It began with plutonium, the first element ever manufactured in quantity by humans. Fearing that the Germans would be the first to weaponise the atom, the United States marshalled brilliant minds and seemingly inexhaustible bodies to find a way to create a nuclear chain reaction of inconceivable explosive power. In a matter of months, the Hanford nuclear facility was built to produce the enigmatic and deadly new material that would fuel atomic bombs. In the desert of eastern Washington State, far from prying eyes, scientists Glenn Seaborg, Enrico Fermi and thousands of others-the physicists, engineers, labourers and support staff at the facility-manufactured plutonium for the bomb dropped on Nagasaki, and for the bombs in the current American nuclear arsenal, enabling the construction of weapons with the potential to end human civilisation. With his characteristic blend of scientific clarity and storytelling, Steve Olson asks why Hanford has been largely overlooked in histories of the Manhattan Project and the Cold War. Olson, who grew up just twenty miles from Hanford's B Reactor, recounts how a small Washington town played host to some of the most influential scientists and engineers in American history as they sought to create the substance at the core of the most destructive weapons ever created. The Apocalypse Factory offers a new generation this dramatic story of human achievement and ultimately, of lethal hubris. *2020 marks the 75th anniversary of the United States' detonation of nuclear weapons over the Japanese cities of Hiroshima and Nagasaki on 6 and 9 August 1945.

It began with plutonium, the first element ever manufactured in quantity by humans. Fearing that the Germans would be the first to weaponise the atom, the United States marshalled brilliant minds and seemingly inexhaustible bodies to find a way to create a nuclear chain reaction of inconceivable explosive power. In a matter of months, the Hanford nuclear facility was built to produce the enigmatic and deadly new material that would fuel atomic bombs. In the desert of eastern Washington State, far from prying eyes, scientists Glenn Seaborg, Enrico Fermi and thousands of others-the physicists, engineers, labourers and support staff at the facility-manufactured plutonium for the bomb dropped on Nagasaki, and for the bombs in the current American nuclear arsenal, enabling the construction of weapons with the potential to end human civilisation. With his characteristic blend of scientific clarity and storytelling, Steve Olson asks why Hanford has been largely overlooked in histories of the Manhattan Project and the Cold War. Olson, who grew up just twenty miles from Hanford's B Reactor, recounts how a small Washington town played host to some of the most influential scientists and engineers in American history as they sought to create the substance at the core of the most destructive weapons ever created. The Apocalypse Factory offers a new generation this dramatic story of human achievement and ultimately, of lethal hubris.

Most people know Greg Graffin as the lead singer of the punk band Bad Religion, but few know that he also received a PhD from Cornell University and teaches evolution at the University of California at Los Angeles. In "Anarchy Evolution," Graffin argues that art and science have a deep connection. As an adolescent growing up when "drugs, sex, and trouble could be had on any given night," Graffin discovered that the study of evolution provided a framework through which he could make sense of the world.

In this provocative and personal book, he describes his own coming of age as an artist and the formation of his naturalist worldview on questions involving God, science, and human existence. While the battle between religion and science is often displayed in the starkest of terms, "Anarchy Evolution" provides fresh and nuanced insights into the long-standing debate about atheism and the human condition. It is a book for anyone who has ever wondered if God really exists.

For months in early 1980, scientists, journalists and ordinary people listened anxiously to rumblings in the long quiescent volcano Mount St. Helens. Still, when a massive explosion took the top off the mountain, no one was prepared. Fifty-seven people died and the lives of many others were changed forever. Steve Olson interweaves history, science and vivid personal stories to portray the disaster as a multi-faceted turning point. Powerful economic, political and historical forces influenced who died when the volcano erupted. The eruption of Mount St. Helens transformed volcanic science, the study of environmental resilience and our perceptions of how to survive on an increasingly dangerous planet.

For months in early 1980, scientists, journalists and ordinary people listened anxiously to rumblings in the long quiescent volcano Mount St. Helens. Still, when a massive explosion took the top off the mountain, no one was prepared. Fifty-seven people died and the lives of many others were changed forever. Steve Olson interweaves history, science and vivid personal stories to portray the disaster as a multi-faceted turning point. Powerful economic, political and historical forces influenced who died when the volcano erupted. The eruption of Mount St. Helens transformed volcanic science, the study of environmental resilience and our perceptions of how to survive on an increasingly dangerous planet.

