More than 200,000 U.S. military personnel participated in atmospheric nuclear weapons tests between 1945 and the 1963 Limited Nuclear Test Ban Treaty. Questions persist, such as whether that test participation is associated with the timing and causes of death among those individuals. This is the report of a mortality study of the approximately 70,000 soldiers, sailors, and airmen who participated in at least one of five selected U.S. nuclear weapons test series1 in the 1950s and nearly 65,000 comparable nonparticipants, the referents. The investigation described in this report, based on more than 5 million person-years of mortality follow-up, represents one of the largest cohort studies of military veterans ever conducted.

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

Since 1992 the Department of Defense (DOD), through the U.S. Army Medical Research and Material Command, has received congressionally earmarked appropriations for programs of biomedical research on prostate, breast, and ovarian cancer; neurofibromatosis; tuberous sclerosis; and other health problems. Appropriations for these Congressionally Directed Medical Research Programs are used to support peer reviewed extramural research project, training, and infrastructure grants. Congress has become concerned about funding increases for these programs given current demands on the military budget. At the request of Congress, the Institute of Medicine (IOM) examined possibilities of augmenting program funding from alternative sources. The resulting IOM book, Strategies to Leverage Research Funding: Guiding DODa (TM)s Peer Reviewed Medical Research Programs, focuses on nonfederal and private sector contributions that could extend the appropriated funds without biasing the peer review project selection process.

More than 5,800 military personnel, mostly Navy personnel and Marines, participated in a series of tests of U.S. warship vulnerability to biological and chemical warfare agents, Project SHAD (Shipboard Hazard and Defense), in the period 1962-1973. Only some of the involved military personnel were aware of these tests at the time. Many of these tests used simulants, substances with the physical properties of a chemical or biological warfare agent, thought at the time to have been harmless. The existence of these tests did not come to light until many decades later. In September 2002, the Institute of Medicine (IOM) agreed to undertake a scientific study, funded by the Veterans' Affairs, of potential long-term health effects of participation in Project SHAD. In general, there was no difference in all-cause mortality between Project SHAD participants and nonparticipant controls, although participants statistically had a significantly higher risk of death due to heart disease, had higher levels of neurodegenerative medical conditions and higher rates of symptoms with no medical basis. Long-Term Health Effects of Participation in Project SHAD focuses on the potential health effects of participation in Project SHAD. It is a useful resource for government defense agencies, scientists and health professionals.

Malaria is an infectious disease common to several parts of the world, including Africa, northern South America, and Asia. During their service in the military, U.S. active members may be sent to any part of the world, including parts of the world where Malaria is an issue. In Liberia in 2003, for example, there was a 28 percent attack rate in Marines who spent a short time ashore, and half of the 80 Marines affected needed to be evacuated to Germany. This was not only costly to the U.S. military but dangerous as well. To fight against this disease, there exists a Malaria Vaccine program in the U.S. military. However, there exists a variety of potential vaccine targets for the most severe and important form of malaria; malaria from the species Plasmodium falciparum. Issues also arise with the fact that there are three possible stages to create vaccines against-preerythrocytic, blood, or transmission. The Department of Defense (DoD), through the commanding general of the U.S. Army Medical Research and Materiel Command (USAMRMC), requested that the Institute of Medicine (IOM) conduct a programmatic review of the military Plasmodium falciparum malaria vaccine research and development program. There was to be a focus on vaccine against the preerythrocytic and blood stages. The IOM formed a committee of 11 experts with collective expertise in malaria vaccine research, parasite immunology, malarial biology, clinical trials and regulatory affairs, industrial and public-sector vaccine development, biologic products research and development (vaccinology), military research and development programs, tropical medicine, and public health. The committee focused different tasks including determining whether the DoD malaria vaccine research and development program is scientifically sound and able to achieve the vaccine program objectives within specified timelines, recommending how to overcome significant, identified barriers, and identifying major strategic goals and timelines based on the material received and presentations made by the DoD's program representatives. Battling Malaria: Strengthening the U.S. Military Malaria Vaccine Program presents the committee's findings, current malaria vaccines, and recommendations for the development of the U.S. Military vaccine research. Table of Contents Front Matter Summary 1 Introduction 2 The Malaria Threat and Need for a Vaccine 3 Malaria Vaccines 4 The U.S. Military Malaria Vaccine Research and Development Program--Scientific Aspects 5 Organization and Management of the Program References Appendix A Vaccine Trials Appendix B Current Requirements for a Malaria Vaccine Appendix C Suggested Design of Trials for Testing Malaria Vaccines in Nonimmune Adults Visiting Endemic Areas Appendix D Patents Appendix E Scientific Advisory Board for DoD Malaria Vaccine Research and Development Program (Draft Charter) Appendix F Recommendations of the IOM Report Protecting Our Forces Appendix G Executive Summary and Recommendations of the DoD Report Acquisition of Vaccine Production Appendix H Open Meeting Agenda Appendix I Committee and Staff Biographies

In Advancing Prion Science, the Institute of Medicinea (TM)s Committee on Transmissible Spongiform Encephalopathies Assessment of Relevant Science recommends priorities for research and investment to the Department of Defensea (TM)s National Prion Research Program (NPRP). Transmissible spongiform encephalopathies (TSEs), also called prion diseases, are invariably fatal neurodegenerative infectious diseases that include bovine spongiform encephalopathy (commonly called mad cow disease), chronic wasting disease, scrapie, and Creutzfeldt-Jakob disease. To develop antemortem diagnostics or therapies for TSEs, the committee concludes that NPRP should invest in basic research specifically to elucidate the structural features of prions, the molecular mechanisms of prion replication, the mechanisms of TSE pathogenesis, and the physiological function of prionsa (TM) normal cellular isoform. Advancing Prion Science provides the first comprehensive reference on present knowledge about all aspects of TSEsa "from basic science to the U.S. research infrastructure, from diagnostics to surveillance, and from prevention to treatment.