Integration of complementary and alternative medicine therapies (CAM) with conventional medicine is occurring in hospitals and physicians offices, health maintenance organizations (HMOs) are covering CAM therapies, insurance coverage for CAM is increasing, and integrative medicine centers and clinics are being established, many with close ties to medical schools and teaching hospitals. In determining what care to provide, the goal should be comprehensive care that uses the best scientific evidence available regarding benefits and harm, encourages a focus on healing, recognizes the importance of compassion and caring, emphasizes the centrality of relationship-based care, encourages patients to share in decision making about therapeutic options, and promotes choices in care that can include complementary therapies where appropriate. Numerous approaches to delivering integrative medicine have evolved. Complementary and Alternative Medicine in the United States identifies an urgent need for health systems research that focuses on identifying the elements of these models, the outcomes of care delivered in these models, and whether these models are cost-effective when compared to conventional practice settings. It outlines areas of research in convention and CAM therapies, ways of integrating these therapies, development of curriculum that provides further education to health professionals, and an amendment of the Dietary Supplement Health and Education Act to improve quality, accurate labeling, research into use of supplements, incentives for privately funded research into their efficacy, and consumer protection against all potential hazards.

Clinical trials are used to elucidate the most appropriate preventive, diagnostic, or treatment options for individuals with a given medical condition. Perhaps the most essential feature of a clinical trial is that it aims to use results based on a limited sample of research participants to see if the intervention is safe and effective or if it is comparable to a comparison treatment. Sample size is a crucial component of any clinical trial. A trial with a small number of research participants is more prone to variability and carries a considerable risk of failing to demonstrate the effectiveness of a given intervention when one really is present. This may occur in phase I (safety and pharmacologic profiles), II (pilot efficacy evaluation), and III (extensive assessment of safety and efficacy) trials. Although phase I and II studies may have smaller sample sizes, they usually have adequate statistical power, which is the committee's definition of a "large" trial. Sometimes a trial with eight participants may have adequate statistical power, statistical power being the probability of rejecting the null hypothesis when the hypothesis is false. Small Clinical Trials assesses the current methodologies and the appropriate situations for the conduct of clinical trials with small sample sizes. This report assesses the published literature on various strategies such as (1) meta-analysis to combine disparate information from several studies including Bayesian techniques as in the confidence profile method and (2) other alternatives such as assessing therapeutic results in a single treated population (e.g., astronauts) by sequentially measuring whether the intervention is falling above or below a preestablished probability outcome range and meeting predesigned specifications as opposed to incremental improvement.

The U.S. Department of Energy's Office of Environmental Management is responsible for managing and cleaning up the waste and contamination at the Hanford Nuclear Reservation, the nation's biggest and most complex nuclear cleanup challenge. At the site, 177 underground tanks collectively contain about 211 million liters of waste that includes high-activity and low-activity materials. At the request of Congress, Final Review of the Study on Supplemental Treatment Approaches of Low-Activity Waste at the Hanford Nuclear Reservation: Review #4 focuses on approaches for treatment and disposal of the supplemental portion of the low-activity waste from the tanks. This review report discusses developments since the publication of Review #3 and provides a summary of public comments on the third committee review report. The authoring committee then shares their views on these comments and whether they change any of the findings or recommendations in the third review report.

In the movement toward standards-based education, an important question stands out: How will this reform affect the 10% of school-aged children who have disabilities and thus qualify for special education? In Educating One and All, an expert committee addresses how to reconcile common learning for all students with individualized education for "one"â€"the unique student. The book makes recommendations to states and communities that have adopted standards-based reform and that seek policies and practices to make reform consistent with the requirements of special education. The committee explores the ideas, implementation issues, and legislative initiatives behind the tradition of special education for people with disabilities. It investigates the policy and practice implications of the current reform movement toward high educational standards for all students. Educating One and All examines the curricula and expected outcomes of standards-based education and the educational experience of students with disabilitiesâ€"and identifies points of alignment between the two areas. The volume documents the diverse population of students with disabilities and their school experiences. Because approaches to assessment and accountability are key to standards-based reforms, the committee analyzes how assessment systems currently address students with disabilities, including testing accommodations. The book addresses legal and resource implications, as well as parental participation in children's education.