Oral health care and medical health care both seek to maintain and enhance human health and well-being. Yet, dentistry and primary care in the United States are largely separated and isolated from each other. Each has its own siloed systems for education, service delivery, financing, and policy oversight. The result has been duplication of effort, a cultural gap between the two professions, and lost opportunities for productive collaboration and better health. On December 6, 2018, in Washington, DC, the National Academies of Sciences, Engineering, and Medicine held a workshop titled Integrating Oral and General Health Through Health Literacy Practices. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction and Overview 2 Integrating Oral Health, Primary Care, and Health Literacy 3 Systems Thinking, Integration, and Health Literacy as a Catalyst 4 Health Literacy and Care Integration 5 Exploring Pathways to Integration 6 Developing a Research Agenda for Integration 7 Reflections on the Workshop References Appendix A Workshop Agenda Appendix B Biographical Sketches

More than 2 million Americans below age 24 self-identify as being of American Indian or Alaska Native descent. Many of the serious behavioral, emotional, and physical health concerns facing young people today are especially prevalent with Native youth (e.g., depression, violence, and substance abuse). Adolescent Native Americans have death rates two to five times the rate of whites in the same age group because of higher levels of suicide and a variety of risky behaviors (e.g., drug and alcohol use, inconsistent school attendance). Violence, including intentional injuries, homicide, and suicide, accounts for three-quarters of deaths for Native American youth ages 12 to 20. Suicide is the second leading cause of death?and 2.5 times the national rate?for Native youth ages 15 to 24. Arrayed against these health problems are vital cultural strengths on which Native Americans can draw. At a workshop held in 2012, by the National Academies of Sciences, Engineering, and Medicine, presenters described many of these strengths, including community traditions and beliefs, social support networks, close-knit families, and individual resilience. In May 2014, the Academies held a follow-up workshop titled Advancing Health Equity for Native American Youth. Participants discussed issues related to (1) the visibility of racial and ethnic disparities in health and health care as a national problem, (2) the development of programs and strategies by and for Native and Indigenous communities to reduce disparities and build resilience, and (3) the emergence of supporting Native expertise and leadership. This report summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction and Themes of the Workshop 2 Voices of Native Youth 3 Contributors to Resilience 4 Health and Well-Being 5 Addressing Health Disparities Through Education 6 Concluding Comments References Appendix A: Workshop Agenda Appendix B: Speaker Biographies Appendix C: Resources

Since 1965 the foreign-born population of the United States has swelled from 9.6 million or 5 percent of the population to 45 million or 14 percent in 2015. Today, about one-quarter of the U.S. population consists of immigrants or the children of immigrants. Given the sizable representation of immigrants in the U.S. population, their health is a major influence on the health of the population as a whole. On average, immigrants are healthier than native-born Americans. Yet, immigrants also are subject to the systematic marginalization and discrimination that often lead to the creation of health disparities. To explore the link between immigration and health disparities, the Roundtable on the Promotion of Health Equity held a workshop in Oakland, California, on November 28, 2017. This summary of that workshop highlights the presentations and discussions of the workshop. Table of Contents Front Matter 1 Introduction 2 The Past and Present of U.S. Immigration Policy 3 Immigration and the Social Determinants of Health 4 The Voices of Immigrants 5 Reflections on the Workshop References Appendix A: Workshop Agenda Appendix B: Speaker Biographical Sketches Appendix C: World Caf Organizations Appendix D: Statement of Task

