Good morning. I and the president of the institute of medicine, and it is my great pleasure to welcome all of you to this very important meeting. I understand that as of yesterday, we have over 700 people registered. Weve limited the size to 250 in order to be manageable in the breakout conversations so a lot of people are going to be here on the webcast. We are seeing the devastating effects of the virus outside of the United States because we are seeing it entered the United States as well. Fortunately the Public Health system responds to the virus is robust and of the small handful of people with ebola in the u. S. Only one has died. In africa the picture is different. We have seen over thousands of cases and high fatality rates. We have just heard that the epidemic is still far from where we need to be. The cdc has predicted that in the worstcase scenario over many people could be affected by january, liberia and sierra leone. What went wrong . There are many lessons to be learned is that we can be better prepared in the future. Among these in my opinion is that it needs to step up efforts to improve infrastructure globally. In fact theyve recently released a report on the global Health Systems which make the case that strengthening the Health System is the future of global health. They wrote a powerful oped eliminating this issue you as a key factor in this crisis. The countries with the Public Health systems. Even in the u. S. We need to pay considerable attention to how we identify and treat individuals with the virus and prevent the dissemination. Its the importance of having the robust preparedness Hospital System and in addition it is important to ensure the guidance and actions are based on uptodate Scientific Evidence we must do the best for patients, providers and society. There are many scientific unknowns where we must put enormous effort we need to know more about the transition and activation and disinfection of the contemporary services. We also need to understand how the personal protective equipment can be best used by anyone that may be exposed to a virus and not just health professionals. So theres a lot of love since learned and there will be lots of opportunity to have that conversation discussion move forward based on what weve learned. So the secretary response together with the nih and cdc asks that we can could be in this workshop to provide information about the scientific priorities on the disease. It is a trusted, independent space that people can debate many topics open my. Weve developed the workshop to inform the Public Health communities of the research that needs to be performed to ensure that they are on the Scientific Evidence to inform the Public Health officials and providers and the public for the most current information about transmission and other measures that should be taken to prevent the spread of ebola. Furthermore what must be performed now for the important specimens and information and data. We should aim to have a system that allows us to collect and analyze data and provide advice in realtime. We will be addressing these in more detail so we need to listen to the various points of view and identify Research Needs and gaps. We are not here to provide a political advice at this time as that is not the intention of this workshop. Weve opened this to the world through the webcast so that no matter where you are, west africa or the u. S. You can learn alongside with the participants. We have over 700 people registered to watch today and the videos will be posted on our website for future reference. I want to put out a slide for the Planning Committee because they came together it. Short time in order to do this to pull this together and because the chair and all the other people who i wont have time to read all the names. This is a workshop where therefore many of the researchers have come together to bring expertise to this issue. I like to acknowledge they brought up the policy, the population for the practice and the Life Sciences division of earth and life science studies. I also think so many of you that come from far and wide to present your research, viewpoint and expert advice to the direction of the research in this country. Some were not able to make it because they were battling the epidemic even as we speak and because our thoughts are with them today. We have a full day ahead of us and we will dive into several areas of the transmission routes cut survival of the virus can protective equipment and behavior, Waste Management and the methods and at the end of the day we will discuss the urgency of researching each topic. So i think that this workshop is timely, important and an exciting moment. We are advising the direction of research where the government and other dollars should be spent spent to send the conversation to be taken lightly. I would like to turn over to doctor goldman who is the chair of the Planning Committee in a meeting and she will make some remarks. Thank you so much to the Planning Committee. Youve done a lot of work in a relatively short pier, tim and i appreciate the volunteerism of love with the speakers who are with us today, but the facilitators and all of you for being in attendance. The other toward him at the National Academy and also online. You will contribute in many ways to this discussion and i appreciate that. The workshop format and the purpose is to foster dialogue about the Research Priorities but of course not to provide a recommendation. We do the leave that its possible to help Foster Research during a response to inform the practice and also ensure guidance in the future is based on the most current science and to make sure