Megan Snair – författare

While the world continues to respond to the COVID-19 pandemic, novel influenza viruses persist as a constant pandemic threat. The global response to COVID-19 has pushed the boundaries on what is possible for rapid pandemic response in several areas, including vaccine research, development, manufacturing, equitable distribution, allocation, and administration. If well understood and sufficiently adapted, these actions could be applied to future pandemic and seasonal influenza vaccine preparedness efforts. However, developing and delivering these more effective vaccines to meet the demand goes beyond simply technical challenges and includes issues across governance, financing, research, supply chain, and public engagement.

To address these challenges, the National Academies of Sciences, Engineering, and Medicine convened a virtual public workshop in May of 2021 to discuss the emerging evidence on unprecedented actions related to COVID-19 that could inform and advance pandemic and seasonal influenza vaccine preparedness efforts and subsequent response. This Proceedings of a Workshop provides a high-level summary of the presentations and discussions that occurred during the workshop.

The economic and physical and health impacts of the COVID-19 pandemic were disproportionately borne by Black, Hispanic, and Native Americans. The true impacts on children and families may not be fully known until after the pandemic ends, but many agree that a new system of care is needed to promote the well-being of children and families in the pandemic''s aftermath.

On September 14-15, 2020, the National Academies of Sciences, Engineering, and Medicine''s Forum for Children''s Well-Being organized a workshop focused on building systems to support children and families in the aftermath of the COVID-19 pandemic. Workshop speakers and organizers paid particular attention to how economic, behavioral, and public health systems that can combat racism and promote the well-being of children and families. Participants engaged in discussionsabout a broad range of existing tools and resources that could be used to further promote family well-being and health equity in the United States.

Over the past decade, providers, policy makers, and stakeholders across a range of disciplines have taken various approaches to addressing the rising incidence of mental, emotional, and behavioral (MEB) health concerns in children and adults. With the recent opioid crisis affecting young people and families across race, ethnicity, and socioeconomic level, and thus adding to the national concern, new efforts and interventions have emerged. However, an overarching system is lacking for the collection of data on these efforts and their efficacy. A strong system for evaluating programs and distributing information could create more opportunities to improve efforts and reduce inefficiencies across programs. Additionally, through engagement of an array of stakeholders from all sectors involved with youth and families, more possibilities for solutions can be realized. To bring together some of these relevant stakeholders and to highlight some of these potential solutions, the National Academies of Sciences, Engineering, and Medicine convened a workshop in October 2019. This publication summarizes the presentations and discussions from the workshop.

In 2009 the Institute of Medicine (IOM) began to assess the need for better-defined medical and public health crisis standards of care (CSC) for catastrophic disasters and public health emergencies. Over the next 10 years, the IOM defined templates for those stakeholders responsible for integrated CSC planning and implementation; created a tool kit with guidance on indicators and triggers; provided a discussion kit for stakeholders to use with their own communities to establish appropriate indicators and triggers to guide their planning; disseminated the messages and key concepts of CSC; and built on the initial efforts to refine certain elements and address remaining gaps. This current Proceedings of a Workshop captures the discussions from a 2019 workshop reviewing the successes and gaps over the last 10 years of CSC work, in order to inform the next phases of planning and implementation.

As part of the overall disability determination process, the Social Security Administration uses a step-by-step approach to understand how severe an individual''s condition is and whether it meets program criteria for disability. The use of various types of biomarkers has been suggested as a way to strengthen the amount and quality of objective evidence available to the review process.

At the request of the Social Security Administration, the National Academies of Sciences, Engineering, and Medicine''s Board on Health Care Services organized a virtual workshop on July 21, 2020, titled The State of the Science of the Use of Biomarkers to Establish the Presence and Severity of Impairments. Workshop discussions focused on the current and potential uses for biomarkers; explored legal and ethical implications associated with biomarker use in clinical decision making; and considered the possible uses of nongenetic biomarkers as tools for the diagnosis or prognosis of the severity of specific physical and mental impairments. This publication summarizes the presentations and discussion of the workshop.

Adolescence is a dynamic time for both brain development and social pressures, making it a critical period to understand mental, emotional, and behavioral health, yet it is often overlooked in terms of policies and service interventions, which makes many young people feel unheard when communicating their own challenges.

To explore best practices in providing and supporting adolescent health services and key messaging and communication strategies related to the mental, emotional, and behavioral health of adolescents, the National Academies of Sciences, Engineering, and Medicine''s Forum for Children''s Well-Being held a workshop on May 5, 2020. The workshop featured a panel of youth representatives who shared their own experiences related to mental, emotional, and behavioral health. This publication summarizes the presentation and discussion of the workshop.

