Study on the Use of Elastomeric Respirators in Health Care

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Protecting the health and safety of health care workers is vital to the health of each of us. Preparing for and responding to a future influenza pandemic or to a sustained outbreak of an airborne transmissible disease requires a high-level commitment to respiratory protection for health care workers across the wide range of settings in which they work and the jobs that they perform. Keeping health care workers healthy is an ethical commitment both in terms of addressing the occupational risks faced by health care workers and of providing for the continuity of patient care and services needed to maintain the health of individuals and communities.

During a public health emergency, challenges will arise concerning the availability of respiratory protective devices (i.e., respirators). Reusable respirators (specifically, reusable half-facepiece elastomeric respirators) are the standard respiratory protection device used in many industries, and they provide an option for use in health care that has to date not been fully explored. The durability and reusability of elastomeric respirators make them desirable for stockpiling for emergencies, where the need for large volumes of respirators can be anticipated. However, they are used infrequently in health care.

Reusable Elastomeric Respirators in Health Care explores the potential for the use of elastomeric respirators in the U.S. health care system with a focus on the economic, policy, and implementation challenges and opportunities. This report examines the practicability of elastomeric use in health care on a routine basis and during an influenza pandemic or other large aerosol-transmissible outbreak, when demand for respiratory protective devices by U.S. health care personnel may be larger than domestic supplies. The report also addresses the issues regarding emergency stockpile management of elastomeric respiratory protective devices.

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226 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-48515-0
ISBN Ebook: 0-309-48516-9
DOI: https://doi.org/10.17226/25275

Suggested citation

National Academies of Sciences, Engineering, and Medicine. 2019. Reusable Elastomeric Respirators in Health Care: Considerations for Routine and Surge Use. Washington, DC: The National Academies Press.

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Linda H. Clever

Linda Hawes Clever, M.D., MACP, is a member of the National Academy of Medicine, Clinical Professor of Medicine at UCSF, Associate Dean for Alumni Affairs at the Stanford University School of Medicine, founding Chair of the Department of Occupational Health at California Pacific Medical Center, and former Editor of the Western Journal of Medicine. She is also founding President of RENEW, a not-for-profit aimed at helping devoted people maintain (and regain) their enthusiasm, effectiveness and purpose, and author of The Fatigue Prescription, Four Steps to Renewing Your Energy, Health and Life. Dr. Clever received undergraduate and medical degrees from Stanford University and had several years of medical residency and fellowships at Stanford and UCSF in internal medicine, infectious diseases, community medicine and occupational medicine. Dr. Clever was the first Medical Director of the teaching clinic at St. Mary’s Hospital in San Francisco where she started patient education and nurse practitioner training and research programs. She started the Department of Occupational Health at the then-Pacific Medical Center and began her activities in the American College of Physicians in which she served as Governor, Chair of the Board of Governors, and Regent. She has written numerous papers, chapters, articles, and editorials. Her areas of special interest include personal and organizational renewal; the interactions of life, work and health; the occupational health of women and health care workers and leadership. In 2010, Dr. Clever was given the American Medical Women’s Association’s Elizabeth Blackwell Medal which is granted to a woman physician who has made the most outstanding contributions to the cause of women in the field of medicine. She also received the Stanford Medal which honors volunteer leaders who have given extraordinary, distinguished and significant service to Stanford University.

M.E. Bonnie Rogers

M.E. Bonnie Rogers, Dr.P.H., M.P.H., is Director of N.C. Occupational Safety and Health Education Research Center, Director of the Occupational Health Nursing Program, and an Associate Professor in the Public Health Leadership Program at the University of North Carolina- Chapel Hill. Dr. Bonnie Rogers specializes in occupational health, with her primary research area being hazards to health care workers. She has numerous peer reviewed publications and books. Dr. Rogers is chairperson of the NIOSH Board of Scientific Counselors, has completed two terms as vice president of the International Commission on Occupational Health and is a fellow in the Collegium Ramazzini. Dr. Rogers has primarily practiced as a public health nurse and an occupational health nurse clinician, educator and researcher. She has conducted numerous occupational health research studies and has published nearly 200 articles, two textbooks in occupational health nursing, delivered more than 450 presentations, and has designed and delivered graduate-level and continuing education courses. She has served on several National Academies’ committees and has held offices for local, state, national and international organizations.

