TY - BOOK AU - Institute of Medicine TI - Veterans and Agent Orange: Update 2000 SN - DO - 10.17226/10098 PY - 2001 UR - https://nap.nationalacademies.org/catalog/10098/veterans-and-agent-orange-update-2000 PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine KW - Conflict and Security Issues AB - Veterans and Agent Orange: Update 2000 examines the state of the scientific evidence regarding associations between diseases and exposure to dioxin and other chemical compounds in herbicides used in Vietnam. It is the fourth in a series of comprehensive reviews of epidemiologic and toxicologic studies of the agents used as defoliants during the Vietnam War. Over forty health outcomes in veterans and their children are addressed. Among the report's conclusions is that there is sufficient evidence of a link between exposure and the development of soft-tissue sarcoma, non-Hodgkin's lymphoma, Hodgkin's disease, and chloracne in veterans. Additionally, it found that scientific studies offer "limited or suggestive" evidence of an association with other diseases in veterans—including Type 2 diabetes, respiratory cancers, prostate cancer, multiple myeloma and some forms of transient peripheral neuropathy—as well as the congenital birth defect spina bifida in veterans' children. ER - TY - BOOK AU - National Research Council TI - Causes and Effects of Stratospheric Ozone Reduction: An Update SN - DO - 10.17226/319 PY - 1982 UR - https://nap.nationalacademies.org/catalog/319/causes-and-effects-of-stratospheric-ozone-reduction-an-update PB - The National Academies Press CY - Washington, DC LA - English KW - Environment and Environmental Studies ER - TY - BOOK AU - Institute of Medicine TI - Veterans and Agent Orange: Update 1998 SN - DO - 10.17226/6415 PY - 1999 UR - https://nap.nationalacademies.org/catalog/6415/veterans-and-agent-orange-update-1998 PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - Third in a series of six congressionally mandated studies occurring biennially, this book is an updated review and evaluation of the available scientific evidence regarding the statistical association between exposure to herbicides used in Vietnam and various adverse health outcomes suspected to be linked with such exposures. As part of the review, the committee convened a workshop at which issues surrounding the reanalysis and the combination of existing data on the health effects of herbicide and dioxin exposure were addressed. This book builds upon the information developed by the IOM committees responsible for the 1994 original report, Veterans and Agent Orange, and Veterans and Agent Orange: Update 1996, but will focus on scientific studies and other information developed since the release of these reports. The two previous volumes have noted that sufficient evidence exists to link soft tissue sarcoma, non-Hodgkin's lymphoma, Hodgkin's disease, and chloracne with exposure. The books also noted that there is "limited or suggestive" evidence to show an association with exposure and a neurological disorder in veterans and with the congenital birth defect spina bifida in veterans' children. This volume will be critically important to both policymakers and physicians in the federal government, Vietnam veterans and their families, veterans organizations, researchers, and health professionals. ER - TY - BOOK AU - Institute of Medicine A2 - Marilyn J. Field A2 - Robert L. Lawrence A2 - Lee Zwanziger TI - Extending Medicare Coverage for Preventive and Other Services SN - DO - 10.17226/9740 PY - 2000 UR - https://nap.nationalacademies.org/catalog/9740/extending-medicare-coverage-for-preventive-and-other-services PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - This report, which was developed by an expert committee of the Institute of Medicine, reviews the first three services listed above. It is intended to assist policymakers by providing syntheses of the best evidence available about the effectiveness of these services and by estimating the cost to Medicare of covering them. For each service or condition examined, the committee commissioned a review of the scientific literature that was presented and discussed at a public workshop. As requested by Congress, this report includes explicit estimates only of costs to Medicare, not costs to beneficiaries, their families, or others. It also does not include cost-effectiveness analyses. That is, the extent of the benefits relative to the costs to Medicare—or to society generally—is not evaluated for the services examined. The method for estimating Medicare costs follows the generic estimation practices of the Congressional Budget Office (CBO). The objective was to provide Congress with estimates that were based on familiar procedures and could be compared readily with earlier and later CBO estimates. For each condition or service, the estimates are intended to suggest the order of magnitude of the costs to Medicare of extending coverage, but the estimates could be considerably higher or lower than what Medicare might actually spend were coverage policies changed. The estimates cover the five-year period 2000-2004. In addition to