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Coeur d'Alene Lake in northern Idaho is an invaluable natural, recreational, and economic resource for communities in Idaho and eastern Washington. Starting in the late 1880s, mining in the Lake's watershed sent heavy metals and other mining wastes into the Lake, resulting in contamination of lake sediments with lead, cadmium, arsenic, and zinc that persists today. The watershed was designated a Superfund site and cleanup has been ongoing for 30 years. However, the Lake's environmental quality and cleanup is overseen by a Lake Management Plan, originally implemented by the Coeur d'Alene Tribe and the state of Idaho. A major focus of that plan is whether lakeshore development might promote low-oxygen (anoxic) conditions that could release toxic metals from lake sediments back into the water column. This report analyzes water quality data collected from the Lake and the watershed over the past 30 years. The analyses indicate that, although the Lake is still heavily contaminated, concentrations of metals in the major inputs to the Lake have declined, and there is no evidence that phosphorus concentrations have been increasing in the last decade or that low-oxygen events are becoming more common. However, the shorelines of the Lake, where exposure to metals or harmful algae is more likely, are not currently monitored. Protecting the water quality of Coeur d'Alene Lake will require that monitoring efforts be expanded to provide an early warning of deteriorating conditions, regular syntheses of data, and targeted studies--all coordinated among interest groups--followed by application of those results to managing the Lake.

Approximately 7.4 million people in the United States live with an intellectual or developmental disability (IDD), defined by the Centers for Disease Control and Prevention as "a group of conditions due to an impairment in physical, learning, language, or behavior areas. These conditions begin during the developmental period, may impact day-to-day functioning, and usually last throughout a person's lifetime." Individuals with IDD and their caretakers face exceptional barriers to staying healthy and accessing appropriate health services. Among these barriers are difficulty finding care providers that are adequately trained in meeting their specialized needs, unwieldy payment structures, and a lack of coordination between the various systems of care with which patients with IDD may interact (e.g., education, social work, various segments of the health care system). The National Academies of Sciences, Engineering, and Medicine hosted a workshop to discuss promising innovations in (1) workforce development, (2) financing and payment, and (3) care coordination; and to share visions for improved systems of care. Participants noted that while many existing approaches could serve as models for improving care, large changes will need to be made in these 3 facets of the care system in order to make them accessible to all IDD patients. This publication summarizes the presentations and discussions of the workshop.

Measuring and analyzing public opinion comes with tremendous challenges, as evidenced by recent struggles to predict election outcomes and to anticipate mass mobilizations. The National Academies of Sciences, Engineering, and Medicine publication Measurement and Analysis of Public Opinion: An Analytic Framework presents in-depth information from experts on how to collect and glean insights from public opinion data, particularly in conditions where contextual issues call for applying caveats to those data. The Analytic Framework is designed specifically to help intelligence community analysts apply insights from the social and behavioral sciences on state-of-the-art approaches to analyze public attitudes in non- Western populations. Sponsored by the intelligence community, the National Academies' Board on Behavioral, Cognitive, and Sensory Sciences hosted a 2-day hybrid workshop on March 8-9, 2022, to present the Analytic Framework and to demonstrate its application across a series of hypothetical scenarios that might arise for an intelligence analyst tasked with summarizing public attitudes to inform a policy decision. Workshop participants explored cutting-edge methods for using large-scale data as well as cultural and ethical considerations for the collection and use of public opinion data. This publication summarizes the presentations and discussions of the workshop.

Since around 1980, fewer Americans than before are doing better than their parents had - that is, more are experiencing downward social and economic mobility in terms of occupational status and income. This trend in downward mobility is occurring amidst high and rising levels of inequality in income, wealth, health, and life expectancy. To better understand the factors that influence social and economic mobility, the Committee on Population and the Committee on National Statistics hosted a workshop on February 14-15, 2022. The proceedings from this workshop identify key priorities for future research and data collection to improve social and economic mobility.

Affecting technological systems at a global-scale, space weather can disrupt high-frequency radio signals, satellite-based communications, navigational satellite positioning and timing signals, spacecraft operations, and electric power delivery with cascading socioeconomic effects resulting from these disruptions. Space weather can also present an increased health risk for astronauts, as well as aviation flight crews and passengers on transpolar flights. In 2019, the National Academies was approached by the National Aeronautics and Space Administration, the National Oceanic and Atmospheric Administration, and the National Science Foundation to organize a workshop that would examine the operational and research infrastructure that supports the space weather enterprise, including an analysis of existing and potential future measurement gaps and opportunities for future enhancements. This request was subsequently modified to include two workshops, the first ("Phase I") of which occurred in two parts on June 16-17 and September 9-11, 2020. The Phase II workshop occurred on April 11-14, 2022, with sessions on agency updates, research needs, data science, observational and modeling needs, and emerging architectures relevant to the space weather research community and with ties to operational needs. This publication summarizes the presentation and discussion of that workshop.