Gloria Addo-Ayensu

Gloria Addo-Ayensu, M.D., M.P.H, is the Director of Health for Fairfax County. In this capacity she provides overall leadership, management and direction for public health programs in the county and serves as the official health advisor to Fairfax County's Board of Supervisors, Health Care Advisory Board and the Human Services Council. She has led a number of local and regional public health initiatives in the areas of emergency preparedness, health promotion and health equity. Throughout her public health career, she has promoted community health and resiliency through partnerships and has a long-term record of successfully leveraging community assets to create innovative, practical and sustainable community-based approaches to complex public health challenges. She earned her Doctor of Medicine and Master's in Public Health from Tulane University and completed her residency training in preventive medicine from the Loma Linda University Medical Center.

Gio J. Baracco

Gio J. Baracco, M.D., is a Professor of Clinical Medicine in the Division of Infectious Diseases at the University of Miami Miller School of Medicine. He is also the Chief of the Infectious Disease Section and Hospital Epidemiologist at the Miami VA Healthcare System. Dr. Baracco’s clinical areas of interest are general infectious diseases, antimicrobial resistance, and hospital epidemiology and infection control. He is certified by the American Board of Internal Medicine in Internal Medicine and Infectious Diseases. His research interests include hospital epidemiology, healthcare emergency preparedness related to high-consequence infections, and antibiotic-resistant bacteria.

Jim Chang

Jim Chang, C.I.H., is a certified industrial hygienist with experience in a broad array of industry sectors including: aerospace, pharmaceuticals, chemicals, defense, environment/emergency response and most recently, healthcare. Since 2006 he has been the Director of Safety and Environmental Health at the University of Maryland Medical Center. Prior to this role, he was Emergency Management Coordinator at Duke University Hospital and held prior positions related to workplace safety and health with GlaxoSmithKline, Reichhold Chemicals, Lockheed, and ICF Technology. Over the course of 3 decades of practice in the field of industrial hygiene, he has sought to shift the “more is better” perception of PPE use to more practical PPE solutions and workplace practices that more effectively protect the nation’s employees from harm. Mr. Chang holds a M.S. in Industrial Hygiene and a B.S. in Chemistry from the University of Michigan. He is a Diplomate of the American Board of Industrial Hygiene, and sits on the Board of Directors of the Chesapeake Regional Safety Council.

Christopher Friese

Christopher Friese, Ph.D., R.N., A.O.C.N., F.A.A.N., has focused his program of research on the measurement and improvement of care delivery for patients with cancer. He joined the faculty of the University of Michigan School of Nursing in 2008 and completed his baccalaureate, masters, and doctoral degrees from the University of Pennsylvania under the mentorship of Linda Aiken. He received a post-doctoral fellowship in Cancer Prevention and Control from the Harvard School of Public Health and Dana-Farber Cancer Institute’s Center for Outcomes and Policy Research. In 2008, he was the first nursing scientist to be awarded a Pathway to Independence research grant from the National Institutes of Health. The author of over 60 peer-reviewed publications, his research has been published in the Journal of Clinical Oncology, Health Affairs, Medical Care, Cancer, Health Services Research, and Nursing Research. His research program has received continuous federal funding since 2009. His research expertise includes secondary analyses of existing databases and surveys of providers and patients. He currently leads a 4-year, $2.3 million study to improve nurses’ use of protective equipment when handling hazardous drugs. Dr. Friese holds advanced certification as an oncology nurse, and continues to practice clinically as a staff nurse in medical oncology, hematological malignancies and stem cell transplantation. In October, 2012, he was inducted as a fellow in the American Academy of Nursing. In 2015, he was awarded the Rose Mary Carroll-Johnson Oncology Nursing Society Distinguished Award for Consistent Contribution to Nursing Literature Award. In 2016, he was one of four faculty across the University of Michigan to be awarded to Henry Russel award for outstanding junior faculty. In academic year 2016-2017, he was selected as a Robert Wood Johnson Foundation health policy fellow in the office of United States Senator Robert P. Casey, Jr.

