National Academies Of Sciences, Engineering, And Medicine Research Articles

Potential Applications and Ethical Considerations for Artificial Intelligence in Traumatic Brain Injury Management

Artificial intelligence (AI) systems have emerged as promising tools for rapidly identifying patterns in large amounts of healthcare data to help guide clinical decision making, as well as to assist with medical education and the planning of research studies. Accumulating evidence suggests AI techniques may be particularly useful for aiding the diagnosis and clinical management of traumatic brain injury (TBI)—a considerably heterogeneous neurologic condition that can be challenging to detect and treat. However, important methodological and ethical concerns with the use of AI in medicine necessitate close monitoring and regulation of these techniques as advancements continue. The purpose of this narrative review is to provide an overview of common AI techniques in medical research and describe recent studies on the possible clinical applications of AI in the context of TBI. Finally, the review describes the ethical challenges with the use of AI in medicine, as well as guidelines from the White House, the Department of Defense (DOD), the National Academies of Sciences, Engineering, and Medicine (NASEM), and other organizations on the appropriate uses of AI in research.

Serum per- and polyfluoroalkyl substance (PFAS) levels and health-related biomarkers in a pilot study of skiers in New England

BackgroundPer- and polyfluoroalkyl substances (PFAS), synthetic chemicals with adverse health effects, are used extensively in consumer products. Ski waxes, applied to the base of skis, contain up to 100% PFAS by mass, but exposure and health effects are poorly characterized. ObjectivesOur objectives were to quantify serum PFAS concentrations among skiers and explore associations with reported ski wax use and biomarkers of cardiometabolic, thyroid, and immune health. MethodsWe recruited 30 active adult skiers to provide non-fasting blood samples and complete questionnaires. We quantified 18 PFAS using mass spectrometry, and measured serum lipids, thyroid hormones, and immunoglobulins. We explored associations of individual and aggregate measures of serum PFAS with wax use indicators and health biomarkers using multivariable regression models, adjusted for age and gender identity. ResultsNine PFAS (PFBS, PFHpS, PFHxS, Sm-PFOS, n-PFOS, PFDA, PFNA, PFUnDA, n-PFOA) were detected in 100% of participants, and MeFOSAA in 93%. Compared to NHANES, median serum concentrations (ng/ml) were similar, but higher in coaches (e.g., PFOAall: 1.1, PFOAcoaches: 2.7, PFOANHANES: 1.2; PFNAall: 0.5, PFNAcoaches: 1.7, PFNANHANES: 0.4). Factors reflecting wax exposure were positively associated with PFAS: e.g., >10 years as a snow sport athlete, compared to ≤10 years, was associated with 3.2 (95% CI: 0.7, 5.6) ng/ml higher aggregate PFAS, as defined by National Academies of Science, Engineering, and Medicine (NASEM). An IQR (6.3 ng/ml) increase in NASEM PFAS was associated with 32.1 (95% CI: 7.0, 57.2), 35.5 (13.5, 57.5), and 12.8 (0.6, 25.1) mg/dl higher total cholesterol, LDL-C, and sdLDL-C, respectively. DiscussionOur study provides early evidence that recreational skiers, particularly coaches, are exposed to PFAS through ski wax. Several PFAS were associated with higher serum lipids among these physically active adults. Interventions to remove PFAS from fluorinated wax could decrease direct exposure to skiers and reduce PFAS release into the environment.