the conclusions about specific coverage issues, the report examines some broader concerns about the processes for making coverage decisions and about the research and organizational infrastructure for these decisions. It also briefly examines the limits of coverage as a means of improving health services and outcomes and the limits of evidence as a means of resolving policy and ethical questions. ER - TY - BOOK TI - The Ozone Depletion Phenomenon DO - 10.17226/9042 PY - 1996 UR - https://nap.nationalacademies.org/catalog/9042/the-ozone-depletion-phenomenon PB - The National Academies Press CY - Washington, DC LA - English KW - AB - Like an infection that grows more and more virulent, the continent-size hole in Earth's ozone layer keeps getting bigger and bigger. Each year since the late 1970s, much of the protective layer of stratospheric ozone above Antarctica has disappeared during September, creating what is popularly known as the ozone hole. The Antarctic hole now measures about 9 million square miles, nearly the size of North America. Less dramatic, still significant, depletion of ozone levels has been recorded around the globe. With less ozone in the atmosphere, more ultraviolet radiation strikes Earth, causing more skin cancer, eye damage, and possible harm to crops. What is ozone? How did researchers discover its role in Earth's atmosphere and the devastating consequences of its depletion? The following article, adapted from an account by Dr. F. Sherwood Rowland, a pioneering researcher in the field who shared the 1995 Nobel Prize in Chemistry for his work, attempts to answer these and other questions. In doing so, it dramatically illustrates how science works and, in particular, how basic research—motivated by a desire to understand nature—often leads to practical results of immense societal benefit that could not have been anticipated when the research first began. ER - TY - BOOK AU - National Academy of Engineering AU - National Academy of Engineering TI - Frontiers of Engineering: Reports on Leading Edge Engineering From the 1998 NAE Symposium on Frontiers of Engineering SN - DO - 10.17226/6411 PY - 1999 UR - https://nap.nationalacademies.org/catalog/6411/frontiers-of-engineering-reports-on-leading-edge-engineering-from-the PB - The National Academies Press CY - Washington, DC LA - English KW - Engineering and Technology ER - TY - BOOK AU - Institute of Medicine TI - Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam SN - DO - 10.17226/2141 PY - 1994 UR - https://nap.nationalacademies.org/catalog/2141/veterans-and-agent-orange-health-effects-of-herbicides-used-in PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - Have U.S. military personnel experienced health problems from being exposed to Agent Orange, its dioxin contaminants, and other herbicides used in Vietnam? This definitive volume summarizes the strength of the evidence associating exposure during Vietnam service with cancer and other health effects and presents conclusions from an expert panel. Veterans and Agent Orange provides a historical review of the issue, examines studies of populations, in addition to Vietnam veterans, environmentally and occupationally exposed to herbicides and dioxin, and discusses problems in study methodology. The core of the book presents: What is known about the toxicology of the herbicides used in greatest quantities in Vietnam. What is known about assessing exposure to herbicides and dioxin. What can be determined from the wide range of epidemiological studies conducted by different authorities. What is known about the relationship between exposure to herbicides and dioxin, and cancer, reproductive effects, neurobehavioral disorders, and other health effects. The book describes research areas of continuing concern and offers recommendations for further research on the health effects of Agent Orange exposure among Vietnam veterans. This volume will be critically important to both policymakers and physicians in the federal government, Vietnam veterans and their families, veterans organizations, researchers, and health professionals. ER - TY - BOOK AU - Institute of Medicine TI - Gulf War and Health: Volume 3: Fuels, Combustion Products, and Propellants SN - DO - 10.17226/11180 PY - 2005 UR - https://nap.nationalacademies.org/catalog/11180/gulf-war-and-health-volume-3-fuels-combustion-products-and PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - The third in a series of congressionally mandated reports on Gulf War veterans’ health, this volume evaluates the long-term, human health effects associated with exposure to selected environmental agents, pollutants, and synthetic chemical compounds believed to have been present during the Gulf War. The committee specifically evaluated the literature on hydrogen sulfide, combustion products, hydrazine and red fuming nitric acid. Both the epidemiologic and toxicologic literature were reviewed. ER - TY - BOOK AU - National Academies of Sciences, Engineering, and Medicine TI - Review of Fate, Exposure, and Effects of Sunscreens in Aquatic Environments and Implications for Sunscreen Usage and Human Health SN - DO - 10.17226/26381 PY - 2022 UR - https://nap.nationalacademies.org/catalog/26381/review-of-fate-exposure-and-effects-of-sunscreens-in-aquatic-environments-and-implications-for-sunscreen-usage-and-human-health PB - The National Academies Press CY - Washington, DC LA - English KW - Environment and Environmental Studies KW - Health and Medicine AB - Regular use of sunscreens has been shown to reduce the risk of sunburn and skin cancer, and slow photoaging of skin. Sunscreens can rinse off into water where people are swimming or wading, and can also enter bodies of water through wastewater such as from bathing or showering. As a result, the ultraviolet (UV) filters - the active ingredients in sunscreens that reduce the amount of UV radiation on skin - have been detected in the water, sediment, and animal tissues in aquatic environments. Because the impact of these filters on aquatic ecosystems is not fully understood, assessment is needed to better understand their environmental impacts. This report calls on the U.S. Environmental Protection Agency to conduct an ecological risk assessment of UV filters to characterize the possible risks to aquatic ecosystems and the species that live in them. EPA should focus on environments more likely to be exposed such as those with heavy recreational use, or where wastewater and urban runoff enter the water. The risk assessment should cover a broad range of species and biological effects and could consider potential interacting effects among UV filters and with other environmental stresses such as climate change. In addition, the report describes the role of sunscreens in preventing skin cancer and what is known about how human health could be affected by potential changes in usage. While the need for a risk assessment is urgent, research is needed to advance understanding of both risks to the environment from UV filters and impacts to human health from changing sunscreen availability and usage. ER - TY - BOOK TI - Conference on Human Health and Global Climate Change: Summary of the Proceedings DO - 10.17226/9100 PY - 1996 UR - https://nap.nationalacademies.org/catalog/9100/conference-on-human-health-and-global-climate-change-summary-of PB - The National Academies Press CY - Washington, DC LA - English KW - KW - Environment and Environmental Studies ER - TY - BOOK AU - National Research Council TI - Critical Aspects of EPA's IRIS Assessment of Inorganic Arsenic: Interim Report SN - DO - 10.17226/18594 PY - 2013 UR - https://nap.nationalacademies.org/catalog/18594/critical-aspects-of-epas-iris-assessment-of-inorganic-arsenic-interim PB - The National Academies Press CY - Washington, DC LA - English KW - Environment and Environmental Studies AB - The US Environmental Protection Agency (EPA) Integrated Risk Information System (IRIS) program develops toxicologic assessments of environmental contaminants. IRIS assessments provide hazard identification and dose-response assessment information. The information is then used in conjunction with exposure information to characterize risks to public health and may be used in risk-based decisionmaking, in regulatory actions, and for other risk-management purposes. Since the middle 1990s, EPA has been in the process of updating the IRIS assessment of inorganic arsenic. In response to a congressional mandate for an independent review of the IRIS assessment of inorganic arsenic, EPA requested that the National Research Council convene a committee to conduct a two-phase study. Critical Aspects of EPA's IRIS Assessment of Inorganic Arsenic is the report of the first phase of that study. This report evaluates critical scientific issues in assessing cancer and noncancer effects of oral exposure to inorganic arsenic and offers recommendations on how the issues could be addressed in EPA's IRIS assessment. ER - TY - BOOK AU - National Academies of Sciences, Engineering, and Medicine TI - Veterans and Agent Orange: Update 11 (2018) SN - DO - 10.17226/25137 PY - 2018 UR - https://nap.nationalacademies.org/catalog/25137/veterans-and-agent-orange-update-11-2018 PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - From 1962 to 1971, the U.S. military sprayed herbicides over Vietnam to strip the thick jungle canopy that could conceal opposition forces, to destroy crops that those forces might depend on, and to clear tall grasses and bushes from the perimeters of US base camps and outlying fire-support bases. Mixtures of 2,4-dichlorophenoxyacetic acid (2,4-D), 2,4,5-trichlorophenoxyacetic acid (2,4,5-T), picloram, and cacodylic acid made up the bulk of the herbicides sprayed. The main chemical mixture sprayed was Agent Orange, a 50:50 mixture of 2,4-D and 2,4,5-T. At the time of the spraying, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), the most toxic form of dioxin, was an unintended contaminant generated during the production of 2,4,5-T and so was present in Agent Orange and some other formulations sprayed in Vietnam. Because of complaints from returning Vietnam veterans about their own health and that of their children combined with emerging toxicologic evidence of adverse effects of phenoxy