Robert Harrison

Robert Harrison, M.D., M.P.H. is Clinical Professor of Medicine at the University of California, San Francisco (UCSF), Division of Occupational and Environmental Medicine. Dr. Robert Harrison joined UCSF in 1984. He founded and directed the UCSF Occupational Health Services for more than 15 years, and now is a senior attending physician. He has diagnosed and treated over 15,000 patients with work- and environmental-induced diseases and injuries. Dr. Harrison is the Associate Director of the UCSF Occupational and Environmental Medicine Residency Program, and the Director of the NIOSH-funded Occupational Health Internship Program. He also directs the worker tracking and investigation program for the California Department of Public Health. Dr. Harrison received his B.A. from the University of Rochester and his M.D. from the Albert Einstein College of Medicine. He is board certified in both internal medicine and occupational medicine. He has served on the California Occupational Safety and Health Administration (Cal/OSHA) Standards Board, and authored numerous publications in the area of occupational medicine.

Sundaresan Jayaraman

Sundaresan Jayaraman, Ph.D., is Kolon Professor in the School of Materials Science and Engineering with a joint appointment in the Scheller College of Business at the Georgia Institute of Technology. He is also the Founding Director of the Kolon Center for Lifestyle Innovation at Georgia Tech. A pioneer in bringing about convergence between textiles and computing, Professor Jayaraman’s research has led to the paradigm of “Fabric is the Computer.” He is also a leader in studying and defining the roles of engineering design, manufacturing and materials technologies in public policy for the nation. Professor Jayaraman and his research students have made significant contributions in the following areas: (i) Smart Textile-based Wearable Systems; (ii) Computer-aided Manufacturing, Automation and Enterprise Architecture Modeling; (iii) Engineering Design and Analysis of Intelligent Textile Structures and Processes; and (iv) Design and Development of Knowledge Based Systems (KBS) for textiles and apparel. His group's research has led to the realization of the world's first Wearable Motherboard™, also known as the “Smart Shirt” (www.smartshirt.gatech.edu). Prior to Georgia Tech, Professor Jayaraman had the privilege of working with Dan Bricklin and Bob Frankston, the Co-Creators of the world’s first spreadsheet – VisiCalc®. During his PhD, he was involved in the design and development of TK!Solver, the world’s first equation-solving program from Software Arts, Inc., Cambridge, MA. He worked there as a Product Manager and then at Lotus Development Corporation (makers of 1-2-3®) in Cambridge, MA. Professor Jayaraman is a recipient of the 1989 Presidential Young Investigator Award from NSF for his research in the area of computer aided manufacturing and enterprise architecture. He is a founding member of the IOM Standing Committee on Personal Protective Equipment in the Workplace (2005-2013). From December 2008 to February 2011, he served on the Board on Manufacturing and Engineering Design of the National Academies. In February 2011, he became a founding member of the National Materials and Manufacturing Board of the National Academies. He has also served on five study committees for the Institute of Medicine and the National Research Council of the National Academies. He is also a founding member of the IEEE Technical Committee on Biomedical Wearable Systems (2004 –2008). In October 2000, Professor Jayaraman received the Georgia Technology Research Leader Award from the state of Georgia.

James S. Johnson

James S. Johnson, Ph.D., retired from the Lawrence Livermore National Laboratory (LLNL) in 2006 after working there since 1972. His position from November 2000 was section leader of the Chemical and Biological Safety Section of the Safety Programs Division. Throughout his career at LLNL, Dr. Johnson was involved with respiratory protection and personal protective equipment as the respiratory program administrator, research scientist, and division and section manager. He is an AIHA fellow; a member of the NFPA Technical Correlating Committee on Fire and Emergency Services Protective Clothing and Equipment; a member of the NFPA Respiratory Protection Equipment Committee; past chair of the International Society for Respiratory Protection, Americas Section; ASTM F23.65 subcommittee chairman for Respiratory Personal Protective Clothing and Equipment (previously ANSI Z88 Committee for Respiratory Protection); and a member of the AIHA Respirator Committee. He has become more active since retirement in the consulting firm he founded in 1978, JSJ and Associates providing industrial hygiene, respiratory protection and expert witness services.

