The COVID-19 pandemic has highlighted existing weaknesses in the United States health care system, while creating a new set of challenges related to caring for people with serious illness. The National Academy of Sciences, Engineering, and Medicine's Roundtable on Quality Care for People with Serious Illness hosted a three-part workshop to explore the initial responses to the pandemic by health care teams providing care to people with serious illness, the impact of the pandemic on the health care workforce, the use of telehealth, issues related to clearly communicating with the public about health emergencies, and policy opportunities to improve care for people with serious illness. Issues related to health equity were discussed throughout the three webinars. Table of Contents Front Matter Proceedings of a Workshop Appendix A: Statement of Task Appendix B: Workshop Agenda

The Department of Homeland Security's (DHS's) BioWatch program aims to provide an early indication of an aerosolized biological weapon attack. The first generation of BioWatch air samplers were deployed in 2003. The current version of this technology, referred to as Generation 2 (Gen-2), uses daily manual collection and testing of air filters from each monitor, a process that can take 12 to 36 hours to detect the presence of biological pathogens. Until April 2014, DHS pursued a next-generation autonomous detection technology that aimed to shorten the time from sample collection to detection to less than 6 hours, reduce the cost of analysis, and increase the number of detectable biological pathogens. Because of concerns about the cost and effectiveness of the proposed Generation 3 system (Gen-3), DHS cancelled its acquisition plans for the next-generation surveillance system. In response to the cancellation announcement, Congress asked the Government Accountability Office (GAO) to conduct a review of the program and the proposed system enhancements that would have been incorporated in BioWatch Gen-3. However, Mike Walter, BioWatch Program manager, Office of Health Affairs, DHS, said that DHS did not agree with all of GAO's characterizations of the BioWatch program efforts described in this review. In response to this, DHS requested that the National Academies of Sciences, Engineering, and Medicine conduct a workshop to further explore the findings of the 2015 GAO report and discuss the impact these findings may have with regard to the future development of the technical capabilities of the BioWatch program. Workshop participants also discussed existing and possible collaborations between BioWatch, public health laboratories, and other stakeholders that could contribute to the enhancement of biosurveillance capabilities at the federal, state, and local levels. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 An Overview of BioWatch Strategic Priorities 3 Recommendations from the Government Accountability Office Report and the Department of Homeland Security Response 4 BioWatch Collaborative Planning 5 Future Opportunities for State and Local Collaboration 6 Reflections on the Workshop References Appendix A: Workshop Agenda Appendix B: Biographical Sketches of Workshop Speakers and Moderators

The field of health literacy has evolved from one focused on individuals to one that recognizes that health literacy is multidimensional. While communicating in a health literate manner is important for everyone, it is particularly important when communicating with those with limited health literacy who also experience more serious medication errors, higher rates of hospitalization and use of the emergency room, poor health outcomes, and increased mortality. Over the past decade, research has shown that health literacy interventions can significantly impact various areas including health care costs, outcomes, and health disparities. To understand the extent to which health literacy has been shown to be effective at contributing to the Quadruple Aim of improving the health of communities, providing better care, providing affordable care, and improving the experience of the health care team, the National Academies of Sciences, Engineering, and Medicine convened a public workshop on building the case for health literacy. This publication summarizes the presentations and discussions from the workshop, and highlights important lessons about the role of health literacy in meeting the Quadruple Aim, case studies of organizations that have adopted health literacy, and discussions among the different stakeholders involved in making the case for health literacy. Table of Contents Front Matter 1 Introduction 2 The Patient Perspective on the Need for Health Literacy 3 Improving Health and the Bottom Line: The Case for Health Literacy 4 Why Health Literacy? 5 Adopting Health Literacy in an Organization 6 Where Do We Go from Here? 7 Reflections on the Day References Appendix A: Workshop Agenda Appendix B: Biographical Sketches of Workshop Moderators, Speakers, and Panelists Appendix C: Improving Health and the Bottom Line: The Case for Health Literacy

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

Living independently and participating in one's community are priorities for many people. In many regions across the United States, there are programs that support and enable people with disabilities and older adults to live where they choose and with whom they choose and to participate fully in their communities. Tremendous progress has been made. However, in many cases, the programs themselves ? and access to them ? vary not only between states but also within states. Many programs are small, and even when they prove to be successful they are still not scaled up to meet the needs of the many people who would benefit from them. The challenges can include insufficient workforce, insufficient funding, and lack of evidence demonstrating effectiveness or value. To get a better understanding of the policies needed to maximize independence and support community living and of the research needed to support implementation of those policies, the National Academies of Sciences, Engineering, and Medicine convened a public workshop in October 2015. Participants explored policies in place that promote independence and community living for older adults and people with physical disabilities, and identified policies and gaps in policies that can be barriers to independence and the research needed to support changing those policies. This report summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 The Importance of Community Living and Maximizing Independence to Individuals and Society 3 Home and Community Settings: Services and Supports for Community Living and Participation 4 Workforce Needs to Support Community Living 5 Financing to Support Community Living 6 Technology to Support Independence 7 Closing Remarks References Appendix A: Workshop Agenda Appendix B: Biographical Sketches of Workshop Speakers and Moderators