Increasing numbers of evidence-based interventions have proven effective in preventing and treating behavioral disorders in children. However, the adoption of these interventions in the health care system and other systems that affect the lives of children has been slow. Moreover, with few exceptions, current training in many fields that involve the behavioral health of children falls short of meeting the needs that exist. In general, this training fails to recognize that behavioral health disorders are among the largest challenges in child health and that changing cognitive, affective, and behavioral health outcomes for children will require new and more integrated forms of care at a population level in the United States. To examine the need for workforce development across the range of health care professions working with children and families, as well as to identify innovative training models and levers to enhance training, the Forum on Promoting Children's Cognitive, Affective, and Behavioral Health held a workshop in November 2016. Workshop panelists and participants discussed the needs for workforce development across the range of health care professions working with children, youth, and families, and identified innovative training models and levers for change to enhance training. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction and Overview 2 Perspectives from Parents 3 The National Landscape of Health Care Training and Workforce Processes 4 Promising Models 5 Accreditation, Certification, and Credentialing 6 Other Child-Serving Settings 7 Collaborative Efforts 8 Possible Next Steps and Reflections on the Workshop References Appendix A: Workshop Statement of Task Appendix B: Workshop Agenda Appendix C: Poster Session Abstracts Appendix D: Biographical Sketches of Planning Committee Members, Workshop Speakers, and Moderators

After decades of increases in the obesity rate among U.S. adults and children, the rate recently has dropped among some populations, particularly young children. What are the factors responsible for these changes? How can promising trends be accelerated? What else needs to be known to end the epidemic of obesity in the United States? To examine these and other pressing questions, the Roundtable on Obesity Solutions, of the National Academies of Sciences, Engineering, and Medicine, held a workshop in September 2016. The workshop brought together leaders from business, early care and education, government, health care, and philanthropy to discuss the most promising approaches for the future of obesity prevention and treatment. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Obesity Trends and Workshop Overview 2 Two Decades of Obesity Prevention and Treatment 3 Early Care and Education 4 Business 5 Physical Activity 6 Treatment Challenges 7 Roles of the U.S. Department of Agriculture 8 The Roles of Foundations References Appendix A: Workshop Agenda Appendix B: Acronyms and Abbreviations Appendix C: Speaker and Facilitator Biographies

Even as the U.S. population becomes steadily more diverse, minorities and women remain underrepresented in clinical trials to develop new drugs and medical devices. Although progress in increasing minority participation in clinical trials has occurred, participation rates do not fully represent the overall population of minorities in the United States. This underrepresentation threatens the health of both these populations and the general population, since greater minority representation could reveal factors that affect health in all populations. Federal legislation has sought to increase the representation of minorities and women in clinical trials, but legislation by itself has not been sufficient to overcome the many barriers to greater participation. Only much broader changes will bring about the meaningful participation of all population groups in the clinical research needed to improve health. To examine the barriers to participation in clinical trials and ways of overcoming those barriers, the National Academies of Sciences, Engineering, and Medicine held a workshop in April 2015. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction and Highlights of the Workshop 2 Historical Perspectives and Context 3 Scientific Issues: Clinically Meaningful Inclusion 4 Recruitment and Retention Issues: Patient, Provider, Institutional, and System Barriers 5 Potential Best Practices and Policy Options References Appendix A: Workshop Agenda Appendix B: Speaker Biographical Sketches Appendix C: Statement of Task

California and other wildfire-prone western states have experienced a substantial increase in the number and intensity of wildfires in recent years. Wildlands and climate experts expect these trends to continue and quite likely to worsen in coming years. Wildfires and other disasters can be particularly devastating for vulnerable communities. Members of these communities tend to experience worse health outcomes from disasters, have fewer resources for responding and rebuilding, and receive less assistance from state, local, and federal agencies. Because burning wood releases particulate matter and other toxicants, the health effects of wildfires extend well beyond burns. In addition, deposition of toxicants in soil and water can result in chronic as well as acute exposures. On June 4-5, 2019, four different entities within the National Academies of Sciences, Engineering, and Medicine held a workshop titled Implications of the California Wildfires for Health, Communities, and Preparedness at the Betty Irene Moore School of Nursing at the University of California, Davis. The workshop explored the population health, environmental health, emergency preparedness, and health equity consequences of increasingly strong and numerous wildfires, particularly in California. This publication is a summary of the presentations and discussion of the workshop. Table of Contents Front Matter 1 Introduction and Overview 2 California Wildfires: Past and Future 3 Populations Impacted by Wildfires 4 Effects of Wildfires on Human Health 5 The Trials of Recovery 6 Enhancing Operational Response 7 The Impact of Mitigation and Preparedness 8 Reflections on the Workshop References Appendix A: Workshop Statement of Task Appendix B: Workshop Agenda Appendix C: Speaker and Planning Committee Biosketches