Development, validation, and clinical assessment of a liquid chromatography-tandem mass spectrometry serum assay for per- and polyfluoroalkyl substances (PFAS) recommended by the National Academies of Science, Engineering, and Medicine (NASEM)

Per- and polyfluoroalkyl substances (PFAS) are widely used in industry, residential, and consumer products. Studies have shown associations between high PFAS exposure and adverse health effects. In 2022, the National Academies of Science, Engineering, and Medicine (NASEM) published Guidance on PFAS Exposure, Testing, and Clinical Follow-up providing laboratory and clinical direction. The Guidance suggests nine PFAS should be measured in serum or plasma specimens and summed to provide a total PFAS concentration using a NASEM-recommended method. Follow-up clinical recommendations are based on the calculated PFAS NASEM summation. We developed and validated a liquid chromatography-tandem mass spectrometry (LC–MS/MS) method in accordance with NASEM recommendations but distinguished by the ability to separate closely related structural isomers. As part of our validation, PFAS prevalence was evaluated in a population survey comprised of clinical donor and remnant specimens (n = 1023 in total). In this study, 82.2% of the specimens had PFAS NASEM summations of 2 to < 20 ng/mL and 2.5% had a summation ≥ 20 ng/mL. The median PFAS NASEM summation was 4.65 ng/mL in this study, lower than the 7.74 ng/mL median observed in the 2017–2020 Centers for Disease Control and Prevention, National Health and Nutrition Examination Survey (n = 3072). This lower median PFAS NASEM summation may reflect a decline in PFAS population levels over time or sample population exposure differences.Graphical

350 Awardee Talk: Beef cattle mineral nutrition: What do we know and where do we go from here

Abstract Trace minerals are pivotal in enhancing cattle growth and ensuring profitability in beef production. Historically, supplementation strategies have aimed at preventing deficiencies, significantly improving growth and reproductive performance. However, as cattle breeding has evolved to achieve remarkable growth rates, the challenges related to health and stress during the feeding period have intensified. This presentation explores refined trace mineral recommendations, focusing on zinc’s “stress requirement” for cattle undergoing transit and health challenges, and its impact on performance. The segmented nature of the beef industry, necessitating multiple transports, induces physiological stress and oxidative stress, highlighting the need for tailored mineral supplementation. Further, when recognizing feedlot cattle as the high-performing athletes they are, the potential benefits of adjusted trace mineral concentrations become apparent. Preliminary findings suggest that optimal zinc concentrations may exceed current National Academies of Sciences, Engineering, and Medicine (NASEM) 2016 recommendations, whereas for other minerals like copper and manganese, the existing guidelines remain appropriate. This presentation will explore the differential effects of increasing dietary zinc and copper in conjunction with various growth-promoting technologies. Preliminary data indicates that increasing zinc concentrations can linearly enhance average daily gain (ADG) and hot carcass weight (HCW), especially when using potent anabolic implants, while the response to increased copper concentrations exhibits a more quadratic relationship with performance. Building upon the foundational work of pioneering researchers in the field of mineral nutrition, this presentation advocates for the continuous refinement and optimization of trace mineral supplementation strategies. By integrating cutting-edge technologies and fostering collaborative research efforts, we aim to further enhance the sustainability of the beef industry. A deeper understanding of trace mineral requirements in the face of modern production challenges will pave the way for more precise and effective nutritional strategies.

MANTA: a negative-triangularity NASEM-compliant fusion pilot plant

Abstract The MANTA (Modular Adjustable Negative Triangularity ARC-class) design study investigated how negative-triangularity (NT) may be leveraged in a compact, fusion pilot plant (FPP) to take a ‘power-handling first’ approach. The result is a pulsed, radiative, ELM-free tokamak that satisfies and exceeds the FPP requirements described in the 2021 National Academies of Sciences, Engineering, and Medicine (NASEM) report ‘Bringing Fusion to the U.S. Grid’ (2021 Bringing Fusion to the U.S. Grid). A self-consistent integrated modeling workflow predicts a fusion power of 450 MW and a plasma gain of 11.5 with only 23.5 MW of power to the scrape-off layer (SOL). This low P SOL together with impurity seeding and high density at the separatrix results in a peak heat flux of just 2.8 MW m−2. MANTA’s high aspect ratio provides space for a large central solenoid (CS), resulting in ∼15 minute inductive pulses. In spite of the high B fields on the CS and the other REBCO-based magnets, the electromagnetic stresses remain below structural and critical current density limits. Iterative optimization of neutron shielding and tritium breeding blanket yield tritium self-sufficiency with a breeding ratio of 1.15, a blanket power multiplication factor of 1.11, toroidal field coil lifetimes of 3100 ± 400 MW · yr, and poloidal field coil lifetimes of at least 890 ± 40 MW · yr. Following balance of plant modeling, MANTA is projected to generate 90 MW of net electricity at an electricity gain factor of ∼ 2.4 . Systems-level economic analysis estimates an overnight cost of US$3.4 billion, meeting the NASEM FPP requirement that this first-of-a-kind be less than US$5 billion. The toroidal field coil cost and replacement time are the most critical upfront and lifetime cost drivers, respectively.

