Catharyn T. Liverman – författare

During an influenza pandemic, healthcare workers will be on the front lines delivering care to patients and preventing further spread of the disease. As the nation prepares for pandemic influenza, multiple avenues for protecting the health of the public are being carefully considered, ranging from rapid development of appropriate vaccines to quarantine plans should the need arise for their implementation. One vital aspect of pandemic influenza planning is the use of personal protective equipment (PPE)—the respirators, gowns, gloves, face shields, eye protection, and other equipment that will be used by healthcare workers and others in their day-to-day patient care responsibilities.

Dual loyalties exist in many medical fields, from occupational health to public health. Military health professionals, as all health professionals, are ethically responsible for their patients'' well-being. In some situations, however, military health professionals can face unique ethical tensions between responsibilities to individual patients and responsibilities to military operations.

This book summarizes the one-day workshop, Military Medical Ethics: Issues Regarding Dual Loyalties, which brought together academic, military, human rights, and health professionals to discuss these ethical challenges. The workshop examined two case studies: decisions regarding returning a servicemember to duty after a closed head injury, and decisions on actions by health professionals regarding a hunger strike by detainees. The workshop also addressed the need for improvements in medical ethics training and outlined steps for organizations to take in supporting better ethical awareness and use of ethical standards.

Children''s health has made tremendous strides over the past century. In general, life expectancy has increased by more than thirty years since 1900 and much of this improvement is due to the reduction of infant and earlychildhood mortality. Given this trajectory toward a healthier childhood, webegin the 21st-century with a shocking development—an epidemic of obesityin children and youth. The increased number of obese childrenthroughout the U.S. during the past 25 years has led policymakers to rankit as one of the most critical public health threats of the 21st-century.

Preventing Childhood Obesity provides a broad-based examination of thenature, extent, and consequences of obesity in U.S. children and youth,including the social, environmental, medical, and dietary factors responsiblefor its increased prevalence. The book also offers a prevention-orientedaction plan that identifies the most promising array of short-term andlonger-term interventions, as well as recommendations for the roles andresponsibilities of numerous stakeholders in various sectors of society toreduce its future occurrence. Preventing Childhood Obesity explores theunderlying causes of this serious health problem and the actions needed toinitiate, support, and sustain the societal and lifestyle changes that canreverse the trend among our children and youth.

At this early phase in addressing the epidemic, actions have begun on a number of levels to improve the dietary patterns and to increase the physical activity levels of young people. Schools, corporations, youth-related organizations, families, communities, foundations, and government agencies are working to implement a variety of policy changes, new programs, and other interventions. These efforts, however, generally remain fragmented and small in scale.

Moreover, the lack of systematic monitoring and evaluation of interventions have hindered the development of an evidence base to identify, apply, and disseminate lessons learned and to support promising efforts to prevent childhood obesity.

Progress in Preventing Childhood Obesity: How Do We Measure Up? examines the progress made by obesity prevention initiatives in the United States from 2004 to 2006. This book emphasizes a call to action for key stakeholders and sectors to commit to and demonstrate leadership in childhood obesity prevention, evaluates all policies and programs, monitors their progress, and encourages stakeholders to widely disseminate promising practices. This book will be of interest to federal, state, and local government agencies; educators and schools; public health and health care professionals; private-sector companies and industry trade groups; media; parents; and those involved in implementing community-based programs and consumer advocacy.

Although asbestos is no longer mined in the United States, prior and ongoing exposures to asbestos continue to contribute to respiratory diseases, including mesothelioma, lung cancer, and asbestosis. To examine ongoing issues and concerns in this field, the National Institute for Occupational Safety and Health (NIOSH) drafted a research roadmap, Asbestos Fibers and Other Elongated Mineral Particles: State of the Science and Roadmap for Research, that provides an overview of the state of the science and a plan for future research in areas including toxicology, mineralogy, epidemiology, and exposure assessment. The focus of the proposed research is on clarifying the relationship between human health effects and the physical and chemical characteristics of a wide range of elongate mineral particles. In 2008, NIOSH asked the Institute of Medicine and the National Research Council to form a committee to provide a review of the scientific and technical quality of the January 2009 draft NIOSH Roadmap document. The present volume provides the committee''s assessment of the Roadmap and recommendations for strengthening its utility for NIOSH, other federal agencies, the private sector, and other stakeholders.