There are many connections between human communities and their surrounding environments that influence community resilience and health in the Gulf of Mexico. The impacts of the Deepwater Horizon oil spill on Gulf communities and ecosystems - coupled with the region's preexisting health challenges and environmental stressors - illustrate the need to better understand these connections. In the future, natural and man-made disasters, climate change impacts, and other environmental stressors will present complex challenges to the physical, mental, and social well-being of communities in the Gulf. Understanding the interrelationships among health, ecological, and economic impacts of disasters and other environmental stressors will be crucial to addressing these challenges. Opportunities for the Gulf Research Program: Community Resilience and Health summarizes a Gulf Research Program workshop held on September 22-23, 2014, in New Orleans, Louisiana. The workshop examined opportunities to improve the health, well-being, and resilience of communities in the Gulf region through discussions with about 50 participants with diverse expertise and experience. These discussions identified perceived needs, challenges, and opportunities that align with the Gulf Research Program's mission and goals - particularly its goal to improve understanding of the connections between human health and the environment to support the development of health and resilient Gulf communities. This workshop is expected to lead to the development of additional Program activities and opportunities for the research community. Table of Contents Front Matter 1 Introduction 2 Human Health, Public Health Practice, and Community Resilience 3 Perspectives on Resilient Communities 4 Reducing Risk and Improving Disaster Recovery 5 Building Resilience in the Gulf Region 6 Capacity to Address Environmental Health Risks 7 Long-term Opportunities 8 Lasting Benefit References A--Workshop Agenda B--Statement of Task C--Speaker Biographies D--Workshop Attendees E--Related Funding Programs

Science, technology, engineering, and mathematics (STEM) permeate the modern world. The jobs people do, the foods they eat, the vehicles in which they travel, the information they receive, the medicines they take, and many other facets of modern life are constantly changing as STEM knowledge steadily accumulates. Yet STEM education in the United States, despite the importance of these subjects, is consistently falling short. Many students are not graduating from high school with the knowledge and capacities they will need to pursue STEM careers or understand STEM-related issues in the workforce or in their roles as citizens. For decades, efforts to improve STEM education have focused largely on the formal education system. Learning standards for STEM subjects have been developed, teachers have participated in STEM-related professional development, and assessments of various kinds have sought to measure STEM learning. But students do not learn about STEM subjects just in school. Much STEM learning occurs out of school-in organized activities such as afterschool and summer programs, in institutions such as museums and zoos, from the things students watch or read on television and online, and during interactions with peers, parents, mentors, and role models. To explore how connections among the formal education system, afterschool programs, and the informal education sector could improve STEM learning, a committee of experts from these communities and under the auspices of the Teacher Advisory Council of the National Research Council, in association with the California Teacher Advisory Council organized a convocation that was held in February 2014. Entitled "STEM Learning Is Everywhere: Engaging Schools and Empowering Teachers to Integrate Formal, Informal, and Afterschool Education to Enhance Teaching and Learning in Grades K-8," the convocation brought together more than 100 representatives of all three sectors, along with researchers, policy makers, advocates, and others, to explore a topic that could have far-reaching implications for how students learn about STEM subjects and how educational activities are organized and interact. This report is the summary of that meeting. STEM Learning is Everywhere explores how engaging representatives from the formal, afterschool, and informal education sectors in California and from across the United States could foster more seamless learning of STEM subjects for students in the elementary and middle grades. The report also discusses opportunities for STEM that may result from the new expectations of the Next Generation Science Standards and the Common Core Standards for Mathematics and Language Arts. Table of Contents Front Matter 1 Introduction to the Convocation 2 Envisioning the Possible 3 Achieving the Vision 4 Implications for Research and Policy 5 Breakout Sessions by Topic 6 Breakout Sessions by Sector 7 Comments from Convocation Participants References Appendix A: Convocation Agenda Appendix B: Convocation Attendees Appendix C: Brief Biographies of Committee Members and Presenters