The Wound Environment Agent-based Model (WEABM): a digital twin platform for characterization and complex therapeutic discovery for volumetric muscle loss.

Volumetric Muscle Loss (VML) injuries are characterized by significant loss of muscle mass, usually due to trauma or surgical resection, often with a residual open wound in clinical settings and subsequent loss of limb function due to the replacement of the lost muscle mass with non-functional scar. Being able to regrow functional muscle in VML injuries is a complex control problem that needs to override robust, evolutionarily conserved healing processes aimed at rapidly closing the defect in lieu of restoration of function. We propose that discovering and implementing this complex control can be accomplished by the development of a Medical Digital Twin of VML. Digital Twins (DTs) are the subject of a recent report from the National Academies of Science, Engineering and Medicine (NASEM), which provides guidance as to the definition, capabilities and research challenges associated with the development and implementation of DTs. Specifically, DTs are defined as dynamic computational models that can be personalized to an individual real world "twin" and are connected to that twin via an ongoing data link. DTs can be used to provide control on the real-world twin that is, by the ongoing data connection, adaptive. We have developed an anatomic scale cell-level agent-based model of VML termed the Wound Environment Agent Based Model (WEABM) that can serve as the computational specification for a DT of VML. Simulations of the WEABM provided fundamental insights into the biology of VML, and we used the WEABM in our previously developed pipeline for simulation-based Deep Reinforcement Learning (DRL) to train an artificial intelligence (AI) to implement a robust generalizable control policy aimed at increasing the healing of VML with functional muscle. The insights into VML obtained include: 1) a competition between fibrosis and myogenesis due to spatial constraints on available edges of intact myofibrils to initiate the myoblast differentiation process, 2) the need to biologically "close" the wound from atmospheric/environmental exposure, which represents an ongoing inflammatory stimulus that promotes fibrosis and 3) that selective, multimodal and adaptive local mediator-level control can shift the trajectory of healing away from a highly evolutionarily beneficial imperative to close the wound via fibrosis. Control discovery with the WEABM identified the following design principles: 1) multimodal adaptive tissue-level mediator control to mitigate pro-inflammation as well as the pro-fibrotic aspects of compensatory anti-inflammation, 2) tissue-level mediator manipulation to promote myogenesis, 3) the use of an engineered extracellular matrix (ECM) to functionally close the wound and 4) the administration of an anti-fibrotic agent focused on the collagen-producing function of fibroblasts and myofibroblasts. The WEABM-trained DRL AI integrates these control modalities and provides design specifications for a potential device that can implement the required wound sensing and intervention delivery capabilities needed. The proposed cyber-physical system integrates the control AI with a physical sense-and-actuate device that meets the tenets of DTs put forth in the NASEM report and can serve as an example schema for the future development of Medical DTs.

