Author: New From NAP

Collecting Sexual Orientation and Gender Identity Data in Electronic Health Records: Workshop Summary reviews the statement of task set to the committee which required them to collect sexual orientation and gender identity data in electronic health records. This report summarizes the invited presentations and facilitated discussions about current practices around sexual orientation and gender identity data collection, the challenges in collecting these data, and ways in which these challenges can be overcome.

Areas of focus for the workshop include the clinical rationale behind collecting these data, standardized questions that can be used to collect these data, mechanisms for supporting providers and patients in the collection of these data, technical specifications involved in creating standards for sexual orientation and gender identity data collection and exchange, and policy considerations related to the health information technology (HIT) Meaningful Use process being overseen by the Department of Health and Human Services. This report summarizes the workshop agenda, select invited speakers and discussants, and moderate the discussions. Invited participants will include lesbian, gay, bisexual, and transgender (LGBT) health care consumer advocates, providers with experience working with LGBT populations, HIT vendors and other HIT specialists, health care administrators, and policy makers.

On May 23, 2012, the Roundtable on Technology, Science, and Peacebuilding convened a workshop at the United States Institute of Peace (USIP) to investigate data sharing as a means of improving coordination among US government and nongovernment stakeholders involved in peacebuilding and conflict management activities. Using Data Sharing to Improve Coordination in Peacebuilding:Report of a Workshop by the National Academy of Engineering and the United States Institute of Peace: Roundtable on Technology, Science, and Peacebuilding addresses the following question: What needs must a data sharing system address to create more effective coordination in conflict zones and to promote the participation of federal agencies and nonfederal organizations in Peacebuilding?

In addition, the workshop served as a means to obtain feedback on the UNITY system, a data-sharing platform developed by the Department of Defense (DOD) and the United States Agency for International Development (USAID). The Roundtable was established in 2011 as a partnership between USIP and the National Academy of Engineering (NAE) to make a measurable and positive impact on conflict management, peacebuilding, and security capabilities by bringing together leaders from the technical and peacebuilding communities. Its members are senior executives and experts from leading governmental organizations, universities, corporations, and nongovernmental organizations.

Its principal goals are: 1. To accelerate the application of science and technology to the process of peacebuilding and stabilization; 2. To promote systematic, high-level communication between peacebuilding and technical organizations on the problems faced and the technical capabilities required for successful peacebuilding; and 3. To collaborate in applying new science and technology to the most pressing challenges faced by local and international peacebuilders working in conflict zones. The Roundtable is strongly committed to action-oriented projects, and the long-term goal of each is to demonstrate viability with a successful field trial. The Roundtable has selected a portfolio of high-impact peacebuilding problems on which to focus its efforts: 1. Adapting agricultural extension services to peacebuilding, 2.Using data sharing to improve coordination in peacebuilding, 3. Sensing emerging conflicts, and 4. Harnessing systems methods for delivery of peacebuilding services.

Biofuels made from algae are gaining attention as a domestic source of renewable fuel. However, with current technologies, scaling up production of algal biofuels to meet even 5 percent of U.S. transportation fuel needs could create unsustainable demands for energy, water, and nutrient resources. Continued research and development could yield innovations to address these challenges, but determining if algal biofuel is a viable fuel alternative will involve comparing the environmental, economic and social impacts of algal biofuel production and use to those associated with petroleum-based fuels and other fuel sources. Sustainable Development of Algal Biofuels was produced at the request of the U.S. Department of Energy.

Higher education is a linchpin of the American economy and society: teaching and research at colleges and universities contribute significantly to the nation’s economic activity, both directly and through their impact on future growth; federal and state governments support teaching and research with billions of taxpayers’ dollars; and individuals, communities, and the nation gain from the learning and innovation that occur in higher education.

In the current environment of increasing tuition and shrinking public funds, a sense of urgency has emerged to better track the performance of colleges and universities in the hope that their costs can be contained without compromising quality or accessibility. Improving Measurement of Productivity in Higher Education presents an analytically well-defined concept of productivity in higher education and recommends empirically valid and operationally practical guidelines for measuring it. In addition to its obvious policy and research value, improved measures of productivity may generate insights that potentially lead to enhanced departmental, institutional, or system educational processes.