Suicide prevention initiatives are part of much broader systems connected to activities such as the diagnosis of mental illness, the recognition of clinical risk, improving access to care, and coordinating with a broad range of outside agencies and entities around both prevention and public health efforts. Yet suicide is also an intensely personal issue that continues to be surrounded by stigma. On September 11-12, 2018, the National Academies of Sciences, Engineering, and Medicine held a workshop in Washington, DC, to discuss preventing suicide among people with serious mental illness. The workshop was designed to illustrate and discuss what is known, what is currently being done, and what needs to be done to identify and reduce suicide risk. Improving Care to Prevent Suicide Among People with Serious Mental Illness summarizes presentations and discussions of the workshop. Table of Contents Front Matter 1 Introduction and Overview 2 Patterns of Risk and the Prevention Landscape 3 Suicide Prevention in Health Care Systems 4 Military Service Members and Veterans 5 Native Americans and Alaska Natives 6 Connecting Prevention Along the Continuum of Care 7 Perspectives on the Future Along the Continuum 8 Ideas from the Breakout Sessions 9 Reflections on the Workshop Appendix A: Workshop Agenda Appendix B: Biographical Sketches

The Roundtable on Obesity Solutions of the National Academies of Sciences, Engineering, and Medicine held a workshop in Washington, DC, on April 6, 2017, titled The Challenge of Treating Obesity and Overweight: A Workshop. The discussions covered treatments for obesity, overweight, and severe obesity in adults and children; emerging treatment opportunities; the development of a workforce for obesity treatments; payment and policy considerations; and promising paths to move forward. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction 2 Treatment of Obesity and Overweight in Adults 3 Treatment of Obesity and Overweight in Children and Adolescents 4 Treating Severe Obesity in Adults 5 Treating Severe Obesity in Adolescents and Children 6 Emerging Opportunities 7 Workforce and Training 8 Payment Considerations 9 Policy Considerations 10 Involving Communities and Individuals References Appendix A: Workshop Agenda Appendix B: Acronyms and Abbreviations Appendix C: Speaker and Facilitator Biographies

Children with disabilities and complex medical and educational needs present a special challenge for policy makers and practitioners. These children exhibit tremendous heterogeneity in their conditions and needs, requiring a varied array of services to meet those needs. Uneven public and professional awareness of their conditions and a research base marked by significant gaps have led to programs, practices, and policies that are inconsistent in quality and coverage. Parents often have to navigate and coordinate, largely on their own, a variety of social, medical, and educational support services, adding to the already daunting financial, logistical, and emotional challenges of raising children with special needs. The unmet needs of children with disabilities and complex medical and educational needs can cause great suffering for these children and for those who love and care for them. To examine how systems can be configured to meet the needs of children and families as they struggle with disabilities and complex health and educational needs, the National Academies of Sciences, Engineering, and Medicine held a workshop in December 2015. The goal of the workshop was to highlight the main barriers and promising solutions for improving care and outcome of children with complex medical and educational needs. Workshop participants examined prevention, care, service coordination, and other topics relevant to children with disabilities and complex health and educational needs, along with their families and caregivers. More broadly, the workshop seeks actionable understanding on key research questions for enhancing the evidence base; promoting and sustaining the quality, accessibility, and use of relevant programs and services; and informing relevant policy development and implementation. By engaging in dialogue to connect the prevention, treatment, and implementation sciences with settings where children are seen and cared for, the forum seeks to improve the lives of children by improving the systems that affect those children and their families. This publications summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction and Overview of the Workshop 2 Perspectives from Individuals and Family Members 3 Disability Names and Numbers 4 Children with Serious Medical Conditions and the Behavioral Health Implications 5 Early Identification and Interventions for Developmental Disabilities Emerging in Childhood 6 Early Identification and Interventions for Youth and Adolescents with Serious Behavioral Health Conditions 7 Media and Public Perceptions and Misperceptions of Children with Disabilities 8 Breakout Groups and the Reflections of Moderators References Appendix A: Workshop Statement of Task Appendix B: Workshop Agenda Appendix C: Biosketches of Workshop Speakers and Moderators