Perspective: Advancing the science regarding temporomandibular disorders

This Special Issue was initiated in response to the call for improved research by the National Academies of Sciences, Engineering, and Medicine (NASEM) (United States) Consensus Study Report on Temporomandibular Disorders (TMDs), a set of putatively localized musculoskeletal conditions. In this Special Issue, the importance of systems biology for TMDs emerges from each of three separate publications. The importance of systems biology to patients is anchored in two domains—laboratory research and clinical observation. The three publications fully speak to the underlying goals in the NASEM recommendations for initiatives: that research on TMDs needs to broaden, that integration between basic and clinical science needs to improve, and that while better evidence is needed, clinicians need to utilize the evidence that already exists. All three of these initiatives, taken together, would lead to better understanding of these complex diseases and to better care of patients with these diseases.

The National Academies of Sciences, Engineering, and Medicine recommendations on Medicaid parity and future of pediatric subspecialty workforce.

Medicaid supports 41% of all births in the US and nearly 347,580 admissions to neonatal intensive care units in 2022. Medicaid reimbursement is critical to child health inclusive of departments of Pediatrics and children's hospitals. Low Medicaid reimbursement is one of the causes for low pediatric subspecialist salaries and has led to workforce challenges. The National Academies of Science, Engineering, and Medicine (NASEM) recently suggested increased Medicaid reimbursement as a strategy to sustain pediatric subspecialist workforce. This review article briefly outlines the importance of Medicaid reimbursement to Neonatal-Perinatal Medicine and its role in providing coverage for preterm births. We also highlight the recommendations of NASEM pertaining to reimbursement that are relevant to neonatal care and its impact on providers, patients, and families. It is imperative that neonatologists join the rest of pediatric subspecialists in lending their support to demonstrate unity in ensuring success in the implementation of the NASEM recommendations.

Triangulation of epidemiological evidence and risk of bias evaluation: A proposed framework and applied example using formaldehyde exposure and risk of myeloid leukemias

Evidence triangulation may help identify the impact of study design elements on study findings and to tease out biased results when evaluating potential causal relationships; however, methods for triangulating epidemiologic evidence are evolving and have not been standardized. Building upon key principles of epidemiologic evidence triangulation and risk of bias assessment, and responding to the National Academies of Sciences, Engineering, and Medicine (NASEM) call for applied triangulation examples, the objective of this manuscript is to propose a triangulation framework and to apply it as an illustrative example to epidemiologic studies examining the possible relationship between occupational formaldehyde exposure and risk of myeloid leukemias (ML) including acute (AML) and chronic (CML) types.A nine-component triangulation framework for epidemiological evidence was developed incorporating study quality and ROB guidance from various federal health agencies (i.e., US EPA TSCA and NTP OHAT). Several components of the triangulation framework also drew from widely used epidemiological analytic tools such as stratified meta-analysis and sensitivity analysis. Regarding the applied example, fourteen studies were identified and assessed using the following primary study quality domains to explore potential key sources of bias: 1) study design and analysis; 2) study participation; 3) exposure assessment; 4) outcome assessment; and 5) potential confounding. Across studies, methodological limitations possibly contributing to biased results were observed within most domains. Interestingly, results from one study – often providing the largest and least-precise relative risk estimates, likely reflecting study biases, deviated from most primary study findings indicating no such associations. Triangulation of epidemiological evidence appears to be helpful in exploring inconsistent results for the identification of study results possibly reflecting various biases. Nonetheless, triangulation methodologies require additional development and application to real-world examples to enhance objectivity and reproducibility.

Refining a Framework to Enhance Communication in the Emergency Department During the Diagnostic Process: An eDelphi Approach