Although asbestos is no longer mined in the United States, prior and ongoing exposures to asbestos continue to contribute to respiratory diseases, including mesothelioma, lung cancer, and asbestosis. To examine ongoing issues and concerns in this field, the National Institute for Occupational Safety and Health (NIOSH) drafted a research roadmap, Asbestos Fibers and Other Elongated Mineral Particles: State of the Science and Roadmap for Research, that provides an overview of the state of the science and a plan for future research in areas including toxicology, mineralogy, epidemiology, and exposure assessment. The focus of the proposed research is on clarifying the relationship between human health effects and the physical and chemical characteristics of a wide range of elongate mineral particles. In 2008, NIOSH asked the Institute of Medicine and the National Research Council to form a committee to provide a review of the scientific and technical quality of the January 2009 draft NIOSH Roadmap document. The present volume provides the committee''s assessment of the Roadmap and recommendations for strengthening its utility for NIOSH, other federal agencies, the private sector, and other stakeholders.

When you purchase a product, you expect it to work. Construction workers on high-rise buildings need to be confident that their safety harnesses will arrest a fall. Firefighters need to know that their gloves and other protective equipment can withstand high temperatures. Healthcare workers administering highly toxic chemotherapy agents need to know that their gloves will withstand penetration. For personal protective technologies (PPT)—where the major purpose of the product is to protect the wearer against a hazard—a deficit in product effectiveness can mean injury, illness, or death. Examining the extent to which products meet specific performance or design criteria is the focus of conformity assessment efforts. For PPT conformity assessment, the ultimate goal is preventing worker illness, injury, or death from hazardous working conditions. Certifying Personal Protective Technologies focuses on conformity assessment for occupational PPT—ensuring that PPT are effective in preventing or reducing hazardous exposures or situations that workers face in their jobs. Because respirators already have an extensive testing and conformity assessment process in place, this book specifically addresses conformity assessment processes for other types of PPT, including eye and face protection, gloves, hearing protectors, and protective clothing.

In 2009, the H1N1 influenza pandemic brought to the forefront the many unknowns about the virulence, spread, and nature of the virus, as well as questions regarding personal protective equipment (PPE) for healthcare personnel. In this book, the Institute of Medicine assesses the progress of PPE research and identifies future directions for PPE for healthcare personnel.

Spinal Cord Injury examines the future directions for research with thegoal to accelerate the development of cures for spinal cord injuries. Whilemany of the recommendations are framed within the context of the specificneeds articulated by the New York Spinal Cord Injury Research Board,the Institute of Medicine''s panel of experts looked very broadly at researchpriorities relating to future directions for the field in general and make recommendationsto strengthen and coordinate the existing infrastructure.Funders at federal and state agencies, academic organizations, pharmaceuticaland device companies, and non-profit organizations will all find thisbook to be an essential resource as they examine their opportunities.

Popular culture often equates testosterone with virility, strength, and the machomale physique. Viewed by some as an "antiaging tonic," testosterone''s reputationand increased use by men of all ages in the United States have outpaced the scientificevidence about its potential benefits and risks. In particular there has been growingconcern about an increase in the number of middle-aged and older men usingtestosterone and the lack of scientific data on the effect it may have on aging males.Studies of testosterone replacement therapy in older men have generally been ofshort duration, involving small numbers of participants and often lacking adequatecontrols. Testosterone and Aging weighs the options of future research directions,examines the risks and benefits of testosterone replacement therapy, assesses thepotential public health impact of such therapy in the United States, and considersethical issues related to the conduct of clinical trials. Testosterone therapy remains anattractive option to many men even as speculation abounds regarding its potential.

The men and women who served in the Gulf War theater were potentially exposed to a wide range of biological and chemical agents. Gulf War and Health: Volume 1 assesses the scientific literature concerning the association between these agents and the adverse health effects currently experienced by a large number of veterans.

Injuries are the leading cause of death and disability among people under age 35 in the United States. Despite great strides in injury prevention over the decades, injuries result in 150,000 deaths, 2.6 million hospitalizations, and 36 million visits to the emergency room each year.

Reducing the Burden of Injury describes the cost and magnitude of the injury problem in America and looks critically at the current response by the public and private sectors, including:

The authors define the field of injury and establish boundaries for the field regarding intentional injuries. This book highlights the crosscutting nature of the injury field, identifies opportunities to leverage resources and expertise of the numerous parties involved, and discusses issues regarding leadership at the federal level.