With rapidly rising rates of mental health disorders, changing patterns of occurrence, and increasing levels of morbidity, the need for a better understanding of the developmental origins and influence of mental health on children''s behavioral health outcomes has become critical. This need for better understanding extends to both the growing prevalence of mental health disorders as well as the role and impact of neurodevelopmental pathways in their onset and expression. Addressing these changes in disease patterns and effects on children and families will require a multifaceted approach that goes beyond simply making changes to clinical care or adding personnel to the health services system. New policies, financing, and implementation can put established best practices and numerous research findings from around the country into action.

The Maternal and Child Health Life Course Intervention Research Network and the Forum for Children''s Well-Being at the National Academies of Sciences, Engineering, and Medicine jointly organized a webinar series to explore how mental health disorders develop over the life course, with a special emphasis on prenatal, early, middle, and later childhood development. This series centered on identifying gaps in our knowledge, exploring possible new strategies for using existing data to enhance understanding of the developmental origins of mental disorders, reviewing potential approaches to prevention and optimization, and proposing new ways of framing how to understand, address, and prevent these disorders from a life course development perspective. This publication summarizes the presentations and discussions from the series.

Transplantation of a solid organ, such as a kidney, heart, or liver, is a lifesaving procedure and is sometimes the only viable treatment for patients experiencing end-stage organ failure as a result of illness or injury. A growing prevalence of solid organ diseases in the United States is contributing to more people needing a transplant and longer wait times on the national transplant waiting list. While transplantation can lengthen a person''s life, the road to recovery is difficult and complex. Transplant recipients commonly experience considerable impairments related to health factors, medication side effects, organ rejection, or other setbacks that can cause functional limitations. A spectrum of services and supports can be beneficial to patient functioning and quality of life, but patient access is variable due to individual, system, and social factors.

To gain an understanding of current scientific findings in the field of solid organ transplantation, the U.S. Social Security Administration asked the National Academies of Sciences, Engineering, and Medicine''s Board on Health Care Services to organize a virtual public workshop to examine disability associated with organ transplantation. The workshop, held March 22-23, 2021, focused on kidney, heart, liver, and lung transplantation, and to a lesser extent intestine transplantation. Subject-matter experts presented on clinical aspects of post-transplantation recovery and described the implications for physical, cognitive, and psychosocial functioning in adults and children. This publication summarizes the presentations and panel discussions from the workshop.

To take stock of lessons learned from COVID-19 around the world and in the United States, the Forum on Microbial Threats held two virtual workshops during 2021. The first workshop focused on what it means to frame the response to COVID-19 through a "syndemic" approach, and what the implications would be for global recovery. The second workshop focused more broadly on key lessons and emerging data from ongoing pandemic response efforts that can be incorporated into current health systems to improve resilience and preparedness for future outbreaks.

This workshop explored the long-term effects of COVID-19 on health equity, including considerations for mental health and social determinants of health. It also addressed uncertainties during a pandemic, such as trust, communication, and engagement and explored approaches to systematize recovery efforts to improve the ongoing responses and prepare for the next pandemic. Experts discussed possibilities for a post-pandemic world and a response strategy for stakeholders that ensures sustained community partnerships and prioritization of health equity. This Proceedings of a Workshop summarizes the presentations and discussions from the second workshop.

Crisis Standards of Care (CSC) inform decisions on medical care during a large-scale crisis such as a pandemic or natural disaster, eliminating the need to make these decisions at the bedside without protections or guidance. Numerous points throughout the COVID-19 pandemic have demonstrated the necessity of this type of crisis planning. The National Academies of Sciences, Engineering, and Medicine Forum on Medical and Public Health Preparedness for Disasters and Emergencies convened a series of public workshops to examine the experiences of healthcare providers during the COVID-19 pandemic and identify lessons that can inform current and future CSC planning and implementation. The workshops examined staffing and workforce needs, planning and implementation of CSC plans, and legal, ethical, and equity considerations of CSC planning. Topics of discussion included improving coordination between the bedside and boardroom, increasing buy-in from elected officials, expanding provider engagement, and addressing health equity issues. This publication summarizes the presentation and discussion of the workshops.

Adolescence is a crucial period of life for the prevention of substance use disorders. Research has shown that early intervention can significantly reduce rates of substance use disorder in adulthood. To learn more about effective family-focused interventions in primary care settings for preventing substance use disorder, the National Academies of Sciences, Engineering, and Medicine hosted a workshop on May 5-6, 2022. The proceedings from that workshop explores existing efforts to incorporate family-focused interventions into state health care policies. It also examines barriers to implementing such interventions as well as lessons learned from successful efforts to scale up these interventions.

