National Academies Press: OpenBook
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×

EXPLORING THE FRONTIERS
OF INNOVATION TO TACKLE
MICROBIAL THREATS

PROCEEDINGS OF A WORKSHOP

Edith Amponsah, Gillian Buckley, Julie Pavlin,
and Anna Nicholson, Rapporteurs

Forum on Microbial Threats

Board on Global Health

Health and Medicine Division

images

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by contracts between the National Academy of Sciences and Aetna Foundation, The California Endowment (#10002009), Health Resources and Services Administration (DHHS-10002817), New York State Health Foundation (#10001272), The Rippel Foundation, and Robert Wood Johnson Foundation (#10001270). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-67533-8
International Standard Book Number-10: 0-309-67533-2
Digital Object Identifier: https://doi.org/10.17226/25746

Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

Copyright 2020 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the frontiers of innovation to tackle microbial threats: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/25746.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×

Image

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×

Image

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.

Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.

For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×

PLANNING COMMITTEE ON EXPLORING THE FRONTIERS OF INNOVATION TO TACKLE MICROBIAL THREATS1

KENT E. KESTER (Co-Chair), Vice President and Head, Translational Science and Biomarkers, Sanofi Pasteur

RAFAEL OBREGÓN (Co-Chair), Chief of Communications for Development, United Nations Children’s Fund

KEVIN ANDERSON, Senior Program Manager, Science and Technology Directorate, U.S. Department of Homeland Security

GREGORY ARMSTRONG, Director, Advanced Molecular Detection, U.S. Centers for Disease Control and Prevention

RICK BRIGHT, Director, Biomedical Advanced Research and Development Authority (BARDA), U.S. Department of Health and Human Services

JOHN BROWNSTEIN, Chief Innovation Officer and Professor, Harvard Medical School

ANDREW CLEMENTS, Deputy Director, Pandemic Influenza and Other Emerging Threats Unit, U.S. Agency for International Development

PETER DASZAK, President, EcoHealth Alliance

LORI FOSTER, Professor, Industrial-Organizational Psychology, North Carolina State University

EVA HARRIS, Professor, Division of Infectious Diseases and Vaccinology; Director, Center for Global Public Health, University of California, Berkeley

ELIZABETH D. HERMSEN, Head, Global Antimicrobial Stewardship, Merck & Co., Inc.

JAMES LAWLER, Associate Professor, Department of Internal Medicine; Director, International Programs and Innovation, University of Nebraska Medical Center College of Medicine

JONNA A. K. MAZET, Professor of Epidemiology and Disease Ecology; Executive Director, One Health Institute, School of Veterinary Medicine, University of California, Davis

THOMAS W. SCOTT, Distinguished Professor, Department of Entomology and Nematology, University of California, Davis

PAIGE E. WATERMAN, Colonel, U.S. Army, Assistant Director, Biological Threats Office of Science and Technology Policy, Executive Office of the President

___________________

1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the rapporteurs and the institution.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×

MARY E. WILSON, Clinical Professor of Epidemiology and Biostatistics, University of California, San Francisco, School of Medicine; Adjunct Professor, Global Health and Population, Harvard T.H. Chan School of Public Health

Health and Medicine Division Staff

GILLIAN BUCKLEY, Senior Program Officer (from March 2020)

EDITH AMPONSAH, Associate Program Officer

HANNAH GOODTREE, Senior Program Assistant

CECILIA MUNDACA SHAH, Project Director (until December 2019)

V. AYANO OGAWA, Senior Program Officer (until December 2019)

YAMROT NEGUSSIE, Program Officer (until November 2019)

STEPHEN CHUKWURAH, Senior Program Assistant (until December 2019)

JULIE PAVLIN, Director, Forum on Microbial Threats; Senior Director, Board on Global Health

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×

FORUM ON MICROBIAL THREATS1

PETER DASZAK (Chair), President, EcoHealth Alliance

KENT E. KESTER (Vice Chair), Vice President and Head, Translational Science and Biomarkers, Sanofi Pasteur

MARY E. WILSON (Vice Chair), Clinical Professor of Epidemiology and Biostatistics, University of California, San Francisco, School of Medicine; Adjunct Professor, Global Health and Population, Harvard T.H. Chan School of Public Health (until December 2019)

KEVIN ANDERSON, Senior Program Manager, Science and Technology Directorate, U.S. Department of Homeland Security

RICK BRIGHT, Director, Biomedical Advanced Research and Development Authority (BARDA), U.S. Department of Health and Human Services

TIMOTHY BURGESS, Director, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences

CRISTINA CASSETTI, Deputy Division Director, Division of Microbial and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health

ANDREW CLEMENTS, Deputy Director, Pandemic Influenza and Other Emerging Threats Unit, U.S. Agency for International Development

MARCOS A. ESPINAL, Director, Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization

KEIJI FUKUDA, School Director and Clinical Professor, The University of Hong Kong School of Public Health (until December 2019)

EVA HARRIS, Professor, Division of Infectious Diseases and Vaccinology; Director, Center for Global Public Health, University of California, Berkeley

ELIZABETH D. HERMSEN, Head, Global Antimicrobial Stewardship, Merck & Co., Inc.

