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Bacterial infections have become more difficult, and sometimes impossible, to treat due to antibiotic resistance, which occurs when bacteria develop the ability to defeat the available drugs designed to kill them. Concerns about rising rates of resistance to available treatment options prompted the federal government to create the 5-year National Action Plan in 2015. The plan called for federal agencies to strengthen surveillance, advance the development of diagnostic tests and new antibiotics, and slow the emergence of resistant bacteria, among other things. This report examines federal efforts and challenges related to (1) surveillance of antibiotic resistance, (2) the development and use of diagnostic testing to identify antibiotic resistance, (3) the development of treatments for resistant infections, and (4) appropriate antibiotic use. GAO is making eight recommendations to strengthen the federal response to combating antibiotic resistance.

The true story of the missing Medsker family from Michigan. Our story had hit Good Morning America, Nancy Grace and numerous national and international media outlets. This is our side of the story told as a warning to those who will be Left Behind after the Rapture and have to experience God's just judgment during "the time of Jacob's trouble" (Jer. 30:7), better known as the Great Tribulation or Tribulation. Our story details our fleeing for our lives from the federal government, as well as documenting the police state that we live in. Yet we know within our story that this would not have happened without the chastising of God, we would not have been one of the few families that are singled out. While we suspected we were on some sort of watchlist, we watched in horror as we slowly became surrounded by spooks. Yet even in all of this God Almighty prevailed and kept us from being caught. It seemed good for us to tell our story as a warning to those who will be Left Behind, so that they might find God, even during the midst of great turmoil throughout the world.

DHS's BioWatch program aims to provide early indication of an aerosolized biological weapon attack. Until April 2014, DHS pursued a next-generation autonomous detection technology (Gen-3), which aimed to enable collection and analysis of air samples in less than 6 hours, unlike the current system (Gen-2), which requires manual intervention and can take up to 36 hours to detect the presence of biological pathogens. DHS is taking steps to address the capability gap that resulted from the cancellation of Gen-3 by exploring other technology upgrades and improvements to the Gen-2 system. GAO was asked to review (1) the technical capabilities of the currently deployed BioWatch system, (2) the Gen-3 testing effort, and (3) characteristics of autonomous detection as a possible option to replace the current BioWatch system. GAO analyzed key program documents, including test plans, test results, and modeling studies. GAO assessed Gen-3 testing against best practices, reviewed relevant literature, and discussed the BioWatch program and testing efforts with key agency officials and national laboratories staff. GAO recommends DHS not pursue upgrades or enhancements for Gen-2 until it reliably establishes the system's current capabilities. GAO also recommends DHS incorporate best practices for testing in conducting any system upgrades.

Several incidents involving the shipment of live pathogens, thought to be inactivated, have recently occurred, potentially exposing people to dangerous pathogens that cause infectious diseases, such as the bacterium that causes anthrax. GAO was asked to evaluate issues related to inactivation of pathogens in high-containment laboratories. This report examines (1) the extent to which incidents involving incomplete inactivation occurred from 2003 through 2015, (2) any challenges that may affect the implementation of inactivation in high-containment laboratories, and (3) the extent to which the Select Agent Program referred violations and enforced regulations related to incidents involving incomplete inactivation. GAO convened an expert meeting with the assistance of the National Academy of Sciences to discuss various issues surrounding inactivation. GAO also reviewed relevant laws, regulations, and guidance, and interviewed officials at laboratories that conduct inactivation. GAO is making six recommendations to HHS and USDA to, among other things, improve the Select Agent Program’s oversight of inactivation by revising reporting forms, improving guidance for development and validation of inactivation protocols, and developing consistent criteria for enforcement of incidents involving incomplete inactivation.