The ultimate goal of planetary protection for outbound missions is to prevent harmful contamination that would inhibit future measurements designed to search for evidence of the existence or evolution of extraterrestrial life. Preventing harmful contamination is achieved by following specific guidelines based on existing scientific knowledge about the destination and the type of mission. This report responds to NASA's request for a study on planetary protection categorization of missions to small bodies, including whether there are particular populations of small bodies for which contamination of one object in the population would not be likely to have a tangible effect on the opportunities for scientific investigation using other objects in the population. In addressing NASA's request, the authoring committee considered surface composition of target bodies and their importance for prebiotic chemistry, along with size of the small-body populations, the current state of knowledge on the types of objects, the likelihood of a future scientific mission returning to any specific object, active object surface processes, and the size.

The widespread adoption of electric vehicles will play a critical role in decarbonizing the transportation sector as the nation moves toward net-zero emissions. Recent announcements from automakers and the federal government, as well as provisions in the Infrastructure Investment and Jobs Act of 2021, aim to stimulate electric vehicle (EV) deployment, and ongoing technology improvements continue to make EVs a more affordable and practical option. However, many challenges remain to meet the needs of all buyers and drivers and to ensure that manufacturing supply chains and the electric system can support this large-scale transformation. As a follow-up activity to its 2021 report Assessment of Technologies for Improving Light-Duty Vehicle Fuel Economy - 2025-2035, the National Academies of Sciences, Engineering, and Medicine convened a 4-day virtual workshop on October 25-28, 2021, to identify some of the challenges to widespread EV deployment and discuss policy, technical, and market strategies to help federal agencies and other stakeholders plan for the future. This publication summarizes the presentation and discussion of the workshop.

Psychiatric illnesses - such as major depressive disorder, anxiety disorder, substance use disorder, and posttraumatic stress disorder (PTSD) - are widely prevalent and represent a substantial health burden worldwide. Yet, conventional medications for mental illnesses often fail to provide relief to patients' disruptive and disabling symptoms. Existing and emerging evidence that psychedelics (e.g., LSD and psilocybin) and entactogens (e.g., MDMA) may be useful as tools to alleviate mental illness has sparked a renaissance of interest by investigators, clinicians, drug developers, and patient advocates in recent years. While promising data on therapeutic efficacy has energized research and development, resolving the mechanisms of action will be important for optimizing the efficacy and safety of these medicines. Further, evaluating the effect of psychedelics and entactogens on mood and behavior comes with unique challenges still in need of resolution. These include unresolved questions relating to blinding, placebo and nocebo effects, and the impact of psychosocial contexts. In response to this renewed interest, the National Academies of Sciences, Engineering, and Medicine's Forum on Neuroscience and Nervous System Disorders convened a workshop on March 29-30, 2022. The workshop brought together a diverse group of stakeholders to explore the use of psychedelics and entactogens as treatments for psychiatric disorders. This Proceedings of a Workshop summarizes the presentations and discussions of the workshop.

Structural racism refers to the public and private policies, institutional practices, norms, and cultural representations that inherently create unequal freedom, opportunity, value, resources, advantage, restrictions, constraints, or disadvantage for individuals and populations according to their race and ethnicity both across the life course and between generations. Developing a research agenda on structural racism includes consideration of the historical and contemporary policies and other structural factors that explicitly or implicitly affect the health and well-being of individuals, families, and communities, as well as strategies to measure those factors. The Committee on Population of the National Academies of Sciences, Engineering, and Medicine convened a 2-day public workshop on May 16-17, 2022, to identify and discuss the mechanisms through which structural racism operates, with a particular emphasis on health and well-being; to develop an agenda for future research and data collection on structural racism; and to strengthen the evidence base for policy making. Speaker presentations and workshop discussions provided insights into known sources of structural racism and rigorous models of health inequity, revealed novel sources and approaches informed by other disciplines and related fields, and highlighted key research and data priorities for future work on structural racism and health inequity.