In an increasingly interconnected world, science and technology research often transects international boundaries and involves researchers from multiple nations. This paradigm provides both new opportunities and new challenges. As science and technology capabilities grow around the world, United States-based organizations are finding that international collaborations and partnerships provide unique opportunities to enhance research and training. At the same time, enhancing international collaboration requires recognition of differences in culture, legitimate national security needs, and critical needs in education and training. Culture Matters is the summary of a workshop convened by the Government-University-Industry Research Roundtable (GUIRR) in July 2013 to address how culture and cultural perception influence and impact the process by which research agreements are made and negotiated across international boundaries. In this workshop, "Culture Matters: An Approach to International Research Agreements", representatives from around the world and from GUIRR's three constituent sectors - government, university, and industry - gathered to provide input into four specific meeting tracks or domains. The tracks focused on research and agreements affecting or involving people/human subjects; environmental and natural resources; science, engineering, and manufacturing; and agriculture and animal issues. This report examines each of these domains and the role that culture and cultural expectations may have in the forging and implementation of international research agreements. Table of Contents Front Matter 1 Introduction and Overview 2 Designing Projects with Culture in Mind 3 Conducting Research in Developing Countries 4 Language 5 Urbanization, Ecological Sustainability, and Social Resilience 6 Intellectual Property 7 Change and Drivers 8 Breakout Session Reports and Concluding Remarks Appendix A: Workshop Agenda Appendix B: Guiding Questions for the Breakout Sessions Appendix C: Speaker Biographies Appendix D: Workshop Participants

Advance Care Planning(ACP)has long been a staple of caring for people with serious illness. Over its history, it has been defined in different ways. Clinicians, researchers, patients, and the public have developed a variety of perspectives about the many aspects of ACP, ranging from the definition to the timing, goals, outcomes, and value of ACP. To better understand the challenges and opportunities for ACP, acknowledge and highlight divergent viewpoints, and examine what is empirically known and not known about ACP and its outcomes, the National Academies of Sciences, Engineering, and Medicine's Roundtable on Quality Care for People with Serious Illness hosted a virtual public workshop, Advance Care Planning: Challenges and Opportunities, on October 26 and November 2, 2020. The workshop explored the paradox of ACP, its evidence base, ways to think differently about ACP, and various approaches to making it more effective.This Proceedings of a Workshop summarizes the presentations and discussions from that workshop. Table of Contents Front Matter Proceedings of a Workshop Appendix A: Statement of Task Appendix B: Workshop Agenda

The field of health literacy has evolved from early efforts that focused on individuals to its current recognition that health literacy is a multidimensional team and system function. Health literacy includes system demands and complexities as well as individual skills and abilities. While communicating in a health-literate manner is truly important for everyone, it can be especially important for those with mental or behavioral health issues and for the systems and teams that interact with them and treat these individuals. The purpose of the workshop, which was held on July 11, 2018, in Washington, DC, was to explore issues associated with effective communication with individuals with mental or behavioral health issues and to identify ways in which health literacy approaches can facilitate communication. In particular, the workshop aimed to gain a better understanding of how behavioral health and mental health concerns can adversely affect communications between providers and patients and their families. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 The Personal Experience 3 Setting the Stage 4 Exploring Innovative Approaches 5 Where Do We Go from Here? 6 Reflections of the Day Appendix A: Workshop Agenda Appendix B: Biographical Sketches of Workshop Moderators, Speakers, and Panelists

In order to better understand the critical issues pertaining to the concept of performance standards for laboratory animal use, the Institute for Laboratory Animal Research Roundtable on Science and Welfare in Laboratory Animal Use held a public workshop on April 20-21, 2015. The purpose of the workshop was to promote the appropriate and responsible care of animals in research, to provide a balanced and civil forum for discussion and collaboration, and to help build transparency and trust among stakeholders. Participants addressed the challenges of defining, developing, implementing, assessing, and validating performance standards to ensure "optimal practices, management, and operations." This report summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 Overview of Performance Standards for the Humane Care and Use of Laboratory Animals 3 Regulatory and Advisory Perspectives 4 End-User Perspectives 5 Detailed Steps in the Development and Implementation of Performance Standards 6 Reports from the Breakout Sessions 7 Sharing Acceptable Performance Standards 8 Reflections on the Workshop Appendix A: Workshop Agenda Appendix B: Biographical Sketches of Workshop Speakers and Organizing Committee Members Appendix C: Statement of Task

Technological Challenges in Antibiotic Discovery and Development is the summary of a workshop convened by the Chemical Sciences Roundtable in September 2013 to explore the current state of antibiotic discovery and examine the technology available to facilitate development. Through formal presentations and panel discussions, participants from academia, industry, federal research agencies discussed the technical challenges present and the incentives and disincentives industry faces in antibiotic development, and identified novel approaches to antibiotic discovery. Antibiotic resistance is a serious and growing problem in modern medicine and it is emerging as a pre-eminent public health threat. Each year in the United States alone, at least two million acquire serious infections with bacteria that are resistant to one or more antibiotics, and at least 23,000 people die annually as a direct result of these antibiotic-resistant infections. In addition to the toll on human life, antibiotic-resistant infections add considerable and avoidable costs to the already overburdened U.S. health care system. This report explores the challenges in overcoming antibiotic resistance, screening for new antibiotics, and delivering them to the sites of infection in the body. The report also discusses a path forward to develop the next generation of potent antimicrobial compounds capable of once again tilting the battle against microbial pathogens in favor of humans. Technological Challenges in Antibiotic Discovery and Development gives a broad view of the landscape of antibiotic development and the technological challenges and barriers to be overcome. Table of Contents Front Matter 1 Introduction and Overview 2 Challenges In Overcoming Antibiotic Resistance 3 Challenges in Screening 4 Challenges In Drug Delivery 5 General Observations Appendix A: Statement of Task Appendix B: Agenda Appendix C: Biographical Information Appendix D: Workshop Attendees