COVID-19 has proven among the worst public health crises in a generation. Public health emergencies (PHE) have always been anticipated. Despite the growing field of PHE preparedness and planning since the turn of the twenty-first century and the preparedness plans and exercises developed, the U.S. experienced a suboptimal national response to the emergence of COVID-19 in early 2020 compared to other countries.

To explore the U.S. PHE preparedness enterprise, the National Academies Forum on Medical and Public Health Preparedness for Disasters and Emergencies convened a workshop in May 2022. They invited participants from government, NGO, and private sector organizations to consider key components, success stories, and failure points in order to identify opportunities for more effective catastrophic disaster, pandemic, and other large scale PHEs planning at the federal, state, local, tribal, and territorial levels. This Proceedings of a Workshop summarizes the discussions held during the workshop.

The National Academies Forum on Traumatic Brain Injury (TBI) convened a workshop in September 2022 to explore biomarkers used to more precisely and objectively diagnose and categorize suspected TBIs. Session discussions addressed developments in TBI biomarker classes including neuroimaging, blood-based, electrophysiological, and other physiological markers; how biomarkers may be used to better guide and monitor treatment after injury; and how they can be used to refine future research studies. Speakers also discussed potential impacts of biomarkers across the trajectory of TBI care and research, efforts to translate and incorporate biomarkers from research settings into clinical practice, and opportunities to advance the field. This Proceedings of a Workshop summarizes the presentations and discussions from the event.

The National Academies National Cancer Policy Forum hosted a Summer 2022 workshop to explore the current state of knowledge regarding risk factors for cancer and best practices for cancer prevention and risk reduction interventions. Speakers reviewed the current evidence base, examined best practices and innovative approaches for clinic- and population-based cancer prevention, and discussed strategies to promote effective communication about cancer prevention. This Proceedings of a Workshop summarizes the discussions held during the workshop. This workshop is the second in a series examining policy issues in cancer prevention and cancer screening. The first workshop, which took place in 2020, focused on advancing the development and implementation of effective, high-quality cancer screening.

The mental and behavioral health care needs of Americans, including veterans, have substantially grown over the past few decades. As the nations largest provider of mental health care, the U.S. Department of Veterans Affairs (VA) faces some of the greatest challenges in meeting the mental health care needs of its population. These challenges are exacerbated by a shrinking mental health care workforce and provider shortages in low-income and rural communities. To address these challenges, and at the request of VA, the National Academies of Sciences, Engineering, and Medicine Forum on Mental Health and Substance Use Disorders held a public workshop on Improving Access to High-Quality Mental Health Care for Veterans to explore the U.S. landscape for mental health care services, including telehealth services. The workshop considered ways to improve veterans timely access to high-quality care for mental health conditions. In particular, it explored internal and external best practices for three critical needs for mental health access (known as tripartite access in VA): urgent/crisis, engagement, and sustained access. This proceedings document summarizes discussions at the workshop.

The National Academies Forum on Microbial Threats and Forum on Neuroscience and Nervous System Disorders hosted a hybrid public workshop in June 2023 to explore opportunities to advance research and treatment of infection-associated chronic illnesses. The illnesses discussed in this workshop, including COVID-19, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), persistent or posttreatment Lyme disease syndrome (PTLDS), and multiple sclerosis (MS), share overlapping mechanisms and symptoms and have been inadequately researched. Recognizing these commonalities, speakers identified the need to advance research more comprehensively, translating to improved diagnostic and treatment options for patients across multiple conditions.

The National Academies Food Forum hosted a public workshop in August 2023 that explored the state of the science on the linkages between dietary patterns and diet-related chronic disease across the lifespan. Workshop presenters looked at dietary assessment, novel biomarkers for assessing dietary quality, and how diet influences the developmental origins of chronic disease, as well as the multitude of modifiable influences on dietary patterns and how these, in turn, affect chronic disease risk and susceptibility. The workshop also examined how to translate science into practice to improve dietary guidance adherence, highlighting examples of organizations working towards advancing the health of communities.

Public-private partnerships (PPPs) are collaborations among public and private entities (e.g., government agencies, research institutions, nonprofit organizations, and industry organizations) that bring together diverse expertise, resources, and perspectives to solve complex challenges. The National Academies National Cancer Policy Forum, in collaboration with the Forum on Drug Discovery, Development, and Translation, hosted a public workshop in October 2023 to examine opportunities to improve the care and outcomes for patients with cancer through PPPs for clinical cancer research.