prevention of Obesity in U.S. Children and Youth Appendix E Compilation of Recommendations and Implementation Actions Appendix F IOM Regional Symposium Progress in Preventing Childhood Obesity: Focus on Schools Appendix G IOM Regional Symposium Progress in Preventing Childhood Obesity: Focus on Communities Appendix H IOM Regional Symposium Progress in Preventing Childhood Obesity: Focus on Industry Appendix I Biographical Sketches Index

Rates of organ donation lag far behind the increasing need. At the start of 2006, more than 90,000 people were waiting to receive a solid organ (kidney, liver, lung, pancreas, heart, or intestine). Organ Donation examines a wide range of proposals to increase organ donation, including policies that presume consent for donation as well as the use of financial incentives such as direct payments, coverage of funeral expenses, and charitable contributions. This book urges federal agencies, nonprofit groups, and others to boost opportunities for people to record their decisions to donate, strengthen efforts to educate the public about the benefits of organ donation, and continue to improve donation systems. Organ Donation also supports initiatives to increase donations from people whose deaths are the result of irreversible cardiac failure. This book emphasizes that all members of society have a stake in an adequate supply of organs for patients in need, because each individual is a potential recipient as well as a potential donor. Table of Contents Front Matter Summary 1 Introduction 2 Trends and Patterns 3 Perspectives and Principles 4 Systems To Support Organ Donation 5 Expanding The Population of Potential 6 Promoting and Facilitating Individual and Family Decisions to Donate 7 Presumed Consent 8 Incentives for Deceased Donation 9 Ethical Considerations In Living Donation 10 Opportunities for Action Appendix A Acronyms Appendix B Workshop Meetings Appendix C First-Person Consent Status and Organ Donor Registry Participation Appendix D Quantifying Self-Interest in Organ Donation Appendix E HRSA's Extramural Research Program Appendix F Washington Hospital Center: Protocol for the Rapid Organ Recovery Program, Transplantation Services Appendix G Committee and Staff Biographies Index

Injuries are the leading cause of death and disability among people under age 35 in the United States. Despite great strides in injury prevention over the decades, injuries result in 150,000 deaths, 2.6 million hospitalizations, and 36 million visits to the emergency room each year. Reducing the Burden of Injury describes the cost and magnitude of the injury problem in America and looks critically at the current response by the public and private sectors, including: Data and surveillance needs. Research priorities. Trauma care systems development. Infrastructure support, including training for injury professionals. Firearm safety. Coordination among federal agencies. The authors define the field of injury and establish boundaries for the field regarding intentional injuries. This book highlights the crosscutting nature of the injury field, identifies opportunities to leverage resources and expertise of the numerous parties involved, and discusses issues regarding leadership at the federal level. Table of Contents Front Matter Executive Summary 1 The Injury Field 2 Magnitude and Cost 3 Surveillance and Data 4 Prevention Research 5 Case Studies on Prevention 6 Trauma Care 7 State and Community Response 8 Federal Response 9 Challenges and Opportunities Appendix A: Acknowledgments Appendix B: Timeline Appendix C: Public Meeting Agenda Appendix D: Acronyms Index

Children's health has made tremendous strides over the past century. In general, life expectancy has increased by more than thirty years since 1900 and much of this improvement is due to the reduction of infant and early childhood mortality. Given this trajectory toward a healthier childhood, we begin the 21st-century with a shocking development?an epidemic of obesity in children and youth. The increased number of obese children throughout the U.S. during the past 25 years has led policymakers to rank it as one of the most critical public health threats of the 21st-century. Preventing Childhood Obesity provides a broad-based examination of the nature, extent, and consequences of obesity in U.S. children and youth, including the social, environmental, medical, and dietary factors responsible for its increased prevalence. The book also offers a prevention-oriented action plan that identifies the most promising array of short-term and longer-term interventions, as well as recommendations for the roles and responsibilities of numerous stakeholders in various sectors of society to reduce its future occurrence. Preventing Childhood Obesity explores the underlying causes of this serious health problem and the actions needed to initiate, support, and sustain the societal and lifestyle changes that can reverse the trend among our children and youth. Table of Contents Front Matter Executive Summary 1 Introduction 2 Extent and Consequences of Childhood Obesity 3 Developing An Action Plan 4 A National Public Health Priority 5 Industry, Advertising, Media, and Public Education 6 Local Communities 7 Schools 8 Home 9 Confronting the Childhood Obesity Epidemic Appendix A: Acronyms Appendix B: Glossary Appendix C: Literature Review Appendix D: Lessons Learned from Public Health Efforts and Their Relevance to Preventing Childhood Obesity Appendix E: Workshop Programs Appendix F: Biographical Sketches Index