Improving Measurement of Productivity in Higher Education constructs valid productivity measures to supplement the body of information used to guide resource allocation decisions at the system, state, and national levels and to assist policymakers who must assess investments in higher education against other compelling demands on scarce resources. By portraying the productive process in detail, this report will allow stakeholders to better understand the complexities of–and potential approaches to–measuring institution, system and national-level performance in higher education.

In September 2010, the White House Office of National AIDS Policy commissioned an Institute of Medicine (IOM) committee to respond to a two-part statement of task concerning how to monitor care for people with HIV. The IOM convened a committee of 17 members with expertise in HIV clinical care and supportive services, epidemiology, biostatistics, health policy, and other areas to respond to this task. The committee’s first report, Monitoring HIV Care in the United States: Indicators and Data Systems, was released in March 2012. The report identified 14 core indicators of clinical HIV care and mental health, substance abuse, and supportive services for use by the Department of Health and Human Services (HHS) to monitor the impact of the National HIV/AIDS Strategy (NHAS) and the Patient Protection and Affordable Care Act (ACA) on improvements in HIV care and identified sources of data to estimate the indicators.

The report also addressed a series of questions related to the collection, analysis, and dissemination of data necessary to estimate the indicators.
In this second report, Monitoring HIV Care in the United States: A Strategy for Generating National Estimates of HIV Care and Coverage, the committee addresses how to obtain national estimates that characterize the health care of people with HIV within the context of the ACA, both before 2014 and after 2014, when key provisions of the ACA will be implemented. This report focuses on how to monitor the anticipated changes in health care coverage, service utilization, and quality of care for people with HIV within the context of the ACA.

To effectively treat patients diagnosed with drug-resistant (DR) tuberculosis (TB) and protect the population from further transmission of this infectious disease, an uninterrupted supply of quality-assured (QA), second-line anti-TB drugs (SLDs) is necessary. Patients diagnosed with multidrug-resistant tuberculosis (MDR TB)—a disease caused by strains of Mycobacterium tuberculosis (M.tb.) resistant to two primary TB drugs (isoniazid and rifampicin)—face lengthy treatment regimens of 2 years or more with daily, directly observed treatment (DOT) with SLDs that are less potent, more toxic, and more expensive than those used to treat drug-susceptible TB. From 2000 to 2009, only 0.2-0.5 percent of the estimated 5 million MDR TB cases globally were treated with drugs of known quality and in programs capable of delivering appropriate care (Keshavjee, 2012). The vast majority of MDR TB patients either died from lack of treatment or contributed to the spread of MDR TB in their communities. A strengthened global supply chain for SLDs could save lives by consistently delivering high quality medicines to more of the people who need them.

This public workshop explored innovative solutions to the problem of how to get the right SLDs for MDR TB to people who critically need them. More specifically, the workshop examined current problems and potential opportunities for coordinated international efforts to ensure that a reliable and affordable supply of high-quality SLDs is available. Developing and Strengthening the Global Supply Chain for Second-Line Drugs for Multidrug-Resistant Tuberculosis: Workshop Summary covers the objectives of the workshop, which were to review:

-To what extent and in what ways current mechanisms are or are not effectively accomplishing what is needed, including consideration of bottlenecks.
-The advantages and disadvantages of centralization in the management of the global drug supply chain, and potential decentralized approaches to improve operations of the supply chain.
-What can be learned from case studies and examples from other diseases (e.g., the Affordable Medicines Facility-malaria (AMFm) and the U.S. President’s Emergency Plan for AIDS Relief [PEPFAR])
– The current allocation of responsibilities and roles of the private (including industry and nonprofit public health organizations) and public sectors, and examination of opportunities for enhancing and optimizing collaboration
-Identification of potential innovative solutions to the problem

Americans have long recognized that investments in public education contribute to the common good, enhancing national prosperity and supporting stable families, neighborhoods, and communities. Education is even more critical today, in the face of economic, environmental, and social challenges. Today’s children can meet future challenges if their schooling and informal learning activities prepare them for adult roles as citizens, employees, managers, parents, volunteers, and entrepreneurs. To achieve their full potential as adults, young people need to develop a range of skills and knowledge that facilitate mastery and application of English, mathematics, and other school subjects. At the same time, business and political leaders are increasingly asking schools to develop skills such as problem solving, critical thinking, communication, collaboration, and self-management – often referred to as “21st century skills.”