CHANDY C. JOHN, Director, Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine

RIMA F. KHABBAZ, Director, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention

MICHAEL MAIR, Acting Director, Office of Counterterrorism and Emerging Threats, U.S. Food and Drug Administration

___________________

1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×

JONNA A. K. MAZET, Professor of Epidemiology and Disease Ecology; Executive Director, One Health Institute, School of Veterinary Medicine, University of California, Davis

SALLY A. MILLER, Professor of Plant Pathology and State Extension Specialist for Vegetable Pathology, Ohio Agricultural Research and Development Center, The Ohio State University

SUERIE MOON, Director of Research, Global Health Centre, Graduate Institute of International and Development Studies, Geneva

DAVID NABARRO, Advisor, Health and Sustainability, 4SD–Skills, Systems, and Synergies for Sustainable Development

RAFAEL OBREGÓN, Chief of Communications for Development, United Nations Children’s Fund

KUMANAN RASANATHAN, Board Member, Health Systems Global

GARY A. ROSELLE, Chief of Medical Service, Veterans Affairs Medical Center; Director, National Infectious Disease Services, Veterans Health Administration

PETER A. SANDS, Executive Director, The Global Fund to Fight AIDS, Tuberculosis and Malaria

THOMAS W. SCOTT, Distinguished Professor, Department of Entomology and Nematology, University of California, Davis

JAY P. SIEGEL, Retired Chief Biotechnology Officer, Head of Scientific Strategy and Policy, Johnson & Johnson (until January 2020)

ALAN TENNENBERG, Chief Medical Officer, Johnson & Johnson Global Public Health

MATTHEW ZAHN, Medical Director, Division of Epidemiology and Assessment, Orange County Health Care Agency

National Academies of Sciences, Engineering, and Medicine Staff

GILLIAN BUCKLEY, Senior Program Officer (from March 2020)

EDITH AMPONSAH, Associate Program Officer

HANNAH GOODTREE, Senior Program Assistant

CECILIA MUNDACA SHAH, Project Director (until December 2019)

V. AYANO OGAWA, Senior Program Officer (until December 2019)

YAMROT NEGUSSIE, Program Officer (until November 2019)

STEPHEN CHUKWURAH, Senior Program Assistant (until December 2019)

JULIE PAVLIN, Director, Forum on Microbial Threats; Senior Director, Board on Global Health

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×

Reviewers

This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.

We thank the following individuals for their review of this proceedings:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by DAVID R. CHALLONER, University of Florida. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×

This page intentionally left blank.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×

Acknowledgments

The workshop summarized in this proceedings is the product of many valuable contributions. Special thanks go to the presenters and discussants who gave generously of their time and expertise to make the event possible. A full list of the speakers and moderators and their biographical information may be found in Appendix C.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×

This page intentionally left blank.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×

This page intentionally left blank.

Page xviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×

Acronyms and Abbreviations

AFP acute flaccid paralysis
AI artificial intelligence
AMP Health Aspen Management Partnership for Health
AMR antimicrobial resistance
BARDA Biomedical Advanced Research and Development Authority
CDC U.S. Centers for Disease Control and Prevention
CDDEP Center for Disease Dynamics, Economics & Policy
CEPI Coalition for Epidemic Preparedness Innovations
CHRF Child Health Research Foundation
cVDPV circulating vaccine-derived polio virus
DARPA Defense Advanced Research Projects Agency
DoD U.S. Department of Defense
DRC Democratic Republic of the Congo
EHP Ebola Host Project
ESKAPE pathogens Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species pathogens
ETU Ebola treatment unit
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×
FDA U.S. Food and Drug Administration
FIND Foundation for Innovative New Diagnostics
HBV hepatitis B virus
HCV hepatitis C virus
HIV human immunodeficiency virus
HPV human papillomavirus
IPV inactivated polio vaccine
JJDC Johnson & Johnson Development Corporation
JPEO-CBRND Joint Program Executive Office for Chemical, Biological, Radiological and Nuclear Defense
LMIC low- and middle-income country
MERS Middle East respiratory syndrome
NAP-AMR national action plan for antimicrobial resistance
NGO nongovernmental organization
NGS next-generation sequencing
OPV oral polio vaccine
PCR polymerase chain reaction
PHEIC public health emergency of international concern
qPCR quantitative polymerase chain reaction
SPARK Shared Platform for Antibiotic Research and Knowledge
USAID U.S. Agency for International Development
VAPP vaccine-associated paralytic polio
VDPV vaccine-derived polio virus
WHO World Health Organization
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×
PageR1
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×
PageR2
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×
PageR3
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×
PageR4
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×
PageR5
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×
PageR6
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×
PageR7
Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×
PageR8
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×
PageR9
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×
PageR10
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×
PageR11
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×
PageR12
Page xiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×
PageR13
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×
PageR14
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×
PageR15
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×
PageR16
Page xvii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×
PageR17
Page xviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×
PageR18
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×
PageR19
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25746.
×
PageR20
Next: 1 Introduction »
Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop Get This Book
×
Buy Paperback | $70.00 Buy Ebook | $54.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

On December 4–5, 2019, the National Academies of Sciences, Engineering, and Medicine held a 1.5-day public workshop titled Exploring the Frontiers of Innovation to Tackle Microbial Threats. The workshop participants examined major advances in scientific, technological, and social innovations against microbial threats. Such innovations include diagnostics, vaccines (both development and production), and antimicrobials, as well as nonpharmaceutical interventions and changes in surveillance. This publication summarizes the presentations and discussions from the workshop.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!