A critical component of the nation's economic vitality is ensuring that all Americans can contribute and prosper. Such contributions presuppose an intentional focus on achieving the highest levels of health possible, which requires that conditions in communities, schools workplaces, and other settings promote health and address the social determinants of health for all community members. Many organizations, in both the private and public sectors, have been establishing partnerships to further healthy workplaces and health equity in general. Many are taking the lead in producing economic growth that is inclusive and responsive to the nation's diverse needs and populations. Increasingly, private?public partnerships are emerging as ways of doing business. Additionally, a variety of new developments in health, health care, and community benefits obligations that are part of the Affordable Care Act have contributed to this interest in economic growth and health and in the creation of new partnerships. To examine past successes and future opportunities, the National Academies of Sciences, Engineering, and Medicine held a workshop in November 2015. The workshop focused on the potential of the private sector to produce a triple bottom line: economic opportunity (including workforce development) and growth, healthy work and community environments, and improved employee health. At the same time, participants looked beyond the private sector to public?private partnerships and to public-sector actions that combine opportunities for economic growth and good health for all. This publication summarizes the presentations and discussions from the workshop. Table of Contents Front Matter 1 Introduction and Organization of the Workshop 2 Paying Attention to Disparities 3 Workforce Development Initiatives in the Chicago Area 4 Health Care Opportunities 5 Community-Based Initiatives 6 Major Topics of the Workshop Appendix A: World Caf Models Appendix B: Workshop Agenda Appendix C: Speaker Biographical Sketches Appendix D: Statement of Task

Health care is in the midst of a dramatic transformation in the United States. Spurred by technological advances, economic imperatives, and governmental policies, information technologies are rapidly being applied to health care in an effort to improve access, enhance quality, and decrease costs. At the same time, the use of technologies by the consumers of health care is changing how people interact with the health care system and with health information. These changes in health care have the potential both to exacerbate and to diminish the stark disparities in health and well-being that exist among population groups in the United States. If the benefits of technology flow disproportionately to those who already enjoy better coverage, use, and outcomes than disadvantaged groups, heath disparities could increase. But if technologies can be developed and implemented in such a way to improve access and enhance quality for the members of all groups, the ongoing transformation of health care could reduce the gaps among groups while improving health care for all. To explore the potential for further insights into, and opportunities to address, disparities in underserved populations the National Academies of Sciences, Engineering, and Medicine held a workshop in October 2014. The workshop focused on (1) how communities are using digital health technologies to improve health outcomes for racial and ethnic minority populations, (2) how community engagement can improve access to high-quality health information for members of these groups, and (3) on models of successful technology-based strategies to reduce health disparities. This report summarizes the presentations and discussions at the workshop. Table of Contents Front Matter 1 Introduction of the Workshop 2 Technology and Health Disparities 3 Engaging Providers and Racial/Ethnic Minority Patients in Digital Strategies 4 Examples of Engaging Racial/Ethnic Minority Communities in Digital Health Strategies 5 Policy and Technology Perspectives 6 Synthesis of Workshop Messages References Appendix A: Examples of eHealth Solutions Featured at the Workshop Appendix B: Workshop Agenda Appendix C: Speaker Biographical Sketches

Engineering is poised to make an even greater contribution to society in the next half century than it has made in the past half century. At its annual meeting on September 28-29, 2014, the National Academy of Engineering celebrated the 50th anniversary of its founding. A highlight of the meeting was a forum of distinguished speakers who considered the achievements of the last 50 years and looked toward the potential achievements of the next 50. The Past Half Century of Engineering - and a Look Forward summarizes their presentations. Table of Contents Front Matter 1 Learning from Adversity: Innovation on the Final Frontier 2 Earth as a Resource 3 The Seeds of the Internet - and Its Future 4 The Great Engineering Advances of the 21st Century 5 Energy in the 21st Century 6 Engineering and Medicine 7 Fifty Years of Materials Science 8 Expanding the Community of Innovators Appendix A: Forum Agenda Appendix B: Biographical Information