Emergency departments (EDs) are susceptible to diagnostic error. Suboptimal communication between the patient and the interdisciplinary care team increases risk to diagnostic safety. The role of communication remains underrepresented in existing diagnostic decision-making conceptual models. The authors used eDelphi methodology, whereby data are collected electronically, to achieve consensus among an expert panel of 18 clinicians, patients, family members, and other participants on a refined ED-based diagnostic decision-making framework that integrates several potential opportunities for communication to enhance diagnostic quality. This study examined the entire diagnostic process in the ED, from prehospital to discharge or transfer to inpatient care, and identified where communication breakdowns could occur. After four iterative rounds of the eDelphi process, including a final validation round by all participants, the project's a priori consensus threshold of 80% agreement was reached. The authors developed a final framework that positions communication more prominently in the diagnostic process in the ED and enhances the original National Academies of Sciences, Engineering, and Medicine (NASEM) and ED-adapted NASEM frameworks. Specific points in the ED journey were identified where more attention to communication might be helpful. Two specific types of communication-information exchange and shared understanding-were identified as high priority for optimal outcomes. Ideas for communication-focused interventions to prevent diagnostic error in the ED fell into three categories: patient-facing, clinician-facing, and system-facing interventions. This project's refinement of the NASEM framework adapted to the ED can be used to develop communications-focused interventions to reduce diagnostic error in this highly complex and error-prone setting.

Fifth National Climate Assessment Reveals Urgent Action Needed to Reduce Greenhouse Gas Emissions

The Fifth National Climate Assessment (NCA5) was released in November 2023 by the U.S. Global Change Research Program. The Assessment evaluates the impacts of a changing climate across 10 US regions and a wide range of biodiversity and other interests, including water, forests and ecosystems, coasts and oceans, agriculture and rural communities, the built environment, energy and transportation, health and air quality, and economic and social systems. The Assessment is the fifth such report released by the US government since 2000, using science‐based data by more than a dozen US agencies and approximately 750 scientists tracking the impacts of climate change, and peer‐reviewed by the National Academies of Sciences, Engineering and Medicine (NASEM).1 The details outlined within the Assessment are not optimistic. In fact, the extensively peer‐reviewed report further quantifies the need to take immediate actions to reduce greenhouse gas (GHG) emissions into the atmosphere. Immediate actions will require both increased mitigation measures to reduce GHG emissions and adaptation measures as we attempt to live with the impacts of a changing climate.

A Causality Assessment Framework for COVID-19 Vaccines and Adverse Events at the COVID-19 Vaccine Safety Research Center.

During the coronavirus disease 2019 (COVID-19) pandemic, conclusively evaluating possible associations between COVID-19 vaccines and potential adverse events was of critical importance. The National Academy of Medicine of Korea established the COVID-19 Vaccine Safety Research Center (CoVaSC) with support from the Korea Disease Control and Prevention Agency to investigate the scientific relationship between COVID-19 vaccines and suspected adverse events. Although determining whether the COVID-19 vaccine was responsible for any suspected adverse event necessitated a systematic approach, traditional causal inference theories, such as Hill's criteria, encountered certain limitations and criticisms. To facilitate a systematic and evidence-based evaluation, the United States Institute of Medicine, at the request of the Centers for Disease Control and Prevention, offered a detailed causality assessment framework in 2012, which was updated in the recent report by the National Academies of Sciences, Engineering, and Medicine (NASEM) in 2024. This framework, based on a weight-of-evidence approach, allows the independent evaluation of both epidemiological and mechanistic evidence, culminating in a comprehensive conclusion about causality. Epidemiological evidence derived from population studies is categorized into four levels-high, moderate, limited, or insufficient-while mechanistic evidence, primarily from biological and clinical studies in animals and individuals, is classified as strong, intermediate, weak, or lacking. The committee then synthesizes these two types of evidence to draw a conclusion about the causal relationship, which can be described as "convincingly supports" ("evidence established" in the 2024 NASEM report), "favors acceptance," "favors rejection," or "inadequate to accept or reject." The CoVaSC has established an independent committee to conduct causality assessments using the weight-of-evidence framework, specifically for evaluating the causality of adverse events associated with COVID-19 vaccines. The aim of this study is to provide an overview of the weight-of-evidence framework and to detail the considerations involved in its practical application in the CoVaSC.