Despite advances in the delivery of high-quality cancer care and improvements in patient outcomes in recent years, disparities in cancer incidence, care, and patient outcomes persist. To examine opportunities to improve health equity across the cancer care continuum, the National Cancer Policy Forum and the Roundtable on the Promotion of Health Equity hosted a public workshop, Promoting Health Equity in Cancer Care, on October 25 and October 26, 2021. This virtual workshop featured presentations and panel discussions on topics that included: opportunities to improve equitable access to affordable, high-quality cancer care; strategies to identify and address the intersectionality of structural racism and implicit bias in cancer care delivery; the potential for quality measurement and payment mechanisms to incentivize health equity in cancer care delivery; and clinical practice data collection efforts to better assess and care for people living with and beyond cancer. This publication summarizes the presentation and discussion of the workshop.

On March 28 and 29, 2022, the Board on Behavioral, Cognitive, and Sensory Sciences at the National Academies of Sciences, Engineering, and Medicine held a virtual symposium entitled Community Interventions to Prevent Veteran Suicide: The Role of Social Determinants to gain a better understanding of social determinants influencing the recent increase in suicide risk and how currently available practice guidelines can inform community-level preventive interventions, particularly those targeting veteran populations. Presenters and participants explored the relevant social, cultural, and economic factors driving changes in suicide risk among veterans and ways that current best practices for suicide prevention and treatment can be applied at the community level. This publication summarizes the presentations and discussion of the symposium.

Over the past few years the common use of telehealth technology has been rapidly expanding. While remote models of care have been successfully used in rural communities for decades, the adoption of telehealth rapidly expanded during the COVID-19 pandemic, narrowing some gaps in care access and equity while exacerbating health care inequities in other ways. At the request of the Social Security Administration, the National Academies hosted a workshop on March 9 and 10, 2022 to examine the use of telehealth for patient evaluation. The workshop explored the evolution of telehealth and commonly used terminology, the impact of inequities in digital access, privacy and cybersecurity concerns, its use in a variety of allied health and medical specialties for patient evaluation, and interstate licensure related to providing telehealth care. This publication provides a high-level summary of the presentations and discussions from the workshop.

There is increasing evidence that civic participation - from voting to volunteering - is a social driver of health. The National Academies of Sciences, Engineering, and Medicine's Roundtable on Population Health Improvement convened a workshop to explore the links between civics and health; between measures of civic engagement and quantitative and qualitative measures of health equity; and the roles that civic infrastructure, narrative, and media play in shaping civic engagement. Presenters discussed voting along with other important dimensions of civic engagement; others include the ability to set agendas, shape how policies are implemented, communicate information, model civic behavior, and support the involvement and inclusion of other individuals and groups.

The persistent trends in suicide necessitate action among mental health care providers and payers, researchers, and community leaders. Health care settings provide an important opportunity for suicide intervention and prevention, but they cannot yet fully manage suicide risk because of a lack of training, knowledge gaps, and reimbursement challenges. School, workplace, and community-based interventions can help reduce the incidence of suicidal behavior, as can better access to care and reduced access to lethal means of suicide. To better understand the strategies to improve access to effective interventions to prevent suicide, the Forum on Mental Health and Substance Use Disorders at the National Academies of Sciences, Engineering, and Medicine hosted a two-part virtual public workshop, Strategies and Interventions to Reduce Suicide, on June 22, 2021, and July 28, 2021. The first webinar examined the scope of the public health problem, discussed implementation of effective approaches for suicide prevention care, and addressed known barriers to health care access. The second webinar focused on building 9-8-8, the new nationwide emergency number designated to the National Suicide Prevention Lifeline. Participants discussed current crisis systems, gaps, challenges, and needs for marginalized populations. This Proceedings of a Workshop summarizes the presentations and discussions that occurred during the workshops.

The COVID-19 pandemic has led to dramatic adjustments in cancer care delivery and cancer research. To examine these changes, the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine convened a virtual workshop, Innovation in Cancer Care and Cancer Research in the Context of the COVID-19 Pandemic, in July 2021. Workshop speakers considered the lessons learned from these adaptations in order to improve the delivery of high-quality cancer care and the conduct of cancer clinical trials in the post-pandemic era. This Proceedings of a Workshop highlights presentations and discussions from the workshop.

To explore issues related to community-driven power-building efforts to improve population health, the Roundtable on Population Health Improvement of the National Academies of Sciences, Engineering, and Medicine hosted a virtual public workshop, "Community Power in Population Health Improvement", on January 28 and 29, 2021. Participants discussed the different components and dimensions of community-led action around different population health improvement topics such as education, transportation, environmental health, healthy eating, and active living, among others. This Proceedings of a Workshop summarizes the presentations and discussion of the workshop.

