The ability to see deeply affects how human beings perceive and interpret the world around them. For most people, eyesight is part of everyday communication, social activities, educational and professional pursuits, the care of others, and the maintenance of personal health, independence, and mobility. Functioning eyes and vision system can reduce an adult's risk of chronic health conditions, death, falls and injuries, social isolation, depression, and other psychological problems. In children, properly maintained eye and vision health contributes to a child's social development, academic achievement, and better health across the lifespan. The public generally recognizes its reliance on sight and fears its loss, but emphasis on eye and vision health, in general, has not been integrated into daily life to the same extent as other health promotion activities, such as teeth brushing; hand washing; physical and mental exercise; and various injury prevention behaviors. A larger population health approach is needed to engage a wide range of stakeholders in coordinated efforts that can sustain the scope of behavior change. The shaping of socioeconomic environments can eventually lead to new social norms that promote eye and vision health. Making Eye Health a Population Health Imperative: Vision for Tomorrow proposes a new population-centered framework to guide action and coordination among various, and sometimes competing, stakeholders in pursuit of improved eye and vision health and health equity in the United States. Building on the momentum of previous public health efforts, this report also introduces a model for action that highlights different levels of prevention activities across a range of stakeholders and provides specific examples of how population health strategies can be translated into cohesive areas for action at federal, state, and local levels. Table of Contents Front Matter Summary 1 Introduction 2 Understanding the Epidemiology of Vision Loss and Impairment in the United States 3 The Impact of Vision Loss 4 Surveillance and Research 5 The Role of Public Health and Partnerships to Promote Eye and Vision Health in Communities 6 Access to Clinical Vision Services: Workforce and Coverage 7 Toward a High-Quality Clinical Eye and Vision Service Delivery System 8 Meeting the Challenge of Vision Loss in the United States: Improving Diagnosis, Rehabilitation, and Accessibility 9 Eye and Vision Health: Recommendations and a Path to Action Appendix A: Committee Biographies Appendix B: Committee Meeting Agendas Appendix C: Glossary Appendix D: Examples of Federal Entities Involved in Advancing Eye Health and Safety Appendix E: Examples of Recommended Eye Protection for Recreational Sports Appendix F: Eye and Vision Care Professionals and Education Appendix G: Medicaid Vision Coverage by State

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

In 2010, more than 105,000 people were injured or killed in the United States as the result of a firearm-related incident. Recent, highly publicized, tragic mass shootings in Newtown, CT; Aurora, CO; Oak Creek, WI; and Tucson, AZ, have sharpened the American public's interest in protecting our children and communities from the harmful effects of firearm violence. While many Americans legally use firearms for a variety of activities, fatal and nonfatal firearm violence poses a serious threat to public safety and welfare. In January 2013, President Barack Obama issued 23 executive orders directing federal agencies to improve knowledge of the causes of firearm violence, what might help prevent it, and how to minimize its burden on public health. One of these orders directed the Centers for Disease Control and Prevention (CDC) to, along with other federal agencies, immediately begin identifying the most pressing problems in firearm violence research. The CDC and the CDC Foundation asked the IOM, in collaboration with the National Research Council, to convene a committee tasked with developing a potential research agenda that focuses on the causes of, possible interventions to, and strategies to minimize the burden of firearm-related violence. Priorities for Research to Reduce the Threat of Firearm-Related Violence focuses on the characteristics of firearm violence, risk and protective factors, interventions and strategies, the impact of gun safety technology, and the influence of video games and other media.

Cardiac arrest often strikes seemingly healthy individuals without warning and without regard to age, gender, race, or health status. Representing the third leading cause of death in the United States, cardiac arrest is defined as "a severe malfunction or cessation of the electrical and mechanical activity of the heart ... [which] results in almost instantaneous loss of consciousness and collapse". Although the exact number of cardiac arrests is unknown, conservative estimates suggest that approximately 600,000 individuals experience a cardiac arrest in the United States each year. In June 2015, the Institute of Medicine (IOM) released its consensus report Strategies to Improve Cardiac Arrest Survival: A Time to Act, which evaluated the factors affecting resuscitation research and outcomes in the United States. Following the release of this report, the National Academies of Sciences, Engineering, and Medicine was asked to hold a workshop to explore the barriers and opportunities for advancing the IOM recommendations. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 Building a National Cardiac Arrest Surveillance System 3 Advancing Cardiac Arrest Research and Translation 4 Improving Public Awareness and Training 5 Enhancing the Emergency Medical Services Response to Cardiac Arrest 6 Enhancing Hospital Response to Cardiac Arrest 7 Effective Collaboration for Cardiac Arrest Appendix A: Recommendations from the Institute of Medicine Report *Strategies to Improve Cardiac Arrest Survival: A Time to Act* Appendix B: Workshop Agenda