Many health care providers do not have either the knowledge or the tools they need in order to apply genetic information in their day-to-day practices. This lack of support is contributing to a substantial delay in the translation of genetic research findings, when appropriate, into improvement in patient outcomes within the health care system. Although the need to improve genetics knowledge among health care providers is clear, the best approaches to educating health care providers in a way that produces meaningful changes in clinical practice are not, especially given the competing coursework and training needs that exist in today's increasingly complex health care settings. To examine the potential and the challenges of providing genetics education, the Roundtable on Translating Genomic-Based Research for Health of the Institute of Medicine hosted a workshop on August 18, 2014. The workshop examined a variety of approaches that could improve the teaching of genetics in the graduate and continuing education of health professionals; these approaches included online and interactive instruction, just-in-time approaches, the development of clinical decision-support tools, and the incorporation of genetics requirements into licensing and accreditation. This report summarizes the presentations and discussion of the event. Table of Contents Front Matter 1 Introduction and Themes of the Workshop 2 Myths and Mistakes in Graduate and Continuing Medical Education 3 Educational Approaches 4 Graduate Health Professional Education and Post-Graduate Training 5 Continuing Medical Education 6 Next Steps to Achieve Effective Genetics Education for Health Professionals References Appendix A: Workshop Agenda Appendix B: Speaker Biographical Sketches Appendix C: Statement of Task Appendix D: Registered Attendees

For the first time in decades, promising news has emerged regarding efforts to curb the obesity crisis in the United States. Obesity rates have fallen among low-income children in 18 states, the prevalence of obesity has plateaued among girls, regardless of ethnicity, and targeted efforts in states such as Massachusetts have demonstrably reduced the prevalence of obesity among children. Although the reasons for this turnaround are as complex and multifaceted as the reasons for the dramatic rise in obesity rates in recent decades, interventions to improve nutrition and increase physical activity are almost certainly major contributors. Yet major problems remain. Diseases associated with obesity continue to incur substantial costs and cause widespread human suffering. Moreover, substantial disparities in obesity rates exist among population groups, and in some cases these disparities are widening. Some groups and regions are continuing to experience increases in obesity rates, and the prevalence of severe obesity is continuing to rise. The Current State of Obesity Solutions in the United States is the summary of a workshop convened in January 2014 by the Institute of Medicine Roundtable on Obesity Solutions to foster an ongoing dialogue on critical and emerging implementation, policy, and research issues to accelerate progress in obesity prevention and care. Representatives of public health, health care, government, the food industry, education, philanthropy, the nonprofit sector, and academia met to discuss interventions designed to prevent and treat obesity. The workshop focused on early care and education, schools, worksites, health care institutions, communities and states, the federal government, and business and industry. For each of these groups, this report provides an overview of current efforts to improve nutrition, increase physical activity, and reduce disparities among populations. Table of Contents Front Matter 1 Introduction 2 Current Epidemiology of Obesity in the United States 3 Early Care and Education 4 Schools 5 Worksites 6 Health Care 7 Communities and States 8 The Federal Government 9 Businesses and Industry 10 Closing Remarks References Appendix A: Workshop Agenda Appendix B: Speaker Biographical Sketches

Many drug developers have examined new strategies for creating efficiencies in their development processes, including the adoption of genomics-based approaches. Genomic data can identify new drug targets for both common and rare diseases, can predict which patients are likely to respond to a specific treatment, and has the potential to significantly reduce the cost of clinical trials by reducing the number of patients that must be enrolled in order to demonstrate safety and efficacy. A key component of the approval of targeted therapeutics is the ability to identify the population of patients who will benefit from treatment, and this has largely hinged on the co-development and co-submission to the FDA of a companion diagnostic test.The co-development process, or the development of the test and drug for the simultaneous submission to FDA, has led to a major alteration in the way that drugs are being developed, with traditionally separate entities-pharmaceutical and diagnostic companies-now working in close collaboration. Refining Processes for the Co-Development of Genome-Based Therapeutics and Companion Diagnostic Tests is the summary of a workshop held by the Roundtable on Translating Genomic-Based Research for Health on February 27, 2013 to examine and discuss challenges and potential solutions for the codevelopment of targeted therapeutics and companion molecular tests for the prediction of drug response. Prior to the workshop, key stakeholders, including laboratory and medical professional societies, were individually asked to provide possible solutions to resolve the concerns raised about co-development of companion diagnostic tests and therapies. Workshop speakers were charged with addressing these solutions in their presentations by providing insight on (1) whether the proposed solutions address the problems described, (2) whether there are other solutions to propose, and (3) what steps could be taken to effectively implement the proposed solutions. Table of Contents Front Matter 1 Introduction 2 Regulatory Perspectives 3 Perspectives from Patients, Providers, and Laboratory Representatives 4 Perspectives of Diagnostic Test and Pharmaceutical Developers 5 Perspectives of Payers and Regulators 6 Concluding Observations References Appendix A: Workshop Agenda Appendix B: Speaker Biographical Sketches Appendix C: Statement of Task Appendix D: Registered Attendees

