Harnessing digital technology to predict, diagnose, monitor, and develop treatments for brain disorders.

Digital technologies-including smartphones, wearables, and social media data-show great potential for helping to alleviate suffering from brain disorders such as Parkinson's disease, Alzheimer's disease, depression, and schizophrenia. However, as researchers, technology developers, disease-focused groups, and others forge forward to take advantage of the tremendous opportunities in this domain, it is important to avoid hype and overpromising, and to ensure that this work is done rigorously and collaboratively. In June 2018, the National Academies of Sciences, Engineering, and Medicine's Forum on Neuroscience and Nervous System Disorders hosted a workshop that brought together a wide range of experts and stakeholders. The workshop provided an opportunity to take stock of the rapidly-evolving landscape and discuss how to work together to address both scientific and practical challenges, so that the potential of digital technologies can be translated into meaningful contributions toward the health of individuals and society. Workshop presentations and discussions focused on four key challenges: transforming data into insight, navigating regulatory pathways, designing user-centered tools, and building partnerships across a complex ecosystem. This article highlights the many issues, challenges, and opportunities discussed by individual participants at the workshop.

The role of structural prediction in rapid syntactic analysis.

A number of recent electrophysiological studies of sentence processing have shown that a subclass of syntactic violations elicits very rapid ERP responses, occurring within around 200 ms of the onset of the violation. Such findings raise the question of how it is possible to diagnose violations so quickly. This paper suggests that very rapid diagnosis of errors is possible specifically in situations where the diagnosis problem is tightly constrained by specific expectations generated before the critical word is presented. In an event-related potentials (ERP) study of visual sentence reading participants encountered violations of a word order constraint (...Max's of...) that has elicited early ERP responses in previous studies. Across conditions the illicit sequence was held constant, while sentence context was used to manipulate the expectation for a noun following the possessor Max's, by manipulating the possibility of ellipsis of the head noun. Results showed that the anterior negativity elicited by the word category violation was attenuated when the availability of ellipsis reduced the expectation for a noun in the position of the offending preposition of, with divergence between conditions starting around 200 ms after the onset of the violation. This suggests a role for structural expectations in accounting for very fast syntactic diagnosis processes.

Investing in the health and well-being of young adults.

Contrary to popular perception, young adults-ages approximately 18-26 years-are surprisingly unhealthy. They are less healthy than adolescents, and they also show a worse health profile than those in their late 20s and 30s. The Affordable Care Act provisions to extend coverage for young adults are well known, and some states had already been pursuing similar efforts before the Affordable Care Act was enacted. These initiatives have resulted in important gains in young adults' heath care coverage. However, too little attention has been paid to the care that young adults receive once they are in the system. Given young adults' health problems, this is a critical omission. The Institute of Medicine and National Research Council recently released a report titled Investing in the Health and Well-Being of Young Adults. The report concludes that young adulthood is a critical developmental period and recommends that young adults ages 18-26 years be treated as a distinct subpopulation in policy, planning, programming, and research. The report also recommends action in three priority areas to improve health care for young adults: improving the transition from pediatric to adult medical and behavioral health care, enhancing preventive care for young adults, and developing evidence-based practices.

Examining the evidence for an independent semantic analyzer: an ERP study in Spanish.

Recent ERP findings challenge the widespread assumption that syntactic and semantic processes are tightly coupled. Syntactically well-formed sentences that are semantically anomalous due to thematic mismatches elicit a P600, the component standardly associated with syntactic anomaly. This 'thematic P600' effect has been attributed to detection of semantically plausible thematic relations that conflict with the surface syntactic structure of the sentence, implying a processing architecture with an independent semantic analyzer. A key finding is that the P600 is selectively sensitive to the presence of plausible verb-argument relations, and that otherwise an N400 is elicited (The hearty meal was devouring … vs. The dusty tabletop was devouring …: Kim & Osterhout, 2005). The current study investigates in Spanish whether the evidence for an independent semantic analyzer is better explained by a standard architecture that rapidly integrates multiple sources of lexical, syntactic, and semantic information. The study manipulated the presence of plausible thematic relations, and varied the choice of auxiliary between passive-biased fue and active-progressive biased estaba. Results show a late positivity that appeared as soon as comprehenders detected an improbable combination of subject animacy, auxiliary bias, or verb voice morphology. This effect appeared at the lexical verb in the fue conditions and at the auxiliary in the estaba conditions. The late positivity elicited by surface thematic anomalies was the same, regardless of the presence of a plausible non-surface interpretation, and no N400 effects were elicited. These findings do not implicate an independent semantic analyzer, and are compatible with standard language processing architectures.

The Institute of Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Events: regional workshop series on the 2009 H1N1 influenza vaccination campaign.

In response to the 2009 H1N1 influenza pandemic, public health authorities launched an ambitious vaccination program to protect tens of millions of Americans from the virus. In April and May 2010, the Institute of Medicine Forum on Medical and Public Health Preparedness for Catastrophic Events hosted a series of 3 regional workshops to examine the 2009 H1N1 vaccination campaign. The workshops brought together stakeholders involved in distributing and dispensing H1N1 vaccine to discuss successes and challenges and to identify strategies to improve future vaccination programs and other medical countermeasure dispensing campaigns. On the basis of the presentations and the discussions that followed, several themes and opportunities for future efforts were identified in the following areas: vaccine supply and demand; state and local implementation of Centers for Disease Control and Prevention/Advisory Committee on Immunization Practices recommendations, including prioritization for vaccination; vaccine formulations and priority groups; opportunities for developing partnerships; opportunities to increase seasonal vaccination rates among pregnant women and health care workers and to increase acceptance of live attenuated nasal spray vaccine; standardization and improvement of immunization information management systems; opportunities to simplify, systematize, and automate processes and practices; and research needs and opportunities.

Institute of Medicine's Forum on Medical and Public Health Preparedness for Catastrophic Events: current initiatives.

It is only possible to achieve a resilient community and an integrated, comprehensive, and resilient health system that can respond effectively to a public health emergency through active collaboration, coordination, and shared responsibility among a broad group of public and private stakeholders and the community itself. The Institute of Medicine established the Forum on Medical and Public Health Preparedness for Catastrophic Events in 2007 to provide a neutral venue for dialogue and collaboration among stakeholders in the preparedness field. In the Forum's first year, the members began to address topics such as medical countermeasures dispensing, crisis standards of care, and medical surge capacity. In the past 9 months, the Forum members have expanded their areas of interest in response to current events and national areas of focus. Current topics include individual, family, and community preparedness and resiliency; medical countermeasures from development through dispensing; and the response to the 2009 H1N1 influenza pandemic. Across all of the initiatives undertaken by the Forum, the common element is that they tackle problems, gaps, and future opportunities that can only be successfully addressed if multiple stakeholders work together.