Overwhelming evidence exists that exposure to outdoor fine particulate matter (PM2.5) is associated with a range of short-term and chronic health impacts, including asthma exacerbation, acute and chronic bronchitis, heart attacks, increased susceptibility to respiratory infections, and premature death, with the burden of these health effects falling more heavily on underserved and marginalized communities. Although less studied to date, indoor exposure to PM2.5 is also gaining attention as a potential source of adverse health effects, particularly given that Americans spend 90 percent of their lives indoors and indoor PM2.5 levels can exceed outdoor levels. To better understand the sources of indoor PM2.5, the possible health effects of exposure to indoor PM2.5, and engineering approaches and interventions to reduce those exposure risks, the National Academies of Sciences, Engineering, and Medicine convened a virtual workshop, Indoor Exposure to Fine Particulate Matter and Practical Mitigation Approaches, on April 14, 21, and 28, 2021. The workshop focused on exposures that occur in residential and school buildings and on existing and practical mitigation technologies and approaches. This publication summarizes the presentation and discussion of the workshop.

A virtual workshop series titled Approaches to Assessing Intake of Food and Dietary Supplements in Pregnant Women and Children 2 to 11 Years of Age was convened in May, 2021 by the Food and Nutrition Board of the National Academies of Sciences, Engineering, and Medicine. The four-day workshop series explored the evidence on methodological approaches to assessing intake of food and dietary supplements in pregnant women and children 2 to 11 years of age. Obtaining reliable and valid dietary intake information for these population groups is particularly difficult - in pregnancy, rapid changes in nutrient needs and dietary intakes occur, and in young children, much of dietary intake is consumed outside the home and is often misreported by the children or their proxy reporters. To advance the quality of the science in these areas, the workshop had four goals: identify the suite of current methods used in dietary assessments, including food and dietary supplements, in pregnant women and children 2 to 11 years of age; identify the methodological challenges and opportunities in improving current methods; explore methodologies in other disciplines and their application in dietary assessments in those populations; and discuss factors to consider when implementing dietary assessment tools in those populations. This publication summarizes the presentations and discussions of the workshop series.

Rising awareness of and increased attention to sexual harassment has resulted in momentum to implement sexual harassment prevention efforts in higher education institutions. Work on preventing sexual harassment is an area that has recently garnered a lot of attention, especially around education and programs that go beyond the standard anti-sexual harassment trainings often used to comply with legal requirements. On April 20-21, 2021, the National Academies of Sciences, Engineering, and Medicine hosted the workshop Developing Evaluation Metrics for Sexual Harassment Prevention Efforts. The workshop explored approaches and strategies for evaluating and measuring the effectiveness of sexual harassment interventions being implemented at higher education institutions and research and training sites, in order to assist institutions in transforming promising ideas into evidence-based best practices. Workshop participants also addressed methods, metrics, and measures that could be used to evaluate sexual harassment prevention efforts that lead to change in the organizational climate and culture and/or a change in behavior among community members. This publication summarizes the presentations and discussion of the workshop.

In response to a request from the National Oceanic and Atmospheric Administration - and with the support of the National Aeronautics and Space Administration and the National Science Foundation - the National Academies of Sciences, Engineering, and Medicine conducted a two-part virtual workshop, "Space Weather Operations and Research Infrastructure," on June 16-17 and September 9-11, 2020. The overall goals of the workshop were to review present space weather monitoring and forecasting capabilities, to consider future observational infrastructure and research needs, and to consider options toward the further development of an effective, resilient, and achievable national space weather program. This publication summarizes the presentation and discussion of the workshop.

"Federal laboratories play a unique role in the U.S. economy. Research and development conducted at these labs has contributed to the advancement or improvement of such key general-purpose technologies as nuclear energy, computers, the Internet, genomics, satellite navigation, the Global Positioning System, artificial intelligence, and virtual reality. Digital output from federal laboratories includes data, metadata, images, software, code, tools, databases, algorithms, and statistical models. Importantly, these digital products are nonrivalrous, meaning that unlike physical products, they can be copied at little or no cost and used by many without limit or additional cost. Advancing Commercialization of Digital Products from Federal Laboratories explores opportunities to add economic value to U.S. industry through enhanced utilization of intellectual property around digital products created at federal laboratories. This report examines the current state of commercialization of digital products developed at the federal labs and, to a limited extent, by extramural awardees, to help identify barriers to commercialization and technology transfer, taking into account differences between government-owned, contractor-operated (GOCO) and government-owned, government-operated (GOGO) federal labs." --