America's national parks provide a wealth of experiences to millions of people every year. What visitors see-landscapes, wildlife, cultural activities-often lingers in memory for life. And what they hear adds a dimension that sight alone cannot provide. Natural sounds can dramatically enhance visitors' experience of many aspects of park environments. In some settings, such as the expanses of Yellowstone National Park, they can even be the best way to enjoy wildlife, because animals can be heard at much greater distances than they can be seen. Sounds can also be a natural complement to natural scenes, whether the rush of water over a rocky streambed or a ranger's explanation of a park's history. In other settings, such as the New Orleans Jazz National Historical Park, sounds are the main reason for visiting a park. The acoustical environment is also important to the well-being of the parks themselves. Many species of wildlife depend on their hearing to find prey or avoid predators. If they cannot hear, their survival is jeopardized-and the parks where they live may in turn lose part of their natural heritage. For all these reasons it is important to be aware of noise (defined as unwanted sound, and in this case usually generated by humans or machinery), which can degrade the acoustical environment, or soundscape, of parks. Just as smog smudges the visual horizon, noise obscures the listening horizon for both visitors and wildlife. This is especially true in places, such as remote wilderness areas, where extremely low sound levels are common. The National Park Service (NPS) has determined that park facilities, operations, and maintenance activities produce a substantial portion of noise in national parks and thus recognizes the need to provide park managers with guidance for protecting the natural soundscape from such noise. Therefore, the focus of the workshop was to define what park managers can do to control noise from facilities, operations, and maintenance, and not on issues such as the effects of noise on wildlife, noise metrics, and related topics. To aid in this effort, NPS joined with the National Academy of Engineering (NAE) and with the US Department of Transportation's John A. Volpe National Transportation Systems Center to hold a workshop to examine the challenges and opportunities facing the nation's array of parks. Entitled "Protecting National Park Soundscapes: Best Available Technologies and Practices for Reducing Park- Generated Noise," the workshop took place October 3-4, 2012, at NPS's Natural Resource Program Center in Fort Collins, Colorado. Protecting National Park Soundscapes is a summary of the workshop. Table of Contents Front Matter 1 Introduction and Themes of the Workshop 2 Noise in the National Parks 3 Report from the Transportation Breakout Group 4 Report from the Facilities and Maintenance Breakout Group 5 Report from the Construction Breakout Group 6 Reflections on the Workshop References Appendix A: Workshop Steering Committee Biographical Information Appendix B: Workshop Agenda Appendix C: Workshop Attendees

The #1 best-seller on franchise development and Amazon #1 best-seller, Grow to Greatness has instantly become the must-read, essential guide on how to build a world-class franchise system faster. This breakthrough book delivers advice and proven, step-by-step systems and processes for emerging and established franchisors, as well as for anyone considering franchising their business. The $29.95 guide has saved existing and potential franchisors thousands of dollars in costly mistakes. -- One hundred+ case examples and checklists reveal how to do it right ... and how not to do it wrong -- Profit from real "best practices" solutions and proven step-by-step processes -- Endorsed by franchising's top brand executives of KFC, Taco Bell, Dunkin' Donuts, Pinkberry, Molly Maids, Postnet, Checkers, AlphaGraphics, Popeye's, Cartridge World, Express Employment Professionals, the International Franchise Association ... and many more. Each benchmark is described in detail, supported by case studies, industry research and steps taken by franchise leaders from various industries. " Steve's Grow to Greatness is the 'Driver's Ed Manual'. It delivers great lessons for startup franchisors and the most seasoned franchise executives. In the words of Bill Rosenberg, founder of Dunkin' Donuts and the International Franchise Association, 'We can avoid failures, if we study success.' Study Grow to Greatness and you will be rewarded." John Reynolds, CFE President, IFA Educational Foundation