Bruce Lippy

Bruce Lippy, Ph.D., CIH, CSP, FAIHA is the Director of Safety Research at CPWR, The Center for Construction Research and Training. He has a Ph.D. in policy from the University of Maryland with coursework concentrated in regulatory economics and quantitative measures of management. He is a Certified Industrial Hygienist and Certified Safety Professional and was recently designated a Fellow of the American Industrial Hygiene Association. As an Associate at the Johns Hopkins Bloomberg School of Public Health, he teaches a graduate course on occupational injury prevention. He currently serves as a member of a team of experts advising management at the U.S. Department of Energy’s Hanford Site on respiratory protection for vapors in the tank farms, where millions of gallons of high level radioactive waste and chemicals are stored in tanks. He served as the technical lead for a team of industrial hygienists providing respiratory protection to heavy equipment operators at the Ground Zero cleanup and also served as co-chair of the team responsible for the final clearance of the AMI Building in Boca Raton, the first to be contaminated during the anthrax attacks. He personally quantitatively fit tested all team members entering the building to conduct final cleanup and testing.

Allison McGeer

Allison McGeer, M.D., is a Professor in the Department of Laboratory Medicine and Pathobiology and at the Dalla Lana School of Public Health at the University of Toronto, and Microbiologist, Infectious Disease Consultant, and Medical Director of Infection Prevention and Control at Sinai Health System. Dr. McGeer is also an infection control consultant to the Baycrest Centre for Geriatric Care. She currently serves on the Influenza Working Group of Canada's National Advisory Committee on Immunization and on the infection control subcommittee of the Ontario Provincial Infectious Diseases Advisory Committee, and is a member of several local, provincial and national pandemic influenza committees. She is an expert reviewer for many research funding agencies including the Canadian Institute of Health Research and US National Institutes of Health, and has served on the editorial boards of several journals, including the Canadian Medical Association Journal, and Infection Control and Hospital Epidemiology. Dr. McGeer completed an undergraduate and master's degree in biochemistry, then her medical degree at the University of Toronto. She specialized in internal medicine and infectious diseases followed by a fellowship in hospital epidemiology at Yale New Haven Hospital. She returned to Mount Sinai Hospital in 1989 as microbiologist and director of infection control. Her major research interests are in the prevention of infection in hospitals and nursing homes, adult immunization and the use of surveillance to advance the prevention, diagnosis and treatment of infectious diseases. She is the principal investigator of the Toronto Invasive Bacterial Diseases Network and the Ontario Group A Streptococcal Study, two collaborative surveillance networks studying the epidemiology of severe community-acquired infections.

Chris Nyquist

Chris Nyquist, M.D., M.P.H., is a Professor of Pediatrics-Infectious Diseases , Medical Director for Infection Prevention and Control, and Medical Director for Occupational Health at the Children’s Hospital Colorado/University of Colorado School of Medicine. She receive her B.S. degree from the University of Michigan in 1985, her M.D. from the University of Michigan Medical School in 1987, and completed her internship and reisdency programs at the UCLA Medical Center Program. Dr. Nyquist completed a fellowship in Pediatric Infectious Diseases at the University of Colorado in 1995, and her M.S.P.H. in 1997. Dr. Nyquist's scientific interests include immunizations, antimicrobial utilization and resistance, and hospital epidemiology/infection control. She is involved in a wide range of teaching activities. In addition, Dr. Nyquist participates in many local, regional, and national committees related to Pediatric Infectious Diseases and Healthcare Epidemiology. Dr. Nyquist is a member of the American Academy of Pediatrics Committee on Infectious Diseases, a board member of the Pediatric Infectious Diseases Society and serves as chair of the SHEA Pediatric Leadership Council.