THE MOVING FORWARD NURSING HOME COALITION: A CALL TO ACTION TO SUPPORT NURSING HOME REFORM

Abstract The Moving Forward Nursing Home Quality Coalition advances the goals outlined by the 2022 National Academies of Sciences, Engineering, and Medicine (NASEM) report aimed at improving nursing home (NH) quality. Over two years, Coalition committee members – along with a network of national leaders, nursing home residents, and the general public – will develop, test and promote action plans that will improve the way the United States finances, delivers, and regulates care in Nursing Homes. The Coalition is comprised of a steering committee and working committees that align with and advance the seven NASEM goals including; 1) advancing delivery of person-centered care; 2) ensuring a well-prepared and compensated workforce; 3) increasing financial transparency and accountability; 4) creating a rational and robust financing system; 5) designing more effective and responsive quality assurance; 6) expanding quality measurement and continuous quality improvement; and 7) adopting health information technology. Coalition committees have engaged in three of four phases of their two-year work plan including convening stakeholders to prioritize and develop action plans to test and promote change. Throughout the work, committee collaboration has ensured action plans are refined and expanded in synergistic ways to shape state and national policy. This presentation will provide an overview of the broader Coalition work and give context for the other presentations which provide an example of collaborative work leading to proposed recommendations for critical policy and regulatory change around person-centered care planning.

POLICY SERIES: THE MOVING FORWARD NURSING HOME COALITION: NURSING HOME REFORM AND THE RESIDENTS’ GOALS, PREFERENCES, AND PRIORITIES

Abstract The 2022 National Academies of Sciences, Engineering, and Medicine (NASEM) report called for nursing facilities to provide “care aligned to the individual’s goals and preferences.” Missing has been an efficient process to uncover the individual’s detailed goals, preferences, and priorities (GPPs). GPPs are a care planning process that translates into actionable interventions, supported by quality measurement to determine whether the care provided aligns with those GPPs, and health information technology to collect GPPs efficiently and to determine if the care provided is concordant with the individual’s GPPs. A diverse set of experts representing the Moving Forward Nursing Home Quality Coalition are collaborating to develop an integrated approach to these shortcomings and will discuss these issues in detail including new approaches to the identification and documentation of GPPs for use in a modified care planning process, the status of health information technologies (HIT) processes being developed to support these changes and the development of new quality measures. While the Moving Forward Coalition is focused on nursing facilities, the approaches being developed here to improve care and to standardize the vocabulary for GPPs are applicable to all care settings. Three committees from the Moving Forward Nursing Home Coalition will present work focused on the development of a standardized GPP care planning process to enhance the identification, documentation, communication, and implementation of resident GPPs, the measurement of the care planning process to support process improvement, and the creation of a HIT-enabled process to measure the concordance of care provided with an individual’s GPPs. This is a collaborative symposium between the Aging Workforce, Hospital Elder Life Program, Measurement, Statistics, and Research Design, Systems Research in Long Term-Care, and Technology and Aging Interest Groups.

MEASURING GOALS, PRIORITIES, AND PREFERENCES: REFORM EFFORTS FOR TRANSPARENCY AND EMPOWERMENT

Abstract Longstanding evidence suggests that the goals, preferences, and priorities (GPP) of individual nursing facility residents may not be adequately addressed during episodes of care. Aligning care with residents’ GPP represents an opportunity to improve outcomes and reduce disparities associated with race, ethnicity, gender orientation, and other characteristics of the resident population. The 2022 National Academies of Sciences, Engineering, and Medicine (NASEM) report recommended improvement in quality measures under the domain of resident and family experience, along with reporting of these measures on Care Compare to improve shared decision-making and transparency. The subcommittee on quality improvement and measurement is focused primarily on measures of GPP as a useful addition to CMS’ plans to expand the Quality Reporting Program (QRP) measure set, which was signaled in the recently issued Skilled Nursing Facility Prospective Payment System (SNF PPS) rule. In this presentation, committee members will discuss the identification and testing plan for one or more resident experience of care measures that assess the experience of care specific to processes of care and the resident’s GPP. This presentation will also discuss the development of a care concordant measure, assessing the relationship between the care provided to the resident and the resident GPPs.