herbicides and TCDD, the National Academies of Sciences, Engineering, and Medicine was asked to perform a comprehensive evaluation of scientific and medical information regarding the health effects of exposure to Agent Orange, other herbicides used in Vietnam, and the various components of those herbicides, including TCDD. Updated evaluations were conducted every two years to review newly available literature and draw conclusions from the overall evidence. Veterans and Agent Orange: Update 11 (2018) examines peer-reviewed scientific reports concerning associations between various health outcomes and exposure to TCDD and other chemicals in the herbicides used in Vietnam that were published between September 30, 2014, and December 31, 2017, and integrates this information with the previously established evidence database. ER - TY - BOOK AU - National Research Council TI - Assessment of Scientific Information for the Radiation Exposure Screening and Education Program: Interim Report DO - 10.17226/10766 PY - 2003 UR - https://nap.nationalacademies.org/catalog/10766/assessment-of-scientific-information-for-the-radiation-exposure-screening-and-education-program PB - The National Academies Press CY - Washington, DC LA - English KW - Environment and Environmental Studies ER - TY - BOOK AU - Institute of Medicine AU - National Academies of Sciences, Engineering, and Medicine TI - Veterans and Agent Orange: Update 2014 SN - DO - 10.17226/21845 PY - 2016 UR - https://nap.nationalacademies.org/catalog/21845/veterans-and-agent-orange-update-2014 PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - From 1962 to 1971, the US military sprayed herbicides over Vietnam to strip the thick jungle canopy that could conceal opposition forces, to destroy crops that those forces might depend on, and to clear tall grasses and bushes from the perimeters of US base camps and outlying fire-support bases. Mixtures of 2,4-dichlorophenoxyacetic acid (2,4-D), 2,4,5-trichlorophenoxyacetic acid (2,4,5-T), picloram, and cacodylic acid made up the bulk of the herbicides sprayed. The main chemical mixture sprayed was Agent Orange, a 50:50 mixture of 2,4-D and 2,4,5-T. At the time of the spraying, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), the most toxic form of dioxin, was an unintended contaminant generated during the production of 2,4,5-T and so was present in Agent Orange and some other formulations sprayed in Vietnam. Because of complaints from returning Vietnam veterans about their own health and that of their children combined with emerging toxicologic evidence of adverse effects of phenoxy herbicides and TCDD, the National Academy of Sciences was asked to perform a comprehensive evaluation of scientific and medical information regarding the health effects of exposure to Agent Orange, other herbicides used in Vietnam, and the various components of those herbicides, including TCDD. Updated evaluations were conducted every two years to review newly available literature and draw conclusions from the overall evidence. Veterans and Agent Orange: Update 2014 is a cumulative report of the series thus far. ER - TY - BOOK AU - National Research Council TI - Arsenic in Drinking Water: 2001 Update SN - DO - 10.17226/10194 PY - 2001 UR - https://nap.nationalacademies.org/catalog/10194/arsenic-in-drinking-water-2001-update PB - The National Academies Press CY - Washington, DC LA - English KW - Environment and Environmental Studies AB - Having safe drinking water is important to all Americans. The Environmental Protection Agency's decision in the summer of 2001 to delay implementing a new, more stringent standard for the maximum allowable level for arsenic in drinking water generated a great deal of criticism and controversy. Ultimately at issue were newer data on arsenic beyond those that had been examined in a 1999 National Research Council report. EPA asked the National Research Council for an evaluation of the new data available. The committee's analyses and conclusions are presented in Arsenic in Drinking Water: 2001 Update. New epidemiological studies are critically evaluated, as are new experimental data that provide information on how and at what level arsenic in drinking water can lead to cancer. The report's findings are consistent with those of the 1999 report that found high risks of cancer at the previous federal standard of 50 parts per billion. In fact, the new report concludes that men and women who consume water containing 3 parts per billion of arsenic daily have about a 1 in 1,000 increased risk of developing bladder or lung cancer during their lifetime. ER - TY - BOOK AU - National Academy of Sciences TI - A Review of the Draft Report of the NCI-CDC Working Group to Revise the 1985 Radioepidemiological Tables SN - DO - 10.17226/10034 PY - 2000 UR - https://nap.nationalacademies.org/catalog/10034/a-review-of-the-draft-report-of-the-nci-cdc-working-group-to-revise-the-1985-radioepidemiological-tables PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine KW - Environment and Environmental Studies AB - The National Research Council was asked by the Centers for Disease Control