Education for Life and Work: Developing Transferable Knowledge and Skills in the 21st Century describes this important set of key skills that increase deeper learning, college and career readiness, student-centered learning, and higher order thinking. These labels include both cognitive and non-cognitive skills- such as critical thinking, problem solving, collaboration, effective communication, motivation, persistence, and learning to learn. 21st century skills also include creativity, innovation, and ethics that are important to later success and may be developed in formal or informal learning environments.

This report also describes how these skills relate to each other and to more traditional academic skills and content in the key disciplines of reading, mathematics, and science. Education for Life and Work: Developing Transferable Knowledge and Skills in the 21st Century summarizes the findings of the research that investigates the importance of such skills to success in education, work, and other areas of adult responsibility and that demonstrates the importance of developing these skills in K-16 education. In this report, features related to learning these skills are identified, which include teacher professional development, curriculum, assessment, after-school and out-of-school programs, and informal learning centers such as exhibits and museums.

A committee under the auspices of the Board on Science, Technology, and Economic Policy (STEP), is conducting a study of selected state and regional programs in order to identify best practices with regard to their goals, structures, instruments, modes of operation, synergies across private and public programs, funding mechanisms and levels, and evaluation efforts. The committee is reviewing selected state and regional efforts to capitalize on federal and state investments in areas of critical national needs. Building the Arkansas Innovation Economy: Summary of a Symposium includes both efforts to strengthen existing industries as well as specific new technology focus areas such as nanotechnology, stem cells, and energy in order to better understand program goals, challenges, and accomplishments. As a part of this review, the committee is convening a series of public workshops and symposia involving responsible local, state, and federal officials and other stakeholders. These meetings and symposia will enable an exchange of views, information, experience, and analysis to identify best practice in the range of programs and incentives adopted. Drawing from discussions at these symposia, fact-finding meetings, and commissioned analyses of existing state and regional programs and technology focus areas, the committee will subsequently produce a final report with findings and recommendations focused on lessons, issues, and opportunities for complementary U.S. policies created by these state and regional initiatives.

Since 1991, the National Research Council, under the auspices of the Board on Science, Technology, and Economic Policy, has undertaken a program of activities to improve policymakers’ understandings of the interconnections of science, technology, and economic policy and their importance for the American economy and its international competitive position. The Board’s activities have corresponded with increased policy recognition of the importance of knowledge and technology to economic growth. One important element of STEP’s analysis concerns the growth and impact of foreign technology programs.1 U.S. competitors have launched substantial programs to support new technologies, small firm development, and consortia among large and small firms to strengthen national and regional positions in strategic sectors. Some governments overseas have chosen to provide public support to innovation to overcome the market imperfections apparent in their national innovation systems. They believe that the rising costs and risks associated with new potentially high-payoff technologies, and the growing global dispersal of technical expertise, underscore the need for national R&D programs to support new and existing high-technology firms within their borders.

Since 1991, the National Research Council, under the auspices of the Board on Science, Technology, and Economic Policy, has undertaken a program of activities to improve policymakers’ understandings of the interconnections of science, technology, and economic policy and their importance for the American economy and its international competitive position. The Board’s activities have corresponded with increased policy recognition of the importance of knowledge and technology to economic growth. The goal of the this symposium was to conduct two public symposia to review and analyze the potential contributions of public-private partnerships and identify other relevant issues for the Department of Energy, Office of Vehicle Technologies, Energy Storage Team’s activities in the energy storage research and development area. The symposia will also identify lessons from these and other domestic and international experiences to help inform DoE as to whether its activities are complete and appropriately focused. Additional topics that emerge in the course of the planning may also be addressed. Building the U.S. Battery Industry for Electric Drive Vehicles: Summary of a Symposium gathers representatives from leading battery manufacturers, automotive firms, university researchers, academic and industry analysts, congressional staff, and federal agency representatives. An individually-authored summary of each symposium will be issued.

