From the use of personal products to our consumption of food, water, and air, people are exposed to a wide array of agents each day-many with the potential to affect health. Exposure Science in the 21st Century: A Vision and A Strategy investigates the contact of humans or other organisms with those agents (that is, chemical, physical, and biologic stressors) and their fate in living systems. The concept of exposure science has been instrumental in helping us understand how stressors affect human and ecosystem health, and in efforts to prevent or reduce contact with harmful stressors. In this way exposure science has played an integral role in many areas of environmental health, and can help meet growing needs in environmental regulation, urban and ecosystem planning, and disaster management. Exposure Science in the 21st Century: A Vision and A Strategy explains that there are increasing demands for exposure science information, for example to meet needs for data on the thousands of chemicals introduced into the market each year, and to better understand the health effects of prolonged low-level exposure to stressors. Recent advances in tools and technologies-including sensor systems, analytic methods, molecular technologies, computational tools, and bioinformatics-have provided the potential for more accurate and comprehensive exposure science data than ever before. This report also provides a roadmap to take advantage of the technologic innovations and strategic collaborations to move exposure science into the future.

Over the last decade, several large-scale United States and international programs have been initiated to incorporate advances in molecular and cellular biology, -omics technologies, analytical methods, bioinformatics, and computational tools and methods into the field of toxicology. Similar efforts are being pursued in the field of exposure science with the goals of obtaining more accurate and complete exposure data on individuals and populations for thousands of chemicals over the lifespan; predicting exposures from use data and chemical-property information; and translating exposures between test systems and humans. Using 21st Century Science to Improve Risk-Related Evaluations makes recommendations for integrating new scientific approaches into risk-based evaluations. This study considers the scientific advances that have occurred following the publication of the NRC reports Toxicity Testing in the 21st Century: A Vision and a Strategy and Exposure Science in the 21st Century: A Vision and a Strategy. Given the various ongoing lines of investigation and new data streams that have emerged, this publication proposes how best to integrate and use the emerging results in evaluating chemical risk. Using 21st Century Science to Improve Risk-Related Evaluations considers whether a new paradigm is needed for data validation, how to integrate the divergent data streams, how uncertainty might need to be characterized, and how best to communicate the new approaches so that they are understandable to various stakeholders.

In anticipation of future environmental science and engineering challenges and technologic advances, EPA asked the National Research Council (NRC) to assess the overall capabilities of the agency to develop, obtain, and use the best available scientific and technologic information and tools to meet persistent, emerging, and future mission challenges and opportunities. Although the committee cannot predict with certainty what new environmental problems EPA will face in the next 10 years or more, it worked to identify some of the common drivers and common characteristics of problems that are likely to occur. Tensions inherent to the structure of EPA's work contribute to the current and persistent challenges faced by the agency, and meeting those challenges will require development of leading-edge scientific methods, tools, and technologies, and a more deliberate approach to systems thinking and interdisciplinary science. Science for Environmental Protection: The Road Ahead outlines a framework for building science for environmental protection in the 21st century and identified key areas where enhanced leadership and capacity can strengthen the agency's abilities to address current and emerging environmental challenges as well as take advantage of new tools and technologies to address them. The foundation of EPA science is strong, but the agency needs to continue to address numerous present and future challenges if it is to maintain its science leadership and meet its expanding mandates.

Advances in molecular biology and toxicology are paving the way for major improvements in the evaluation of the hazards posed by the large number of chemicals found at low levels in the environment. The National Research Council was asked by the U.S. Environmental Protection Agency to review the state of the science and create a far-reaching vision for the future of toxicity testing. The book finds that developing, improving, and validating new laboratory tools based on recent scientific advances could significantly improve our ability to understand the hazards and risks posed by chemicals. This new knowledge would lead to much more informed environmental regulations and dramatically reduce the need for animal testing because the new tests would be based on human cells and cell components. Substantial scientific efforts and resources will be required to leverage these new technologies to realize the vision, but the result will be a more efficient, informative and less costly system for assessing the hazards posed by industrial chemicals and pesticides.

"On November 7-8, 2013, the Institute of Medicine's Roundtable on Environmental Health Sciences, Research, and Medicine held a workshop to discuss approaches related to identifying and reducing potential environmental public health risks to new and existing industrial chemicals present in society. Industrial chemicals include chemicals used in industrial processes or commercial products, not including those found in food, pesticides, or pharmaceuticals. Identifying and Reducing Environmental Health Risks of Chemicals in Our Society is a summary and synthesis of the presentations and discussions that took place during the two days of the workshop. The workshop examined successes and areas for improvement within current regulatory programs for assessing industrial chemical safety, frameworks for chemical prioritization to inform targeted testing and risk management strategies, concepts of sustainability and green chemistry that support the design and use of safer alternatives, and efforts to reduce the risk of chemicals in our society."--Publisher's description.

Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.

“For Erin Brockovich fans, a David vs. Goliath tale with a twist” (The New York Times Book Review)—the incredible true story of the lawyer who spent two decades building a case against DuPont for its use of the hazardous chemical PFOA, uncovering the worst case of environmental contamination in history—affecting virtually every person on the planet—and the conspiracy that kept it a secret for sixty years. The story that inspired Dark Waters, the major motion picture from Focus Features starring Mark Ruffalo and Anne Hathaway, directed by Todd Haynes. 1998: Rob Bilott is a young lawyer specializing in helping big corporations stay on the right side of environmental laws and regulations. Then he gets a phone call from a West Virginia farmer named Earl Tennant, who is convinced the creek on his property is being poisoned by runoff from a neighboring DuPont landfill, causing his cattle and the surrounding wildlife to die in hideous ways. Earl hasn’t even been able to get a water sample tested by any state or federal regulatory agency or find a local lawyer willing to take the case. As soon as they hear the name DuPont—the area’s largest employer—they shut him down. Once Rob sees the thick, foamy water that bubbles into the creek, the gruesome effects it seems to have on livestock, and the disturbing frequency of cancer and other health problems in the area, he’s persuaded to fight against the type of corporation his firm routinely represents. After intense legal wrangling, Rob ultimately gains access to hundreds of thousands of pages of DuPont documents, some of them fifty years old, that reveal the company has been holding onto decades of studies proving the harmful effects of a chemical called PFOA, used in making Teflon. PFOA is often called a “forever chemical,” because once in the environment, it does not break down or degrade for millions of years, contaminating the planet forever. The case of one farmer soon spawns a class action suit on behalf of seventy thousand residents—and the shocking realization that virtually every person on the planet has been exposed to PFOA and carries the chemical in his or her blood. What emerges is a riveting legal drama “in the grand tradition of Jonathan Harr’s A Civil Action” (Booklist, starred review) about malice and manipulation, the failings of environmental regulation; and one lawyer’s twenty-year struggle to expose the truth about this previously unknown—and still unregulated—chemical that we all have inside us.