The environment is increasingly recognized as having a powerful effect on human and ecological health, as well as on specific types of human morbidity, mortality, and disability. While the public relies heavily on federal and state regulatory agencies for protection from exposures to hazardous substances, it often looks to health professionals for information about routes of exposure and the nature and extent of associated adverse health consequences. However, most health professionals acquire only a minimal knowledge of toxicology during their education and training.

In 1967 the National Library of Medicine (NLM) created an information resource, known today as the Toxicology and Environmental Health Information Program (TEHIP). In 1995 the NLM asked the Institute of Medicine to examine the accessiblity and utility of the TEHIP databases for the work of health professionals.

This resulting volume contains chapters on TEHIP and other toxicology and environmental health databases, on understanding the toxicology and environmental health information needs of health professionals, on increasing awareness of information resources through training and outreach, on accessing and navigating the TEHIP databases, and on program issues and future directions.

Pharmacotherapy, as a means of treating drug addiction in combination with other treatment modalities, has received too little attention from the research community, the pharmaceutical industry, public health officials, and the federal government. Medications to combat drug addiction could have an enormous impact on the medical consequences and socioeconomic problems associated with drug abuse, both for drug-dependent individuals and for American society as a whole. This book examines the current environment for and obstacles to the development of anti-addiction medications, specifically those for treating opiate and cocaine addictions, and proposes incentives for the pharmaceutical industry that would help overcome those obstacles and accelerate the development of anti-addiction medications.

During an influenza pandemic, healthcare workers will be on the front lines delivering care to patients and preventing further spread of the disease. As the nation prepares for pandemic influenza, multiple avenues for protecting the health of the public are being carefully considered, ranging from rapid development of appropriate vaccines to quarantine plans should the need arise for their implementation. One vital aspect of pandemic influenza planning is the use of personal protective equipment (PPE)—the respirators, gowns, gloves, face shields, eye protection, and other equipment that will be used by healthcare workers and others in their day-to-day patient care responsibilities.

Dual loyalties exist in many medical fields, from occupational health to public health. Military health professionals, as all health professionals, are ethically responsible for their patients'' well-being. In some situations, however, military health professionals can face unique ethical tensions between responsibilities to individual patients and responsibilities to military operations.

This book summarizes the one-day workshop, Military Medical Ethics: Issues Regarding Dual Loyalties, which brought together academic, military, human rights, and health professionals to discuss these ethical challenges. The workshop examined two case studies: decisions regarding returning a servicemember to duty after a closed head injury, and decisions on actions by health professionals regarding a hunger strike by detainees. The workshop also addressed the need for improvements in medical ethics training and outlined steps for organizations to take in supporting better ethical awareness and use of ethical standards.

Concerns about the health of veterans of recent military conflicts have given rise to broader questions regarding the health consequences of service in any major military engagement. The Veterans Program Enhancement Act of 1998 directed the Secretary of Veterans Affairs to enter into an agreement with the National Academy of Sciences to help develop a plan for establishing'' a national center (or centers) for the study of war-related illnesses and postdeployment health issues. In response to this legislation, the Department of Veterans Affairs (VA) asked the Institute of Medicine (IOM) to convene a committee of experts. The charge to the committee was to (1) assist the VA in developing a plan for establishing a national center (or centers) for the study of war-related illnesses and postdeployment health issues, and (2) assess preliminary VA plans and make recommendations regarding such efforts.

When you purchase a product, you expect it to work. Construction workers on high-rise buildings need to be confident that their safety harnesses will arrest a fall. Firefighters need to know that their gloves and other protective equipment can withstand high temperatures. Healthcare workers administering highly toxic chemotherapy agents need to know that their gloves will withstand penetration. For personal protective technologies (PPT)—where the major purpose of the product is to protect the wearer against a hazard—a deficit in product effectiveness can mean injury, illness, or death. Examining the extent to which products meet specific performance or design criteria is the focus of conformity assessment efforts. For PPT conformity assessment, the ultimate goal is preventing worker illness, injury, or death from hazardous working conditions. Certifying Personal Protective Technologies focuses on conformity assessment for occupational PPT—ensuring that PPT are effective in preventing or reducing hazardous exposures or situations that workers face in their jobs. Because respirators already have an extensive testing and conformity assessment process in place, this book specifically addresses conformity assessment processes for other types of PPT, including eye and face protection, gloves, hearing protectors, and protective clothing.

In 2009, the H1N1 influenza pandemic brought to the forefront the many unknowns about the virulence, spread, and nature of the virus, as well as questions regarding personal protective equipment (PPE) for healthcare personnel. In this book, the Institute of Medicine assesses the progress of PPE research and identifies future directions for PPE for healthcare personnel.