Interprofessional diagnostic management teams: a scoping review protocol

BackgroundDiagnostic errors are a major problem in healthcare. In 2015, the report “Improving Diagnosis in Health Care” by the National Academies of Sciences, Engineering, and Medicine (NASEM) stated that it is likely that most people will experience at least one diagnostic error in their lifetime. The report suggests implementing diagnostic management teams, including patients and their relatives, diagnosticians, and healthcare professionals who support the diagnostic process, to limit diagnostic error and improve patient safety. Implementing interprofessional diagnostic management teams (IDMT), however, is not an easy task due to the complexity of the diagnostic processes and the traditional organization of healthcare with divided departments and healthcare professional who operate in different geographic locations. As this topic is still emerging, a scoping review is ideal to determine the scope of the body of literature on IDMT, indicate the volume of literature and studies available and identify any gaps in knowledge. In a long-term perspective, this scoping review will contribute to prevent diagnostic errors and improve patient safety, for adults and children with physical health issues.MethodsWe will conduct this scoping review in accordance with the JBI methodology and report it based on the PRISMA-ScR. We will systematically search six databases (EMBASE, PubMed, CINAHL, Academic Search Premier, SCOPUS and Web of Science) for papers published between 1985 and 2023 that describe the use of interprofessional diagnostic management teams. The participants included will be adults and children seeking diagnostic care for physical health issues. The concept studied will be interprofessional diagnostic management teams, and the context will be the diagnostic process in the healthcare system. Studies examining the diagnostic process in psychiatry, odontology or complementary medicine will be excluded. Data extraction, including key study characteristics and findings, will be done by two reviewers independently. Any disagreement will be resolved by discussion and eventually by including the two remainder reviewers.DiscussionTo our knowledge, this will be the first scoping review regarding IDMT and the derived effects on diagnostic safety and can therefore be a very important contribution to improve patient safety significantly during the diagnostic process.Protocol registrationThe project is registered at Open Science Framework (OSF) with ID: osf.io/kv2n6.

Proposed Priorities for Low-Dose Radiation Research and Their Relevance to the Practice of Radiology.

Because ionizing radiation is widely used in medical imaging and in military, industry, and commercial applications, programmatic management and advancement in knowledge is needed, especially related to the health effects of low-dose radiation. The U.S. Congress in partnership with the U.S. Department of Energy called on the National Academies of Sciences, Engineering, and Medicine (NASEM) to develop a long-term strategic and prioritized agenda for low-dose radiation research. Low doses were defined as dose amounts less than 100 mGy or low-dose rates less than 5 mGy per hour. The 2022 NASEM report was divided into sections detailing the low-dose radiation exposure and health effects, scientific basis for radiation protection, status of low-dose radiation research, a prioritized radiation research agenda, and essential components of a low-dose radiation research program, including resources needed and recommendations for financial recourse. The purpose of this review is to summarize this report and examine the recommendations to assess how these pertain to the practice of radiology and medicine.

Using in silico tools to predict flame retardant metabolites for more informative exposomics-based approaches.