The symposium was held in Michigan in order to provide direct access to the policymakers and industrial participants drawn from the concentration of battery manufacturers and automotive firms in the region. The symposium reviewed the current state, needs, and challenges of the U.S. advanced battery manufacturing industry; challenges and opportunities in battery R&D, commercialization, and deployment; collaborations between the automotive industry and battery industry; workforce issues, and supply chain development. It also focused on the impact of DoE’s investments and the role of state and federal programs in support of this growing industry. This task of this report is to summarize the presentations and discussions that took place at this symposium. Needless to say, the battery industry has evolved very substantially since the conference was held, and indeed some of the caveats raised by the speakers with regard to overall demand for batteries and the prospects of multiple producers now seem prescient. At the same time, it is important to understand that it is unrealistic to expect that all recipients of local, state, or federal support in a complex and rapidly evolving industry will necessarily succeed. A number of the firms discussed here have been absorbed by competitors, others have gone out of business, and others continue to progress.

The goal of the U.S. Department of Defense’s (DoD’s) Chemical and Biological Defense Program (CBDP) is to provide support and world-class capabilities enabling he U.S. Armed Forces to fight and win decisively in chemical, biological, radiological, and nuclear (CBRN) environments. To accomplish this objective, the CBDP must maintain robust science and technology capabilities to support the research, development, testing, and evaluation required for the creation and validation of the products the program supplies.

The threat from chemical and biological attack evolves due to the changing nature of conflict and rapid advances in science and technology (S&T), so the core S&T capabilities that must be maintained by the CBDP must also continue to evolve. In order to address the challenges facing the DoD, the Deputy Assistant Secretary of Defense (DASD) for Chemical and Biological Defense (CBD) asked the National Research Council (NRC) to conduct a study to identify the core capabilities in S&T that must be supported by the program.

The NRC Committee on Determining Core Capabilities in Chemical and Biological Defense Research and Development examined the capabilities necessary for the chemical and biological defense S&T program in the context of the threat and of the program’s stated mission and priorities. Determining Core Capabilities in Chemical and Biological Defense Science and Technology contains the committee’s findings and recommendations. It is intended to assist the DASD CBD in determining the best strategy for acquiring, developing, and/or maintaining the needed capabilities.

Founded during the Civil War as the Army Medical Museum, the Armed Forces Institute of Pathology (AFIP) amassed the world’s largest collection of human pathologic specimens and was considered a premier consultation, education, and research facility by the end of the 20th century. Samples from the AFIP were instrumental in helping to solve public health mysteries, such as the sequence of the genome of the 1918 influenza virus that killed more than 40 million people worldwide.

In 2005, the federal Base Realignment and Closure Commission recommended that the AFIP be closed, and its biorepository was transferred to the newly created Joint Pathology Center. During the transition, the Department of Defense asked the IOM to provide advice on operating the biorepository, managing its collection, and determining appropriate future use of specimens for consultation, education, and research.

Future Uses of the Department of Defense Joint Pathology Center Biorepository, the IOM proposes a series of protocols, standards, safeguards, and guidelines that could help to ensure that this national treasure continues to be available to researchers in the years to come, while protecting the privacy of the people who provided the materials and maintaining the security of their personal information.

The theme of this international symposium is the promotion of greater sharing of scientific data for the benefit of research and broader development, particularly in the developing world. This is an extraordinarily important topic. Indeed, I have devoted much of my own career to matters related to the concept of openness. I had the opportunity to promote and help build the open courseware program at the Massachusetts Institute of Technology (MIT). This program has made the teaching materials for all 2,000 subjects taught at MIT available on the Web for anyone, anywhere, to use anytime at no cost. In countries where basic broadband was not available, we shipped it in on hard drives and compact disks. Its impact has been worldwide, but it has surely had the greatest impact on the developing world. I am also a trustee of a nonprofit organization named Ithaca that operates Journal Storage (JSTOR) and other entities that make scholarly information available at very low cost.

The culture of science has been international and open for centuries. Indeed, the scientific enterprise can only work when all information is open and accessible, because science works through critical analysis and replication of results. In recent years, as some scientific data, and especially technological data, have increased in economic value frequently has caused us to be far less open with information than business and free enterprise require us to be. Indeed, the worldwide shift to what is known as open innovation is strengthening every day.