Preventing terrorists from smuggling nuclear or radiological material to carry out an attack in the United States is a top national priority. DNDO's mission is to improve capabilities to deter, detect, respond to, and attribute responsibility for nuclear terrorist attacks, in coordination with domestic and international partners. As part of this mission, DNDO conducts R&D on radiation and nuclear detection devices. GAO was asked to review DNDO's management of its R&D program. This report (1) provides information on the types of R&D projects DNDO started in fiscal years 2008 through 2013, (2) examines the extent to which DNDO's process for planning and selecting R&D projects to fund aligns its investments with gaps in the GNDA, and (3) examines the steps DNDO takes to evaluate the outcomes of R&D projects in which it invests. GAO recommends, among other things, that DNDO document how its research investments align with its research challenges and gaps in the GNDA, and that it take a systematic approach for evaluating the extent to which outcomes of its R&D investments collectively contribute to addressing its research challenges.

DHS's BioWatch program aims to provide early indication of an aerosolized biological weapon attack. Until April 2014, DHS pursued a next-generation autonomous detection technology (Gen-3), which aimed to enable collection and analysis of air samples in less than 6 hours, unlike the current system (Gen-2), which requires manual intervention and can take up to 36 hours to detect the presence of biological pathogens. DHS is taking steps to address the capability gap that resulted from the cancellation of Gen-3 by exploring other technology upgrades and improvements to the Gen-2 system. GAO was asked to review (1) the technical capabilities of the currently deployed BioWatch system, (2) the Gen-3 testing effort, and (3) characteristics of autonomous detection as a possible option to replace the current BioWatch system. GAO analyzed key program documents, including test plans, test results, and modeling studies. GAO assessed Gen-3 testing against best practices, reviewed relevant literature, and discussed the BioWatch program and testing efforts with key agency officials and national laboratories staff. GAO recommends DHS not pursue upgrades or enhancements for Gen-2 until it reliably establishes the system's current capabilities. GAO also recommends DHS incorporate best practices for testing in conducting any system upgrades.

Providing a safe and adequate supply of water is perhaps the most essential municipal service. Lead-contaminated drinking water in Flint, Michigan and ongoing drought in several U.S. regions highlight challenges water utilities are facing. In times of shortage, conflicts over limited freshwater resources -- including for irrigation, power production, and municipal water use -- increase. Further, freshwater shortages are expected to continue into the future. This report examines (1) technologies that could reduce demand on freshwater supplies by improving distribution system efficiency; (2) technologies that could increase water supplies by using nontraditional water sources; and (3) locations and types of water utilities where these technologies are most commonly adopted. Figures. This is a print on demand report.

An expansive, yet succinct, analysis of the Philosophy of Religion – from metaphysics through theology. Organized into two sections, the text first examines truths concerning what is possible and what is necessary. These chapters lay the foundation for the book’s second part – the search for a metaphysical framework that permits the possibility of an ultimate explanation that is correct and complete. A cutting-edge scholarly work which engages with the traditional metaphysician’s quest for a true ultimate explanation of the most general features of the world we inhabit Develops an original view concerning the epistemology and metaphysics of modality, or truths concerning what is possible or necessary Applies this framework to a re-examination of the cosmological argument for theism Defends a novel version of the Leibnizian cosmological argument

Neutron detectors are used to detect neutron radiation in science, security, and other applications. For ex., large-area detectors detect neutrons at science facilities across the world and radiation portal monitors screen vehicles and cargo at ports and border crossings for nuclear material that terrorists could use in a nuclear weapon. Helium-3 is a critical component of such neutron detectors, and in 2008 the U.S. government became aware of a severe shortage of helium-3 gas. While demand for it has increased, helium-3 is currently produced as a byproduct of the radioactive decay of tritium, and the U.S. ceased tritium production in 1988. The shortage has led science facilities and federal agencies to identify or develop alternative detector technologies. This report reviewed the effectiveness of alternative neutron detector technologies that do not use helium-3. It assessed (1) what alternative neutron detectors are currently available and their effectiveness, and (2) the status of research on alternative neutron detector technologies under development for future availability. Figures and tables. This is a print on demand report.