The Institute of Medicine carried out a study mandated by Congress and sponsored by the Department of Veterans Affairs to provide an assessment of several issues related to noise-induced hearing loss and tinnitus associated with service in the Armed Forces since World War II. The resulting book, Noise and Military Service: Implications for Hearing Loss and Tinnitus, presents findings on the presence of hazardous noise in military settings, levels of noise exposure necessary to cause hearing loss or tinnitus, risk factors for noise-induced hearing loss and tinnitus, the timing of the effects of noise exposure on hearing, and the adequacy of military hearing conservation programs and audiometric testing. The book stresses the importance of conducting hearing tests (audiograms) at the beginning and end of military service for all military personnel and recommends several steps aimed at improving the military services' prevention of and surveillance for hearing loss and tinnitus. The book also identifies research needs, emphasizing topics specifically related to military service. Table of Contents Front Matter Executive Summary 1 Overview of the Problem and Introduction 2 Noise-Induced Hearing Loss 3 Noise and Noise-Induced Hearing Loss in the Military 4 Tinnitus 5 Responding to Noise Risks: Hearing Conservation Programs in the Military 6 Reports of Audiometric Testing in Service Medical Records of Military Veterans 7 Conclusions and Comments Appendix A Legislative Language from Public Law 107-330 Appendix B Agendas for Information-Gathering Meetings Appendix C Definitions Appendix D Summary Tables on Epidemiological Studies Appendix E Results from Alternative Analyses of Data on Reports of Audiometric Testing in Service Medical Records Appendix F Selected Sources of Information on Sound Pressure Levels Measured in and Around Military Systems and Equipment Appendix G Department of Defense Hearing Conservation Report Forms Appendix H Biographical Sketches of Committee Members

The vaccine used to protect humans against the anthrax disease, called Anthrax Vaccine Adsorbed (AVA), was licensed in 1970. It was initially used to protect people who might be exposed to anthrax where they worked, such as veterinarians and textile plant workers who process animal hair. When the U. S. military began to administer the vaccine, then extended a plan for the mandatory vaccination of all U. S. service members, some raised concerns about the safety and efficacy of AVA and the manufacture of the vaccine. In response to these and other concerns, Congress directed the Department of Defense to support an independent examination of AVA. The Anthrax Vaccine: Is It Safe? Does It Work? reports the study's conclusion that the vaccine is acceptably safe and effective in protecting humans against anthrax. The book also includes a description of advances needed in main areas: improving the way the vaccine is now used, expanding surveillance efforts to detect side effects from its use, and developing a better vaccine. Table of Contents Front Matter Executive Summary 1 Introduction 2 Background 3 Anthrax Vaccine Efficacy 4 Safety: Introduction 5 Safety: Case Reports 6 Safety: Epidemiologic Studies 7 Anthrax Vaccine Manufacture 8 Future Needs Appendix A Statement of Task Appendix B Biographical Sketches Appendix C Information-Gathering Meeting Agendas Appendix D Anthrax Vaccine Adsorbed Package Inserts Appendix E Vaccine Adverse Event Reporting System (VAERS) Form Appendix F Anthrax Vaccine Expert Committee (AVEC) Case Assessment Form Appendix G DMSS Analyses Requested by the IOM Committee to Assess the Safety and Efficacy of the Anthrax Vaccine Appendix H An Assessment of the Safety of the Anthrax Vaccine: A Letter Report

There is growing interest in using performance measurement as a means of holding federal, state, and local health agencies accountable for their use of public funds. Health Performance Measurement in the Public Sector is the second of two books for the U.S. Department of Health and Human Services on using and improving performance measurement in publicly funded health programs and the implications for data needs and systems. This book focuses on data and information system issues at the federal, state, and local levels. Recommendations address: Policy framework for selecting performance measures and using performance measurement. Operational principles related to data and data systems that support performance measurement. Essential investments in data systems and in training and technical assistance. Research needed to improve performance measures and performance measurement. Table of Contents Front Matter Executive Summary 1 Introduction 2 Putting Performance Measurement in Context 3 Performance Measurement Considerations for Publicly Funded Health Programs 4 Data and Information Systems: Issues for Performance Measurement 5 Strategies for Supporting Performance Measurement Through a National Information Network A Potential Health Outcome and Risk Status Measures B Workshop Agenda C Biographical Sketches

Vaccines have made it possible to eradicate the scourge of smallpox, promise the same for polio, and have profoundly reduced the threat posed by other diseases such as whooping cough, measles, and meningitis. What is next? There are many pathogens, autoimmune diseases, and cancers that may be promising targets for vaccine research and development. This volume provides an analytic framework and quantitative model for evaluating disease conditions that can be applied by those setting priorities for vaccine development over the coming decades. The committee describes an approach for comparing potential new vaccines based on their impact on morbidity and mortality and on the costs of both health care and vaccine development. The book examines: Lessons to be learned from the polio experience. Scientific advances that set the stage for new vaccines. Factors that affect how vaccines are used in the population. Value judgments and ethical questions raised by comparison of health needs and benefits. The committee provides a way to compare different forms of illness and set vaccine priorities without assigning a monetary value to lives. Their recommendations will be important to anyone involved in science policy and public health planning: policymakers, regulators, health care providers, vaccine manufacturers, and researchers. Table of Contents Front Matter Executive Summary Introduction Progress in Vaccine Development Considerations of Candidate Vaccines Overview of Analytic Approach and Results Review of the Analytical Model Ethical Considerations and Caveats Observations References Appendix 1: Borrelia burgdorferi Appendix 2: Chlamydia Appendix 3: Coccidioides Immitis Appendix 4: Cytomegalovirus Appendix 5: Enterotoxigenic E. coli Appendix 6: Epstein-Barr Virus Appendix 7: Helicobacter pylori Appendix 8: Hepatitis C Appendix 9: Herpes Simplex Virus Appendix 10: Histoplasma capsulatum Appendix 11: Human Paillomavirus Appendix 12: Influenza A and B Appendix 13: Insulin-Dependent Diabetes Mellitus Appendix 14: Melanoma Appendix 15: Multiple Sclerosis Appendix 16: Mycobacterium tuberculosis Appendix 17: Neisseria gonnorrhea Appendix 18: Neisseria meningitidis Appendix 19: Parainfluenza Virus Appendix 20: Respiratory Syncytial Virus Appendix 21: Rheumatoid Arthritis Appendix 22: Rotavirus Appendix 23: Shigella Appendix 24: Streptococcus, Group A Appendix 25: Streptococcus, Group B Appendix 26: Streptococcus pneumoniae Appendix 27: Information on accessing Electronic Spreadsheets Appendix 28: Summary of Workshops Appendix 29: Questions Posed to Outside Experts and List of Responders Index