Finally, since the end of World War II, the realities of modern military conflict and now terrorism have led governments to restrict information through classification. This is important, but I believe that we classify far too much information. The last thing we need today, at the beginning of the twenty-first century, is further arbitrary limitations on the free flow of scientific information, whether by policies established by governments and businesses, or by lack of information infrastructure. For all these reasons, the international sharing of scientific data is one of the topics of great interest here at the National Academies and has been the subject of many of our past reports. This is the primary reason why this symposium has been co-organized by the NRC’s Policy and Global Affairs Division—the Board on International Scientific Organizations (BISO) and the Board on Research Data and Information (BRDI). The Case for International Sharing of Scientific Data: A Focus on Developing Countries: Proceedings of a Symposium summarizes the symposium.

Digital technologies and networks are now part of everyday work in the sciences, and have enhanced access to and use of scientific data, information, and literature significantly. They offer the promise of accelerating the discovery and communication of knowledge, both within the scientific community and in the broader society, as scientific data and information are made openly available online. The focus of this project was on computer-mediated or computational scientific knowledge discovery, taken broadly as any research processes enabled by digital computing technologies. Such technologies may include data mining, information retrieval and extraction, artificial intelligence, distributed grid computing, and others. These technological capabilities support computer-mediated knowledge discovery, which some believe is a new paradigm in the conduct of research. The emphasis was primarily on digitally networked data, rather than on the scientific, technical, and medical literature. The meeting also focused mostly on the advantages of knowledge discovery in open networked environments, although some of the disadvantages were raised as well.

The workshop brought together a set of stakeholders in this area for intensive and structured discussions. The purpose was not to make a final declaration about the directions that should be taken, but to further the examination of trends in computational knowledge discovery in the open networked environments, based on the following questions and tasks:

1. Opportunities and Benefits: What are the opportunities over the next 5 to 10 years associated with the use of computer-mediated scientific knowledge discovery across disciplines in the open online environment? What are the potential benefits to science and society of such techniques?
2. Techniques and Methods for Development and Study of Computer-mediated Scientific Knowledge Discovery: What are the techniques and methods used in government, academia, and industry to study and understand these processes, the validity and reliability of their results, and their impact inside and outside science?
3. Barriers: What are the major scientific, technological, institutional, sociological, and policy barriers to computer-mediated scientific knowledge discovery in the open online environment within the scientific community? What needs to be known and studied about each of these barriers to help achieve the opportunities for interdisciplinary science and complex problem solving?
4. Range of Options: Based on the results obtained in response to items 1-3, define a range of options that can be used by the sponsors of the project, as well as other similar organizations, to obtain and promote a better understanding of the computer-mediated scientific knowledge discovery processes and mechanisms for openly available data and information online across the scientific domains. The objective of defining these options is to improve the activities of the sponsors (and other similar organizations) and the activities of researchers that they fund externally in this emerging research area.

The Future of Scientific Knowledge Discovery in Open Networked Environments: Summary of a Workshop summarizes the responses to these questions and tasks at hand.

Physical fitness affects our ability to function and be active. At poor levels, it is associated with such health outcomes as diabetes and cardiovascular disease. Physical fitness testing in American youth was established on a large scale in the 1950s with an early focus on performance-related fitness that gradually gave way to an emphasis on health-related fitness. Using appropriately selected measures to collected fitness data in youth will advance our understanding of how fitness among youth translates into better health.

In Fitness Measures and Health Outcomes in Youth, the IOM assesses the relationship between youth fitness test items and health outcomes, recommends the best fitness test items, provides guidance for interpreting fitness scores, and provides an agenda for needed research.

The report concludes that selected cardiorespiratory endurance, musculoskeletal fitness, and body composition measures should be in fitness surveys and in schools. Collecting fitness data nationally and in schools helps with setting and achieving fitness goals and priorities for public health at an individual and national level.

The United States is in the midst of a major demographic shift. In the coming decades, people aged 65 and over will make up an increasingly large percentage of the population: The ratio of people aged 65+ to people aged 20-64 will rise by 80%. This shift is happening for two reasons: People are living longer, and many couples are choosing to have fewer children and to have those children somewhat later in life. The resulting demographic shift will present the nation with economic challenges, both to absorb the costs and to leverage the benefits of an aging population.