In 2006 the National Institutes of Health (NIH) established the Clinical and Translational Science Awards (CTSA) Program, recognizing the need for a new impetus to encourage clinical and translational research. At the time it was very difficult to translate basic and clinical research into clinical and community practice; making it difficult for individual patients and communities to receive its benefits. Since its creation the CTSA Program has expanded, with 61 sites spread across the nation's academic health centers and other institutions, hoping to provide catalysts and test beds for policies and practices that can benefit clinical and translation research organizations throughout the country. The NIH contracted with the Institute of Medicine (IOM) in 2012 to conduct a study to assess and provide recommendations on appropriateness of the CTSA Program's mission and strategic goals and whether changes were needed. The study was also address the implementation of the program by the National Center for Advancing Translational Sciences (NCATS) while exploring the CTSA's contributions in the acceleration of the development of new therapeutics. A 13-member committee was established to head this task; the committee had collective expertise in community outreach and engagement, public health and health policy, bioethics, education and training, pharmaceutical research and development, program evaluation, clinical and biomedical research, and child health research. The CTSA Program at NIH: Opportunities for Advancing Clinical and Translational Research is the result of investigations into previous program evaluations and assessments, open-session meetings and conference class, and the review of scientific literature. Overall, the committee believes that the CTSA Program is significant to the advancement of clinical and translational research through its contributions. The Program would benefit from a variety of revisions, however, to make it more efficient and effective. Table of Contents Front Matter Summary 1 Introduction 2 A Vision for the CTSA Program in a Changing Landscape 3 Leadership 4 Crosscutting Topics 5 Conclusion: Opportunities for Action Appendix A: Data Sources and Methods Appendix B: Committee Biographical Sketches

At the request of NASA, an IOM committee reviewed NASA Human Research Program's (HRP's) Scientific Merit Assessment Processes for directed research. Directed research is commissioned or noncompetitively awarded research that is not competitively solicited because of specific reasons, such as time limitations or highly focused or constrained research topics. The scientific merit assessment processes have been developed by NASA to evaluate individual directed research tasks in order to ensure the scientific integrity of the HRP's directed research portfolio. The committee examined the HRP's current scientific merit assessment processes and conducted a public workshop to identify best practices among other federal agencies that use various assessment processes for similar types of directed research. Review of NASA Human Research Program's Scientific Merit Processes: Letter Report finds that the scientific merit assessment process used by the HRP for directed research is scientifically rigorous and is similar to the processes and merit criteria used by many other federal agencies and organizations - including the Department of Defense, National Institutes of Health, and the United States Department of Agriculture - for comparable types of research. This report also makes recommendations on ways to streamline and bolster the accountability and transparency of NASA's current processes. Table of Contents Front Matter Letter Report REFERENCES Appendix A: Workshop Agenda and List of Participants Appendix B: Committee Biosketches