The nurse workforce constitutes the largest sector of health professionals in the United States and includes individuals with varying educational backgrounds and expertise. Like other health professions, nursing includes a large number of specialties and subspecialties. Nurses may seek certification, based on various standards and criteria, from a wide range of organizations. Similarly, organizations may participate in nursing credentialing programs, which typically reflect the attainment of various nursing care standards and outcome measures. It is, however, unclear how this additional training and education affects health care quality and patient health. Future Directions of Credentialing Research in Nursing examines short- and long-term strategies to advance research on nurse certification and organizational credentialing. This report summarizes a workshop convened by the Institute of Medicine in September 2014 to examine a new framework and research priorities to guide future research on the impact of nurse credentialing and certification on outcomes for nurses, organizations, and patients. Over 100 people attended the workshop, which focused on topics such as emergent priorities for research in nursing credentialing; critical knowledge gaps and methodological limitations in the field; promising developments in research methodologies, health metrics, and data infrastructures to better evaluate the impact of nursing credentialing; and short- and long-term strategies to encourage continued activity in nursing credentialing research. Future Directions of Credentialing Research in Nursing is a record of the presentations, discussion, and break-out sessions of this event. Table of Contents Front Matter 1 Introduction 2 A New Framework for Credentialing Research in Nursing 3 Strengthening Data and Health Informatics for Credentialing Research 4 Challenges and Opportunities in Credentialing Research Methodologies 5 Assessing Core Competencies in Nursing Credentialing 6 Nursing Credentialing Within a Complex Health Care Landscape 7 Taking the Temperature: Stakeholder Reactions and Suggestions References Appendix A: Workshop Agenda Appendix B: Glossary

From the origin of the leak, to the amount of oil released into the environment, to the spill's duration, the 2010 Gulf of Mexico oil spill poses unique challenges to human health. The risks associated with extensive, prolonged use of dispersants, with oil fumes, and with particulate matter from controlled burns are also uncertain. There have been concerns about the extent to which hazards, such as physical and chemical exposures and social and economic disruptions, will impact the overall health of people who live and work near the area of the oil spill. Although studies of previous oil spills provide some basis for identifying and mitigating the human health effects of these exposures, the existing data are insufficient to fully understand and predict the overall impact of hazards from the Deepwater Horizon oil spill on the health of workers, volunteers, residents, visitors, and special populations. "Assessing the Effects of the Gulf of Mexico Oil Spill on Human Health" identifies populations at increased risks for adverse health effects and explores effective communication strategies to convey health information to these at-risk populations. The book also discusses the need for appropriate surveillance systems to monitor the spill's potential short- and long-term health effects on affected communities and individuals. "Assessing the Effects of the Gulf of Mexico Oil Spill on Human Health" is a useful resource that can help policy makers, public health officials, academics, community advocates, scientists, and members of the public collaborate to create a monitoring and surveillance system that results in "actionable" information and that identifies emerging health risks in specific populations.