Aging and the Macroeconomy: Long-Term Implications of an Older Population presents the fundamental factors driving the aging of the U.S. population, as well as its societal implications and likely long-term macroeconomic effects in a global context. The report finds that, while population aging does not pose an insurmountable challenge to the nation, it is imperative that sensible policies are implemented soon to allow companies and households to respond. It offers four practical approaches for preparing resources to support the future consumption of households and for adapting to the new economic landscape.

On June 15, 2011, the Air Force Space Command established a new vision, mission, and set of goals to ensure continued U.S. dominance in space and cyberspace mission areas. Subsequently, and in coordination with the Air Force Research Laboratory, the Space and Missile Systems Center, and the 14th and 24th Air Forces, the Air Force Space Command identified four long-term science and technology (S&T) challenges critical to meeting these goals. One of these challenges is to provide full-spectrum launch capability at dramatically lower cost, and a reusable booster system (RBS) has been proposed as an approach to meet this challenge.

The Air Force Space Command asked the Aeronautics and Space Engineering Board of the National Research Council to conduct an independent review and assessment of the RBS concept prior to considering a continuation of RBS-related activities within the Air Force Research Laboratory portfolio and before initiating a more extensive RBS development program. The committee for the Reusable Booster System: Review and Assessment was formed in response to that request and charged with reviewing and assessing the criteria and assumptions used in the current RBS plans, the cost model methodologies used to fame [frame?] the RBS business case, and the technical maturity and development plans of key elements critical to RBS implementation.

The committee consisted of experts not connected with current RBS activities who have significant expertise in launch vehicle design and operation, research and technology development and implementation, space system operations, and cost analysis. The committee solicited and received input on the Air Force launch requirements, the baseline RBS concept, cost models and assessment, and technology readiness. The committee also received input from industry associated with RBS concept, industry independent of the RBS concept, and propulsion system providers which is summarized in Reusable Booster System: Review and Assessment.

Beginning with the germ theory of disease in the 19th century and extending through most of the 20th century, microbes were believed to live their lives as solitary, unicellular, disease-causing organisms . This perception stemmed from the focus of most investigators on organisms that could be grown in the laboratory as cellular monocultures, often dispersed in liquid, and under ambient conditions of temperature, lighting, and humidity. Most such inquiries were designed to identify microbial pathogens by satisfying Koch’s postulates.3 This pathogen-centric approach to the study of microorganisms produced a metaphorical “war” against these microbial invaders waged with antibiotic therapies, while simultaneously obscuring the dynamic relationships that exist among and between host organisms and their associated microorganisms—only a tiny fraction of which act as pathogens.

Despite their obvious importance, very little is actually known about the processes and factors that influence the assembly, function, and stability of microbial communities. Gaining this knowledge will require a seismic shift away from the study of individual microbes in isolation to inquiries into the nature of diverse and often complex microbial communities, the forces that shape them, and their relationships with other communities and organisms, including their multicellular hosts.

On March 6 and 7, 2012, the Institute of Medicine’s (IOM’s) Forum on Microbial Threats hosted a public workshop to explore the emerging science of the “social biology” of microbial communities. Workshop presentations and discussions embraced a wide spectrum of topics, experimental systems, and theoretical perspectives representative of the current, multifaceted exploration of the microbial frontier. Participants discussed ecological, evolutionary, and genetic factors contributing to the assembly, function, and stability of microbial communities; how microbial communities adapt and respond to environmental stimuli; theoretical and experimental approaches to advance this nascent field; and potential applications of knowledge gained from the study of microbial communities for the improvement of human, animal, plant, and ecosystem health and toward a deeper understanding of microbial diversity and evolution. The Social Biology of Microbial Communities: Workshop Summary further explains the happenings of the workshop.

The California Institute for Regenerative Medicine (CIRM) was created in 2005 by The California Stem Cell Research and Cures Act (Proposition 71) to distribute $3 billion in state funds for stem cell research. The passage of Proposition 71 by the voters of California occurred at a time when federal funding for research involving human embryonic stem cells was uncertain, given the ethical questions raised by such research. During its initial period of operations, CIRM has successfully and thoughtfully provided more than $1.3 billion in awards to 59 California institutions, consistent with its stated mission.