When you purchase a product, you expect it to work. Construction workers on high-rise buildings need to be confident that their safety harnesses will arrest a fall. Firefighters need to know that their gloves and other protective equipment can withstand high temperatures. Healthcare workers administering highly toxic chemotherapy agents need to know that their gloves will withstand penetration. For personal protective technologies (PPT)-where the major purpose of the product is to protect the wearer against a hazard-a deficit in product effectiveness can mean injury, illness, or death. Examining the extent to which products meet specific performance or design criteria is the focus of conformity assessment efforts. For PPT conformity assessment, the ultimate goal is preventing worker illness, injury, or death from hazardous working conditions. Certifying Personal Protective Technologies focuses on conformity assessment for occupational PPT-ensuring that PPT are effective in preventing or reducing hazardous exposures or situations that workers face in their jobs. Because respirators already have an extensive testing and conformity assessment process in place, this book specifically addresses conformity assessment processes for other types of PPT, including eye and face protection, gloves, hearing protectors, and protective clothing. Table of Contents Front Matter Summary 1 Introduction 2 Role of Government Agencies in Conformity Assessment 3 Current PPT Conformity Assessment Processes 4 Impact and Issues in Conformity Assessment for PPT 5 Conformity Assessment for Non-Respirator PPT: A Risk-Based Framework 6 Findings and Recommendations 7 Toward a Comprehensive Approach to Safe and Effective PPT for Workers Appendix A: Agendas of Public Meetings Appendix B: Workshop Participants Appendix C: Biographical Sketches of Committee Members

Review of NASA's Evidence Reports on Human Health Risks: 2013 Letter Report is the first in a series of five reports from the Institute of Medicine that will independently review more than 30 evidence reports that the National Aeronautics and Space Administration has compiled on human health risks for long-duration and exploration space flights. This report builds on the 2008 IOM report Review of NASA's Human Research Program Evidence Books: A Letter Report, which provided an initial and brief review of the evidence reports. This letter report reviews three 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. The report analyzes each evidence report's overall quality, which included readability; internal consistency; the source and breadth of cited evidence; identification of existing knowledge and research gaps; authorship expertise; and, if applicable, response to recommendations from the 2008 IOM letter report. Table of Contents Front Matter Review of NASA's evidence reports on human health risks: 2013 letter report. References Appendix A: Meeting Agendas Appendix B: Committee Biosketches

Although epilepsy is one of the nation's most common neurological disorders, public understanding of it is limited. Many people do not know the causes of epilepsy or what they should do if they see someone having a seizure. Epilepsy is a complex spectrum of disorders that affects an estimated 2.2 million Americans in a variety of ways, and is characterized by unpredictable seizures that differ in type, cause, and severity. Yet living with epilepsy is about much more than just seizures; the disorder is often defined in practical terms, such as challenges in school, uncertainties about social situations and employment, limitations on driving, and questions about independent living. The Institute of Medicine was asked to examine the public health dimensions of the epilepsies, focusing on public health surveillance and data collection; population and public health research; health policy, health care, and human services; and education for people with the disorder and their families, health care providers, and the public. In Epilepsy Across the Spectrum, the IOM makes recommendations ranging from the expansion of collaborative epilepsy surveillance efforts, to the coordination of public awareness efforts, to the engagement of people with epilepsy and their families in education, dissemination, and advocacy for improved care and services. Taking action across multiple dimensions will improve the lives of people with epilepsy and their families. The realistic, feasible, and action-oriented recommendations in this report can help enable short- and long-term improvements for people with epilepsy. For all epilepsy organizations and advocates, local, state, and federal agencies, researchers, health care professionals, people with epilepsy, as well as the public, Epilepsy Across the Spectrum is an essential resource. Table of Contents Front Matter Summary 1 Introduction 2 Surveillance, Measurement, and Data Collection 3 Epidemiology and Prevention 4 Health Care: Quality, Access, and Value 5 Health Professional Education 6 Quality of Life and Community Resources 7 Educating People with Epilepsy and Their Families 8 Public Education and Awareness 9 Next Steps and Recommendations Appendix A: Workshop Agendas Appendix B: IOM Data-Gathering Effort Appendix C: Data on Specialized Epilepsy Centers: Report to the Institute of Medicine's Committee on the Public Health Dimensions of the Epilepsies Appendix D: Health Professionals Who Care for People with Epilepsy: Possible Roles and Relevant Boards and Organizations Appendix E: Committee Biographies