and Prevention (CDC) to review the draft report of the National Cancer Institute (NCI)-CDC's working group charged with revising the 1985 radioepidemiological tables. To this end, a subcommittee was formed consisting of members of the Council's Committee on an Assessment of the Centers for Disease Control and Prevention Radiation Programs and other experts. The original tables were mandated under Public Law 97-414 (the "Orphan Drug Act") and were intended to provide a means of estimating the probability that a person who developed any of a series of radiation-related cancers, developed the cancer as a result of a specific radiation dose received before the onset of the cancer. The mandate included a provision for periodic updating of the tables. The motivation for the current revision reflects the availability of new data, especially on cancer incidence, and new methods of analysis, and the need for a more thorough treatment of uncertainty in the estimates than was attempted in the original tables. ER - TY - BOOK AU - Institute of Medicine A2 - David E. Longnecker A2 - Frederick J. Manning A2 - Melvin H. Worth, Jr. TI - Review of NASA's Longitudinal Study of Astronaut Health SN - DO - 10.17226/10903 PY - 2004 UR - https://nap.nationalacademies.org/catalog/10903/review-of-nasas-longitudinal-study-of-astronaut-health PB - The National Academies Press CY - Washington, DC LA - English KW - Space and Aeronautics AB - As part of its ongoing commitment to the nation's space program, NASA's medical leadership asked the Institute of Medicine (IOM) to review specific aspects of the scientific basis, policies, and procedures associated with the Longitudinal Study of Astronaut Health (LSAH). NASA created the LSAH in 1992 to address a variety of issues, including both the health of astronauts during space flight and the longer-term health issues that might be associated with space flight and flight training. ER - TY - BOOK AU - National Research Council TI - Arsenic in Drinking Water SN - DO - 10.17226/6444 PY - 1999 UR - https://nap.nationalacademies.org/catalog/6444/arsenic-in-drinking-water PB - The National Academies Press CY - Washington, DC LA - English KW - Environment and Environmental Studies AB - The U.S. Environmental Protection Agency (EPA) has been considering a more stringent regulation of arsenic in water. A significant reduction in the maximum contaminant level (MCL) could increase compliance costs for water utilities. This book discusses the adequacy of the current EPA MCL for protecting human health in the context of stated EPA policy and provides an unbiased scientific basis for deriving the arsenic standard for drinking water and surface water. Arsenic in Drinking Water evaluates epidemiological data on the carcinogenic and noncarcinogenic health effects of arsenic exposure of Taiwanese populations and compares those effects with the effects of arsenic exposure demonstrated in other countries—including the United States. The book also reviews data on toxicokinetics, metabolism, and mechanism and mode of action of arsenic to ascertain how these data could assist in assessing human health risks from arsenic exposures. This volume recommends specific changes to improve the toxicity analyses and risk characterization. The implications of the changes for EPA's current MCL for arsenic are also described. ER - TY - BOOK AU - Institute of Medicine TI - Gulf War and Health: Volume 2: Insecticides and Solvents SN - DO - 10.17226/10628 PY - 2003 UR - https://nap.nationalacademies.org/catalog/10628/gulf-war-and-health-volume-2-insecticides-and-solvents PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine KW - Environment and Environmental Studies AB - Gulf War and Health, Volume 2, is the second in a series of congressionally-mandated studies by the Institute of Medicine that provides a comprehensive assessment of the available scientific literature on potential health effects of exposure to certain biological, chemical, and environmental agents associated with the Gulf War. In this second study, the committee evaluated the published, peer-reviewed literature on exposure to insecticides and solvents thought to have been present during the 1990-1991 war. Because little information exists on actual exposure levels – a critical factor when assessing health effects – the committee could not draw specific conclusions about the health problems of Gulf War veterans. However, the study found some evidence, although usually limited, to link specific long-term health outcomes with exposure to certain insecticides and solvents. The next phase of the series will examine the literature on potential health effects associated with exposure to selected environmental pollutants and particulates, such as oil-well fires and jet fuels. ER - TY - BOOK TI - Arsenic: Medical and Biological Effects of Environmental Pollutants DO - 10.17226/9003 PY - 1977 UR - https://nap.nationalacademies.org/catalog/9003/arsenic-medical-and-biological-effects-of-environmental-pollutants PB - The National Academies Press CY - Washington, DC LA - English KW - Environment and Environmental Studies ER -