the data is gathered before they are launched. The research will help inform public guidance and critical guidelines but we are not here to review those or participate in developing them. So the outline for the day is that we will begin with some plenary talks that will help us come to a common understanding about the it has already established in this area as well as understanding the potential gaps that exist and then we will split into four breakout area is one on transmission routes and exit for the ebola a virus into the second on the insect in the environment and a third on personal protective equipment and personal behavior to prevent transmission and reduce exposure to the ebola virus and the handling of potential contaminated materials. We know that Health Care Workers are at risk and this shows the epidemic transmission diagram from the cases that occurred earlier this year in nigeria. On this side are the blue Health Care Workers and responders of all kinds whether kind whether they are Health Care Workers or family care providers that have been particularly at risk requiring this disease so we know that the workforce is at risk. When we think about the risk like this in the context of protecting the workers, we are thinking about exposure and at the concept of exposure has to do with the contact between the outer boundary of the human body and the public and one extra of pollutants in this case the virus such as the ebola virus that requires the presence of the pollution and actual contact with it and usually a quantification of the amount of the pollutants and the kind of contact this is how this is normally done. So the whole paradigm for the Environmental Health has to do with looking at agents such as either biological fluids or an allaround server or is and exposure routes in the case of needle sticks or respiratory perhaps and biological response such as Infectious Disease and or just any responses to that infection. In that framework what is the agent and we are going to learn more later today about this agent on the ebola virus and its very interesting and dangerous. When we think about how people might have contact with it what is important to understand and this is important in the epidemic in sierra leone that documents a fair portion of the case of diarrhea and vomiting and a smaller proportion cough and so these are three ways that awfully fluids are certainly going to potentially be involved with caregivers. Animal hosts are another question. We know in the situation in africa but there are animals involved into the dont know how those dynamics work in the ecology of the disease but we dont know if they are potential risks with companion animals and so theres been a little bit of a question about what to do with companion animals into this is simply a picture of one of the nurses with her dog both of whom sent home on friday and the other one after being quarantined for 21 days. So there are basic strategies and Public Health he is to prevent injury and people from receiving harm and the environment and arranging from of course trying not to create a hazard of the first place of reducing or preventing or modifying a hazard all the way through some of the things that could be done in the future like increasing resistance and improving Emergency Response and care and rehabilitation. But here we are really focused on these three things in the middle ground, separating time and space and modifying the basic structures and finding ways to separate people who might be at risk from the hazard it in particular we are most concerned about again responders and care providers of all kind whether occupationally involved in providing care or family members. And when we think about occupational exposures and potential interventions that we can use to get lemonade or reduce exposures, we think about these as occurring on the hierarchy where we know that it is far more efficacious if we can engineer the environment or change the process to prevent the possibility of exposure in the first place, less effective is to take administrative for programmatic behavioral approaches where we try to change the way that people work together, the behavior of the cases and the least efficacious they use a personal protective equipment. This is a personal protective equipment is really considered to be a last resort, but something that is very, very necessary if there is no way to protect people through engineering or administrative approaches. We have a lot of information and there are existing criteria. We are here to review the spec just to remind you we are not starting from ground zero. These are the protocols that every university currently has on their website which are labeled draft, which i think that means even for emory is experienced with treating these kinds of illnesses. We currently have Waste Management protocols. We have the u. S. Department of transportation has many regulations and theres an enormous patchwork of state and local regulations about the management and handling of the bio hazardous waste. At the same time the few cases that we have in the United States have posed in the challenges in terms of the quantities of the ways that have been generated. On the one case the entire truck pulled up after the appointment to haul off the waste and in dallas with one patient 140 barrels 55gallon barrels were generated and in fact there were controversies about how the ashes were incinerating the waste would be handled in for the competing not to take those actions so we will produce a workshop report that will be prepared by the institute of medicine. This will be publicly available what transpired here at the