Each year in the United States, more than 4,000 occupational fatalities and more than 3 million occupational injuries occur along with more than 160,000 cases of occupational illnesses. Incorporating patients' occupational information into electronic health records (EHRs) could lead to more informed clinical diagnosis and treatment plans as well as more effective policies, interventions, and prevention strategies to improve the overall health of the working population. At the request of the National Institute for Occupational Safety and Health, the IOM appointed a committee to examine the rationale and feasibility of incorporating occupational information in patients' EHRs. The IOM concluded that three data elements - occupation, industry, and work-relatedness - were ready for immediate focus, and made recommendations on moving forward efforts to incorporate these elements into EHRs. Table of Contents Front Matter Incorporating Occupational Information in Electronic Health Records Appendix A: Workshop Agenda Appendix B: Workshop Participants Appendix C: Committee Biographies

In 2009, the H1N1 influenza pandemic brought to the forefront the many unknowns about the virulence, spread, and nature of the virus, as well as questions regarding personal protective equipment (PPE) for healthcare personnel. In this book, the Institute of Medicine assesses the progress of PPE research and identifies future directions for PPE for healthcare personnel.

Although asbestos is no longer mined in the United States, prior and ongoing exposures to asbestos continue to contribute to respiratory diseases, including mesothelioma, lung cancer, and asbestosis. To examine ongoing issues and concerns in this field, the National Institute for Occupational Safety and Health (NIOSH) drafted a research roadmap, Asbestos Fibers and Other Elongated Mineral Particles: State of the Science and Roadmap for Research, that provides an overview of the state of the science and a plan for future research in areas including toxicology, mineralogy, epidemiology, and exposure assessment. The focus of the proposed research is on clarifying the relationship between human health effects and the physical and chemical characteristics of a wide range of elongate mineral particles. In 2008, NIOSH asked the Institute of Medicine and the National Research Council to form a committee to provide a review of the scientific and technical quality of the January 2009 draft NIOSH Roadmap document. The present volume provides the committee's assessment of the Roadmap and recommendations for strengthening its utility for NIOSH, other federal agencies, the private sector, and other stakeholders.

An estimated 11,000 spinal cord injuries occur each year in the United States and more than 200,000 Americans suffer from maladies associated with spinal cord injury. This includes paralysis, bowel and bladder dysfunction, sexual dysfunction, respiratory impairment, temperature regulation problems, and chronic pain. During the last two decades, longstanding beliefs about the inability of the adult central nervous system to heal itself have been eroded by the flood of new information from research in the neurosciences and related fields. However, there are still no cures and the challenge of restoring function in the wake of spinal cord injuries remains extremely complex. Spinal Cord Injury examines the future directions for research with the goal to accelerate the development of cures for spinal cord injuries. While many of the recommendations are framed within the context of the specific needs articulated by the New York Spinal Cord Injury Research Board, the Institute of Medicine's panel of experts looked very broadly at research priorities relating to future directions for the field in general and make recommendations to strengthen and coordinate the existing infrastructure. Funders at federal and state agencies, academic organizations, pharmaceutical and device companies, and non-profit organizations will all find this book to be an essential resource as they examine their opportunities. Table of Contents Front Matter Executive Summary 1 Introduction 2 Progression of Spinal Cord Injury 3 Tools for Assessing Spinal Cord Injury and Repair 4 Current Therapeutic Interventions 5 Progress Toward Neuronal Repair and Regeneration 6 Developing New Therapeutic Interventions: From the Laboratory to the Clinic 7 Research Organization: Creating an Environment to Accelerate Progress 8 State Programs in Spinal Cord Injury Appendix A Study Process Appendix B Acronyms Appendix C Glossary of Major Terms Appendix D Tools to Assess Spinal Cord Injury Outcomes Appendix E Clinical Trials of Methylprednisolone Appendix F Examples of Alternative Therapies Appendix G Spinal Cord Injury Clinical Trials Published from 1998 to 2003 Appendix H Legislation Sponsoring State Spinal Cord Injury Research Appendix I Committee and Staff Biographies Index