Introduction: The positive identification of xenobiotics and their metabolites in human biosamples is an integral aspect of exposomics research, yet challenges in compound annotation and identification continue to limit the feasibility of comprehensive identification of total chemical exposure. Nonetheless, the adoption of in silico tools such as metabolite prediction software, QSAR-ready structural conversion workflows, and molecular standards databases can aid in identifying novel compounds in untargeted mass spectral investigations, permitting the assessment of a more expansive pool of compounds for human health hazard. This strategy is particularly applicable when it comes to flame retardant chemicals. The population is ubiquitously exposed to flame retardants, and evidence implicates some of these compounds as developmental neurotoxicants, endocrine disruptors, reproductive toxicants, immunotoxicants, and carcinogens. However, many flame retardants are poorly characterized, have not been linked to a definitive mode of toxic action, and are known to share metabolic breakdown products which may themselves harbor toxicity. As U.S. regulatory bodies begin to pursue a subclass- based risk assessment of organohalogen flame retardants, little consideration has been paid to the role of potentially toxic metabolites, or to expanding the identification of parent flame retardants and their metabolic breakdown products in human biosamples to better inform the human health hazards imposed by these compounds. Methods: The purpose of this study is to utilize publicly available in silico tools to 1) characterize the structural and metabolic fates of proposed flame retardant classes, 2) predict first pass metabolites, 3) ascertain whether metabolic products segregate among parent flame retardant classification patterns, and 4) assess the existing coverage in of these compounds in mass spectral database. Results: We found that flame retardant classes as currently defined by the National Academies of Science, Engineering and Medicine (NASEM) are structurally diverse, with highly variable predicted pharmacokinetic properties and metabolic fates among member compounds. The vast majority of flame retardants (96%) and their predicted metabolites (99%) are not present in spectral databases, posing a challenge for identifying these compounds in human biosamples. However, we also demonstrate the utility of publicly available in silico methods in generating a fit for purpose synthetic spectral library for flame retardants and their metabolites that have yet to be identified in human biosamples. Discussion: In conclusion, exposomics studies making use of fit-for-purpose synthetic spectral databases will better resolve internal exposure and windows of vulnerability associated with complex exposures to flame retardant chemicals and perturbed neurodevelopmental, reproductive, and other associated apical human health impacts.

External evaluation of the prediction equation for milk fat yield by the 2021 NASEM dairy model using data from eastern Canadian dairy herds

In 2021, the National Academies of Sciences, Engineering, and Medicine (NASEM) issued an equation to predict milk fat yield using dairy cow characteristics and diet composition as input variables. This model was evaluated externally using a data set composed of 541 feed and production records obtained from 23 eastern Canadian dairy herds. The use of the developed equation requires the prediction of dry matter intake. Cow intake used in the model assessment has been obtained by NASEM equations based on (1) animal factors, or (2) a combination of feed composition and animal factors. The prediction of milk fat yield was shown to be accurate. The best prediction was obtained using intake estimated based solely on animal factors (concordance correlation coefficient = 0.68).

Improving Graduate Medical Education by Aggregating Data Across the Medical Education Continuum.

Meaningful improvements to graduate medical education (GME) have been achieved in recent decades, yet many GME improvement pilots have been small trials without rigorous outcome measures and with limited generalizability. Thus, lack of access to large-scale data is a key barrier to generating empiric evidence to improve GME. In this article, the authors examine the potential of a national GME data infrastructure to improve GME, review the output of 2 national workshops on this topic, and propose a path toward achieving this goal.The authors envision a future where medical education is shaped by evidence from rigorous research powered by comprehensive, multi-institutional data. To achieve this goal, premedical education, undergraduate medical education, GME, and practicing physician data must be collected using a common data dictionary and standards and longitudinally linked using unique individual identifiers. The envisioned data infrastructure could provide a foundation for evidence-based decisions across all aspects of GME and help optimize the education of individual residents.Two workshops hosted by the National Academies of Sciences, Engineering, and Medicine Board on Health Care Services explored the prospect of better using GME data to improve education and its outcomes. There was broad consensus about the potential value of a longitudinal data infrastructure to improve GME. Significant obstacles were also noted.Suggested next steps outlined by the authors include producing a more complete inventory of data already being collected and managed by key medical education leadership organizations, pursuing a grass-roots data sharing pilot among GME-sponsoring institutions, and formulating the technical and governance frameworks needed to aggregate data across organizations.The power and potential of big data is evident across many disciplines, and the authors believe that harnessing the power of big data in GME is the best next step toward advancing evidence-based physician education.