Mike Schmoldt

Mike Schmoldt, P.E, C.I.H. C.H.M.M. is a Program Industrial Hygienist at Argonne National Laboratory. He most recently worked as a Senior Industrial Hygienist at the Dept. of Energy (DOE) Hanford site and at the Pacific Northwest National Laboratory operated by Battelle. At Hanford, he was the Respiratory Protection Program Administrator (RPPA) during stimulus funding which expanded the work force using respirators to over 2,500 workers on SCBA, airline and air purifying respirators for work with hazardous chemicals and radionuclides. Studies were conducted to improve respiratory equipment maintenance, perform microbial contamination surveys, improve respirator cleaning, equipment modernization and development of quality improvements with manufacturers. He worked with labor, management and manufacturers to develop better user manuals, product features and new products for respiratory protection. Through improved procurement practices he saved over $1.9 million in one year in procurement costs for stocking respiratory protection equipment while improving supply chain reliability. Mr. Schmoldt has been a senior engineer/project manager and with Top 10 ENR engineering firms (Fluor, CH2M Hill, EarthTech/URS/AECOM) and was the federal programs Midwest Health and Safety Manager for Montgomery Watson-Harza. For Olin, he served as the Chief of Environmental Engineering at the Badger Army Ammunition Plant where he was in charge of 13 hazardous waste clean-up sites and operating Part B permitted RCRA storage, thermal treatment and interim remedial measures for groundwater cleanup of chemicals from manufacturing military ammunition. Mr. Schmoldt established a statewide Hazardous Materials Manger position with the University of Wisconsin System which conducted a 2-year clean-sweep of University and other state agencies legacy hazardous wastes. Mr. Schmoldt was a voting member of the 2015 ANSI Z88.2 Practices for Respiratory Protection committee representing the members of the American Industrial Hygiene Association’s Respiratory Protection Committee. Mr. Schmoldt chaired the national DOE Respiratory Protection Program Administrations group for 3 years. He served for 1 year as chairman for the draft ANSI committee for development of CBRN respirator standards. To improve the management of heat stress for workers in personal protective equipment and respirators, Mr. Schmoldt developed and implemented a heat stress management program at Hanford using physiological monitoring which was later recognized by the National Safety Council with the Campbell Innovation Award and the OSHA VPP Innovation awards. His work focuses on the development of practical solutions for environmental and occupation health hazards. Mr. Schmoldt is currently completing his Ph.D. in Environmental Science (pending dissertation) from Washington State University, and holds an M.S. in Occupational Health and Industrial Hygiene from the University of Michigan, an M.S. and B.S. in Environmental Science & Engineering from the University of Iowa and an M.B.A. in management from Edgewood College.

Skip I. Skivington

Skip Skivington, M.B.A., has worked at Kaiser Permanente for 26 years, and is currently Vice President of Healthcare Continuity Management and Support Services. Skip also concurrently served as Interim Vice President of Supply Chain during the period of 2005 to 2009. Skip currently has executive responsibility for several key national departments to include: nutrition services, corporate meeting services, travel, emergency management and business continuity. Since 2000, Skip has been responsible for the implementation of a formal healthcare continuity management program throughout Kaiser Permanente. In addition to leading this formal planning process as the organization’s national incident manager, and immediately following the anthrax attacks in October 2001, Skip formed and leads Kaiser Permanente’s threat assessment and response program consisting of an executive oversight council, and functional working groups in the disciplines of clinical (physicians, nursing, pharmacy and lab), facilities, community linkages, people, legal, communications and education, information technology, member services, supply chain and public policy. Skip is a member of the State of California Joint Advisory Committee for Public Health Preparedness, and was a member of the recently concluded National Academies Standing Committee on the Strategic National Stockpile. Skip is a frequent speaker on the role of healthcare during disasters. Skip was a member of the CDC technical evaluation panel which reviewed and evaluated the grant proposals for the provisioning of medical treatment for injuries associated with non-emergency responders following the WTC disaster. Skip is a past chair of The US Conference Board’s Business Continuity & Crisis Management Council. Following Hurricanes Katrina and Rita, Skip led two Kaiser Permanente medical response teams consisting of physicians, nurses and mental health providers to the Gulf Region at the request of the US Surgeon General. Finally, Skip co-lead the US Government’s Hospital Incident Command System (HICS) Revisions IV and V Projects. These HICS updates were conducted on behalf of the State of California via a national working group representing hospitals throughout the country along with input from national agencies to include the American Hospital Association, US Department of Health and Human Services, Federal Emergency Management Association and The Joint Commission.

