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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
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