As it transitions to a broadened portfolio of grants to stimulate progress toward its translational goals, the Institute should obtain cohesive, longitudinal, and integrated advice; restructure its grant application review process; and enhance industry epresentation in aspects of its operations. CIRM’s unique governance structure, while seful in its initial stages, might diminish its effectiveness moving forward. The California Institute for Regenerative Medicine: Science, Governance, and the Pursuit of Cures recommends specific steps to enhance CIRM’s organization and management, as well as its scientific policies and processes, as it transitions to the critical next stages of its research and development program.

The Standing Committee on Defense Materials Manufacturing and Infrastructure (DMMI) conducted a workshop on July 23-24, 2012, to share information and gather perspectives on issues concerning Materials and Manufacturing Capabilities for Sustaining Defense Systems. This workshop, held at the headquarters building of the National Academies, 2101 Constitution Avenue N.W., Washington D.C., was conducted according to the procedures of the National Research Council (NRC) for a convening activity. That is, all workshop participants—including presenters, members of the DMMI standing committee, Reliance 21, invited guests, and visitors—spoke as individuals, and no overall findings, conclusions, or recommendations were developed during or as a result of the workshop. All statements and views summarized in this publication are attributable only to those individuals who expressed them. It is worth noting that the sponsor, Reliance 21, is a Department of Defense group of professionals that was established to enable the DOD science and technology (S&T) community to work together to enhance Defense S&T programs, eliminate unwarranted duplication, and strengthen cooperation among the military services and other DOD agencies.

The DMMI standing committee named a workshop planning group to develop the workshop agenda and decide on invited guests and presenters, in accordance with the statement of task approved by the Governing Board of the NRC. The planning group also consulted with the Reliance 21 materials and processing community of interest.

The presentations and discussions during the workshop are summarized sequentially in the main part of this report. As an aid to readers, nine themes have been identified by the author that recurred in multiple presentations and discussions. Materials and Manufacturing Capabilities for Sustaining Defense Systems: Summary of a Workshop explains these nine themes and summarizes the two day workshop.

Lead is a ubiquitous metal in the environment, and its adverse effects on human health are well documented. Lead interacts at multiple cellular sites and can alter protein function in part through binding to amino acid sulfhydryl and carboxyl groups on a wide variety of structural and functional proteins. In addition, lead mimics calcium and other divalent cations, and it induces the increased production of cytotoxic reactive oxygen species. Adverse effects associated with lead exposure can be observed in multiple body systems, including the nervous, cardiovascular, renal, hematologic, immunologic, and reproductive systems. Lead exposure is also known to induce adverse developmental effects in utero and in the developing neonate.

Lead poses an occupational health hazard, and the Occupational Safety and Health Administration (OSHA) developed a lead standard for general industry that regulates many workplace exposures to this metal. The standard was promulgated in 1978 and encompasses several approaches for reducing exposure to lead, including the establishment of a permissible exposure limit (PEL) of 50 μg/m3 in air (an 8-hour time-weighted average [TWA]), exposure guidelines for instituting medical surveillance, guidelines for removal from and return to work, and other risk-management strategies. An action level of 30 μg/m3 (an 8-hour TWA) for lead was established to trigger medical surveillance in employees exposed above that level for more than 30 days per year. Another provision is that any employee who has a blood lead level (BLL) of 60 μg/dL or higher or three consecutive BLLs averaging 50 μg/dL or higher must be removed from work involving lead exposure. An employee may resume work associated with lead exposure only after two BLLs are lower than 40 μg/dL. Thus, maintaining BLLs lower than 40 μg/dL was judged by OSHA to protect workers from adverse health effects. The OSHA standard also includes a recommendation that BLLs of workers who are planning a pregnancy be under 30μg/dL.

In light of knowledge about the hazards posed by occupational lead exposure, the Department of Defense (DOD) asked the National Research Council to evaluate potential health risks from recurrent lead exposure of firing-range personnel. Specifically, DOD asked the National Research Council to determine whether current exposure standards for lead on DOD firing ranges protect its workers adequately.The committee also considered measures of cumulative lead dose. Potential Health Risks to DOD Firing-Range Personnel from Recurrent Lead Exposure will help to inform decisions about setting new air exposure limits for lead on firing ranges, about whether to implement limits for surface contamination, and about how to design lead-surveillance programs for range personnel appropriately.