Patricia Stone

Patricia Stone, Ph.D., R.N., FAAN, is the Centennial Professor of Health Policy and Director of the Center for Health Policy at the Columbia University School of Nursing. She is one of the few nurse researchers among other interdisciplinary researchers (economists, hospital epidemiologists, and health services researchers) who deeply understand the complications and rigor of conducting real world comparative and economic evaluations in the context of improving the quality of care and specifically preventing healthcare-associated infections. Dr. Stone has a long history of conducting research in this area and has been the prinicipal investigator on many federal and foundation supported grants. This expertise and her sustained scholarly efforts in this area have been recognized and improved healthcare in a variety of ways. She has served on a number of important policy making committees (e.g., she co-chaired two National Quality Forum Technical Advisory Panels and she served as an expert for the Massachusetts Expert Panel on Healthcare-Associated Infections and California Health Department). Additionally, her work on the cost of healthcare-associated infections have been cited in major publications including important reports written by the Centers for Disease Control and Prevention (guidelines and a burden of illness study) and the Health and Human Services Healthcare-Associated Infections Action Plan. These activities have contributed to recent changes in health policy (e.g., federal and state legislation mandating that hospitals report both process and outcome data related to healthcare-associated infections) as well as the type of data the hospitals are collecting. Dr. Stone is passionate about conducting policy relevant research and educating the next generation of nurse and interdisciplinary scientists.

Tener G. Veenema

Tener Goodwin Veenema, Ph.D., M.P.H., M.S., R.N., FAAN, is Associate Professor of Nursing and Public Health at the Johns Hopkins School of Nursing and the Johns Hopkins Bloomberg School of Public Health. As an internationally recognized expert in disaster nursing and public health emergency preparedness, she has served as senior scientist to the DHHS Office of Human Services Emergency Preparedness and Response (OHSEPR), Department of Homeland Security, Veterans Affairs Emergency Management Evaluation Center (VEMEC), and the Federal Emergency Management Agency (FEMA). An accomplished disaster researcher, Dr. Veenema has sustained significant career funding, is a member of the American Red Cross National Scientific Advisory Board and is an elected Fellow in the American Academy of Nursing, the National Academies of Practice, and the Royal College of Surgeons, Dublin, Ireland. Dr. Veenema is frequently sought as a keynote speaker and consultant in public health emergency preparedness. Her work has been directed towards affecting policies related to disaster and public health management through national and international consultations, serving on national and international advisory boards, and reviewing existing policies and making recommendations for strengthening those policies. Dr. Veenema is an expert in workforce development and developed the ReadyRN educational campaign for front line nurses. She has taught public health preparedness for over twenty five years and has authored four highly successful national e-learning courses in public health preparedness for health care providers (Coursera, Elsevier, MC Strategies, American Red Cross). Dr. Veenema is editor of Disaster Nursing and Emergency Preparedness for Chemical, Biological and Radiological Terrorism and Other Hazards, 4th Ed., the leading textbook in the field and developer of Disaster Nursing, an innovative technology application (“App”) for the I-phone and I-pad (Unbound Medicine). In 2013 Dr. Veenema was awarded the Florence Nightingale Medal of Honor (International Red Crescent) the highest international award in Nursing for her professional service in disasters and public health emergencies. She received a Fulbright U.S. Scholar Award (2017) and was selected Visiting Research Scholar to Torrens Disaster Institute (Australia, 2017). Dr. Veenema received master's degrees in nursing administration (1992), pediatrics (1993), and public health (1999) and a Ph.D. in health services research and policy (2001) from the University of Rochester School of Medicine and Dentistry. Dr. Veenema has previously served on the National Academy of Medicine (NAM) CDC Standing Committee for the Strategic National Stockpile and she currently serves as the 2017-18 NAM Distinguished Nurse Scholar-in-Residence.

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Study on the Use of Elastomeric Respirators in Health Care

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Study on the Use of Elastomeric Respirators in Health Care

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Featured publication

Reusable Elastomeric Respirators in Health Care: Considerations for Routine and Surge Use

Description

Collaborators

Committee

Sponsors

Staff

Parent projects

Standing Committee on Personal Protective Equipment for Workplace Safety and Health

Major units and sub-units

Contact

Contact us

Provide feedback

Request materials

More like this

Standing Committee on Personal Protective Equipment for Workplace Safety and Health

Transportation Research Board Executive Office

National Cooperative Highway Research Program

Modernizing Mathematics Education for Grades 9-14

Sustaining Community Engagement in Genomics Research: A Workshop

Toward a Framework to Improve Diversity and Inclusion in Clinical Trials - A Workshop

Clinical Trials of Far UV to Reduce Indoor Transmission of Respiratory Infections