Occupational health nurses (OHNs) are front-line advocates for preventing illness and injury and protecting health in a variety of workplace settings, including the areas of agriculture, construction, health care, manufacturing, and public safety. OHNs need education and training in respiratory protection in order to ensure both their safety and the safety of America''s workers. At the request of the National Personal Protective Technology Laboratory of the National Institute for Occupational Safety and Health, the Institute of Medicine (IOM) examined existing respiratory protection curricula and made recommendations to improve education and training in respiratory protection for OHNs. The IOM finds that current respiratory protection education receives varying amounts of dedicated time and resources and is taught using a variety of approaches. Several recommendations are made to improve the respiratory protection education and training of OHNs.

Each year in the United States, more than 4,000 occupational fatalities and more than 3 million occupational injuries occur along with more than 160,000 cases of occupational illnesses. Incorporating patients'' occupational information into electronic health records (EHRs) could lead to more informed clinical diagnosis and treatment plans as well as more effective policies, interventions, and prevention strategies to improve the overall health of the working population. At the request of the National Institute for Occupational Safety and Health, the IOM appointed a committee to examine the rationale and feasibility of incorporating occupational information in patients'' EHRs. The IOM concluded that three data elements - occupation, industry, and work-relatedness - were ready for immediate focus, and made recommendations on moving forward efforts to incorporate these elements into EHRs.

Each year in the United States, more than 4,000 occupational fatalities and more than 3 million occupational injuries occur along with more than 160,000 cases of occupational illnesses. Incorporating patients'' occupational information into electronic health records (EHRs) could lead to more informed clinical diagnosis and treatment plans as well as more effective policies, interventions, and prevention strategies to improve the overall health of the working population. At the request of the National Institute for Occupational Safety and Health, the IOM appointed a committee to examine the rationale and feasibility of incorporating occupational information in patients'' EHRs. The IOM concluded that three data elements - occupation, industry, and work-relatedness - were ready for immediate focus, and made recommendations on moving forward efforts to incorporate these elements into EHRs.

At the request of NASA, an IOM committee reviewed NASA Human Research Program''s (HRP''s) Scientific Merit Assessment Processes for directed research. Directed research is commissioned or noncompetitively awarded research that is not competitively solicited because of specific reasons, such as time limitations or highly focused or constrained research topics.

The scientific merit assessment processes have been developed by NASA to evaluate individual directed research tasks in order to ensure the scientific integrity of the HRP''s directed research portfolio. The committee examined the HRP''s current scientific merit assessment processes and conducted a public workshop to identify best practices among other federal agencies that use various assessment processes for similar types of directed research.

Review of NASA Human Research Program''s Scientific Merit Processes: Letter Report finds that the scientific merit assessment process used by the HRP for directed research is scientifically rigorous and is similar to the processes and merit criteria used by many other federal agencies and organizations - including the Department of Defense, National Institutes of Health, and the United States Department of Agriculture - for comparable types of research. This report also makes recommendations on ways to streamline and bolster the accountability and transparency of NASA''s current processes.

In 2006 the National Institutes of Health (NIH) established the Clinical and Translational Science Awards (CTSA) Program, recognizing the need for a new impetus to encourage clinical and translational research. At the time it was very difficult to translate basic and clinical research into clinical and community practice; making it difficult for individual patients and communities to receive its benefits. Since its creation the CTSA Program has expanded, with 61 sites spread across the nation''s academic health centers and other institutions, hoping to provide catalysts and test beds for policies and practices that can benefit clinical and translation research organizations throughout the country.

The NIH contracted with the Institute of Medicine (IOM) in 2012 to conduct a study to assess and provide recommendations on appropriateness of the CTSA Program''s mission and strategic goals and whether changes were needed. The study was also address the implementation of the program by the National Center for Advancing Translational Sciences (NCATS) while exploring the CTSA''s contributions in the acceleration of the development of new therapeutics. A 13-member committee was established to head this task; the committee had collective expertise in community outreach and engagement, public health and health policy, bioethics, education and training, pharmaceutical research and development, program evaluation, clinical and biomedical research, and child health research.

The CTSA Program at NIH: Opportunities for Advancing Clinical and Translational Research is the result of investigations into previous program evaluations and assessments, open-session meetings and conference class, and the review of scientific literature. Overall, the committee believes that the CTSA Program is significant to the advancement of clinical and translational research through its contributions. The Program would benefit from a variety of revisions, however, to make it more efficient and effective.