"The U.S. Social Security Administration (SSA) administers programs that provide disability benefits. Once SSA establishes the presence of a severe impairment, it determines whether the impairment meets the criteria in the Listing of Impairments (Listings) that qualify a candidate for disability benefits. The current Listings that address hearing loss treated with cochlear implantation contain criteria that evaluate hearing ability through a speech recognition test called the Hearing in Noise Test (HINT). Since its development in 1994, the HINT has been widely used to measure cochlear implant candidacy and postoperative outcomes. However, the test characteristics, the state of cochlear implant technology, and the environment that made the HINT a common choice of assessment in 1994 are different in 2021. The HINT has several limitations in its characteristics and deviation from its intended use. At the request of SSA, the National Academies of Sciences, Engineering, and Medicine convened a consensus study committee to identify and recommend generalized testing procedures and criteria for evaluating the level of functional hearing ability needed to make a disability determination in adults and children after cochlear implantation. The committee's report, Evaluating Hearing Loss for Individuals with Cochlear Implants, details and supports its findings, conclusions, and recommendations based on published evidence and professional judgment." --

"Each year, tens of millions of individuals in the U.S. suffer from neurological and psychiatric disorders including neurodegenerative diseases such as Alzheimer's Disease and Parkinson's Disease, and psychiatric disorders such as autism spectrum disorder, depression and schizophrenia. Treatments for these diseases are often completely lacking or only partially effective, due in large part to the difficulty of conducting brain research and the complexity of the brain itself. Researchers in recent years have developed new models to better represent and study the human brain. The three models considered in this report, all of which generate and use pluripotent stem cells from healthy individuals and patients, are human neural organoids, human neural transplants, and human-animal neural chimeras. The Emerging Field of Human Neural Organoids, Transplants, and Chimeras: Science, Ethics, and Governance reviews the status of research, considers its benefits and risks, discusses associated ethical issues, and considers governance mechanisms for this type of research." --

"Over the past several decades, fertility rates have fallen substantially in low- and middle-income countries, and efforts to limit fertility, primarily through the implementation of family planning programs, have become increasingly widespread. Although there is a substantial scholarly literature on the determinants of contraceptive use and other measures to limit fertility and on the resulting differentials in fertility, relatively little is known about the role played by women's empowerment as both a determinant and a consequence of fertility decline. In addition, there continues to be little consensus about the link between fertility decline and broader societal impacts, including economic development. The National Academies of Sciences, Engineering, and Medicine convened a workshop, "Family Planning, Women's Empowerment, and Population and Societal Impacts," in September 2020. This event brought together experts and stakeholders to discuss conceptual, methodological, and policy issues regarding the relationships among family planning, women's empowerment, fertility decline, and population and societal impacts. The discussion was intended to inform research and policy focused on the issues of women's roles and empowerment and on longstanding questions surrounding the determinants and consequences of fertility reduction behavior. This publication summarizes the presentations and discussion of the workshop." --

The spring of 2020 marked a change in how almost everyone conducted their personal and professional lives, both within science, technology, engineering, mathematics, and medicine (STEMM) and beyond. The COVID-19 pandemic disrupted global scientific conferences and individual laboratories and required people to find space in their homes from which to work. It blurred the boundaries between work and non-work, infusing ambiguity into everyday activities. While adaptations that allowed people to connect became more common, the evidence available at the end of 2020 suggests that the disruptions caused by the COVID-19 pandemic endangered the engagement, experience, and retention of women in academic STEMM, and may roll back some of the achievement gains made by women in the academy to date. The Impact of COVID-19 on the Careers of Women in Academic Sciences, Engineering, and Medicine identifies, names, and documents how the COVID-19 pandemic disrupted the careers of women in academic STEMM during the initial 9-month period since March 2020 and considers how these disruptions - both positive and negative - might shape future progress for women. This publication builds on the 2020 report Promising Practices for Addressing the Underrepresentation of Women in Science, Engineering, and Medicine to develop a comprehensive understanding of the nuanced ways these disruptions have manifested. The Impact of COVID-19 on the Careers of Women in Academic Sciences, Engineering, and Medicine will inform the academic community as it emerges from the pandemic to mitigate any long-term negative consequences for the continued advancement of women in the academic STEMM workforce and build on the adaptations and opportunities that have emerged.