Cardiac arrest can strike a seemingly healthy individual of any age, race, ethnicity, or gender at any time in any location, often without warning. Cardiac arrest is the third leading cause of death in the United States, following cancer and heart disease. Four out of five cardiac arrests occur in the home, and more than 90 percent of individuals with cardiac arrest die before reaching the hospital. First and foremost, cardiac arrest treatment is a community issue - local resources and personnel must provide appropriate, high-quality care to save the life of a community member. Time between onset of arrest and provision of care is fundamental, and shortening this time is one of the best ways to reduce the risk of death and disability from cardiac arrest. Specific actions can be implemented now to decrease this time, and recent advances in science could lead to new discoveries in the causes of, and treatments for, cardiac arrest. However, specific barriers must first be addressed. Strategies to Improve Cardiac Arrest Survival examines the complete system of response to cardiac arrest in the United States and identifies opportunities within existing and new treatments, strategies, and research that promise to improve the survival and recovery of patients. The recommendations of Strategies to Improve Cardiac Arrest Survival provide high-priority actions to advance the field as a whole. This report will help citizens, government agencies, and private industry to improve health outcomes from sudden cardiac arrest across the United States. Table of Contents Front Matter Summary 1 Introduction 2 Understanding the Public Health Burden of Cardiac Arrest: The Need for National Surveillance 3 The Public Experience with Cardiac Arrest 4 Emergency Medical Services Response to Cardiac Arrest 5 In-Hospital Cardiac Arrest and Post-Arrest Care 6 Resuscitation Research and Continuous Quality Improvement 7 Recommendations and Key Opportunities A-- Acronyms B-- Meeting Agendas C-- Committee Biographies D-- Selected Results from Commissioned Analyses E-- Map of U.S. States with CPR Training as a High School Graduation Requirement F-- Utstein Guideline - Endorsed Data Elementsfor Reporting Out-of-Hospital Cardiac Arrest

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

Health care in the United States is more expensive than in other developed countries, costing $2.7 trillion in 2011, or 17.9 percent of the national gross domestic product. Increasing costs strain budgets at all levels of government and threaten the solvency of Medicare, the nation's largest health insurer. At the same time, despite advances in biomedical science, medicine, and public health, health care quality remains inconsistent. In fact, underuse, misuse, and overuse of various services often put patients in danger. Many efforts to improve this situation are focused on Medicare, which mainly pays practitioners on a fee-for-service basis and hospitals on a diagnoses-related group basis, which is a fee for a group of services related to a particular diagnosis. Research has long shown that Medicare spending varies greatly in different regions of the country even when expenditures are adjusted for variation in the costs of doing business, meaning that certain regions have much higher volume and/or intensity of services than others. Further, regions that deliver more services do not appear to achieve better health outcomes than those that deliver less. Variation in Health Care Spending investigates geographic variation in health care spending and quality for Medicare beneficiaries as well as other populations, and analyzes Medicare payment policies that could encourage high-value care. This report concludes that regional differences in Medicare and commercial health care spending and use are real and persist over time. Furthermore, there is much variation within geographic areas, no matter how broadly or narrowly these areas are defined. The report recommends against adoption of a geographically based value index for Medicare payments, because the majority of health care decisions are made at the provider or health care organization level, not by geographic units. Rather, to promote high value services from all providers, Medicare and Medicaid Services should continue to test payment reforms that offer incentives to providers to share clinical data, coordinate patient care, and assume some financial risk for the care of their patients. Medicare covers more than 47 million Americans, including 39 million people age 65 and older and 8 million people with disabilities. Medicare payment reform has the potential to improve health, promote efficiency in the U.S. health care system, and reorient competition in the health care market around the value of services rather than the volume of services provided. The recommendations of Variation in Health Care Spending are designed to help Medicare and Medicaid Services encourage providers to efficiently manage the full range of care for their patients, thereby increasing the value of health care in the United States.

Interim Report of the Committee on Geographic Variation in Health Care Spending and Promotion of High-Value Health Care: Preliminary Committee Observations is designed to provide the committee's preliminary observations for the 113th Congress as it considers further Medicare reform. This report contains only key preliminary observations related primarily to the committee's commissioned analyses of Medicare Parts A (Hospital Insurance program), B (Supplementary Medical Insurance program) and D (outpatient prescription drug benefit), complemented by other empirical investigations. It does not contain any observations related to the committee's commissioned analyses of the commercial insurer population, Medicare Advantage, or Medicaid, which will be presented in the committee's final report after completion of quality-control activities. This interim report excludes conclusions or recommendations related to the committee's consideration of the geographic value index or other payment reforms designed to promote highvalue care. Additional analyses are forthcoming, which will influence the committee's deliberations. These analyses include an exploration of how Medicare Part C (Medicare Advantage) and commercial spending, utilization, and quality vary compared with, and possibly are influenced by, Medicare Parts A and B spending, utilization, and quality. The committee also is assessing potential biases that may be inherent to Medicare and commercial claims-based measures of health status. Based on this new evidence and continued review of the literature, the committee will confirm the accuracy of the observations presented in this interim report and develop final conclusions and recommendations, which will be published in the committee's final report. Table of Contents Front Matter Interim Report REFERENCES Appendix A: Glossary Appendix B: Statement of Task