workshop. There will be further deliberations by the Planning Committee. What will be in the report well emerge from what the speakers at the workshop brings forward. It will be published by the National Academies and the decent ideas will be those that the workshop participants and lost the National Academies of the Planning Committee and there will be no former consensus findings and recommendations coming from this activity. Said, with that and to conclude once again by being here i would now like to turn to doctor the coal who is the assistant secretary for preparedness and Emergency Response at the department of health and human services, and she will give you a perspective from the standpoint of her agency for this workshop. Thank you for being here. Thank you to all of you for coming. In. And for tuning in on the web and other ways. And thanks very much to the Planning Committee for rapidly putting this together. I thought that i would take a quick step back and get a bit of perspective. I came into this position in 2009 just as the h1n1 was ramping up. I ended up on a phone call around the country each talking about the temptations that are in the icu. And a group of us listened to them and thought if we could get a download of cases to this it should be possible that if people survive this disease we go out to the nih Research Network and to entity agreed to modify the protocols for sending the identified data and we felt that we were on our way. It turns out that it took six months for the Human Subjects Committee of the respective universities to approve the changes to the protocol and we completely missed the window to know how fast to treat people. 18 months later we learned from the work that about 40 of the children who died died right from the resistant staph and not from h1n1. And it was with that that i said we are not as equipped as we need to be to do science and to do the kind of research that needs to be done in an emergency either to affect the course and trajectory of the emergency or to be sure that we are never in the same situation twice. Its in the spirit that we are holding the workshop today. My office has launched a fairly comprehensive science Response Initiative which is now across the hhs. One immediate outcome is that there is a Public Health emergency and it is they send that it could be used in an emergency. Another immediate outcome of that work has been a process that is set up in a meeting. In any emergency its important to get the groups of experts together not only inside of the government but outside of the government to identify with the Research Priorities are for the consideration review. So in that spirit we have a standing arrangement in the institute of medicine so that in the event of an emergency or disaster or another publichealth crisis we can ask them to convene a group of experts that would be you and other interested parties to help identify what the Research Priorities are that well help manage this event and not be in the same situation the next time theres a lot of science already going on and i dont want you to think that there isnt. For example, the same candidates are promising and are now finishing the safety studies that and i each at walter reed and hopefully will go into Clinical Trials in west africa in december. A number have been developed and are in various phases the various phases of testing and will be subject we expect to the rigorous Clinical Trials. Those are not the focus. Similarly the group has put together a finishing the development of the practice guidelines. I want you to understand that is the kind that science is going on and it does not need to be the focus here. But the focus really needs to be on impacting the Public Health and medical response for this and for the future. During the people are rising or after deepwater horizon, we put together the different federal agencies that were involved in doing the research during that event. We learned that there were 17 different federal agencies all of whom were involved in research or science or one way or another they largely didnt know about one another. And because of the way that they collected a lot of the data it became very difficult to leverage all of the tremendous work that has been done. In this event under the auspices of the office of the Science Technology policy at the white house all the different agencies ranging from hhs to the department of transportation to the department of energy and beyond have come together to identify what it is that they can bring to the site and what it is they are doing and identify both priorities and opportunities for the collaboration. However, we do need to hear from people outside of the federal government about this and that is a part of the genesis for this. When we planned this workshop we were in a very different situation in the epidemic and we are now. We have not yet had a case or cases in the United States and so we are going to be a little bit flexible today in terms of how we think about this agenda and how we identify together with the science parodies are but regardless we started seeing that the public and the Healthcare Workers had many concerns about how to protect themselves but in west africa and here. Environmental issues always come up in situations like this both to guide the Public Health response and to address the public concerns. I dont know how many of you saw the piece in the news this weekend about some of the challenges not only with the patients apartment in dallas but the fact that right now the ashes remain in limbo because theres not any there is not any place that will accept them. In the interface between science and d