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Maternal fever during pregnancy or delivery can also set off this kind of inflammatory response. Blood type incompatibility between mother and child. Exposure to toxic substances. Mothers who have been exposed to toxic substances during pregnancy, such as methyl mercury, are at a heightened risk of having a baby with cerebral palsy. Mothers with thyroid abnormalities, intellectual disability, excess protein in the urine, or seizures.

Mothers with any of these conditions are slightly more likely to have a child with CP. There are also medical conditions during labor and delivery, and immediately after delivery that act as warning signs for an increased risk of CP. However, most of these children will not develop CP. Babies with cerebral palsy are more likely to be in a breech position feet first instead of head first at the beginning of labor.

Babies who are unusually floppy as fetuses are more likely to be born in the breech position. Complicated labor and delivery. A baby who has vascular or respiratory problems during labor and delivery may already have suffered brain damage or abnormalities. Small for gestational age. Babies born smaller than normal for their gestational age are at risk for cerebral palsy because of factors that kept them from growing naturally in the womb.

The Apgar score is a numbered rating that reflects a newborn's physical health. Doctors periodically score a baby's heart rate, breathing, muscle tone, reflexes, and skin color during the first minutes after birth. A low score at minutes after delivery is often considered an important sign of potential problems such as CP. Severe, untreated jaundice can kill brain cells and can cause deafness and CP.

An infant who has seizures faces a higher risk of being diagnosed later in childhood with CP. Cerebral palsy related to genetic abnormalities cannot be prevented, but a few of the risk factors for congenital cerebral palsy can be managed or avoided. Rh incompatibilities can also be managed early in pregnancy.

Acquired cerebral palsy, often due to head injury, is often preventable using common safety tactics, such as using car seats for infants and toddlers. People have stiff muscles and awkward movements. Forms of spastic cerebral palsy include:. Hyperactivity in the muscles of the face and tongue makes some children grimace or drool.

They find it difficult to sit straight or walk. Intelligence is rarely affected in these forms of cerebral palsy. Children with ataxic CP will often have poor coordination and walk unsteadily with a wide-based gait.

They have difficulty with quick or precise movements, such as writing or buttoning a shirt, or a hard time controlling voluntary movement such as reaching for a book. For example, a child with mixed CP may have some muscles that are too tight and others that are too relaxed, creating a mix of stiffness and floppiness.

Approximately 30 — 50 percent of individuals with CP will be intellectually impaired. Mental impairment is more common among those with spastic quadriplegia than in those with other types of cerebral palsy. As many as half of all children with CP have one or more seizures. Children with both cerebral palsy and epilepsy are more likely to have intellectual disability. Delayed growth and development. Children with moderate to severe CP, especially those with spastic quadriparesis, often lag behind in growth and development.

In babies this lag usually takes the form of too little weight gain. In young children it can appear as abnormal shortness, and in teenagers it may appear as a combination of shortness and lack of sexual development.

The muscles and limbs affected by CP tend to be smaller than normal, especially in children with spastic hemiplegia, whose limbs on the affected side of the body may not grow as quickly or as long as those on the normal side. Spinal deformities and osteoarthritis. Spinal deformities can make sitting, standing, and walking difficult and cause chronic back pain. Pressure on and misalignment of the joints may result in osteoporosis a breakdown of cartilage in the joints and bone enlargement.

Some children with CP have difficulty understanding and organizing visual information. Other children may have defective vision or blindness that blurs the normal field of vision in one or both eyes.

Impaired hearing is also more frequent among those with CP than in the general population. Some children have partial or complete hearing loss, particularly as the result of jaundice or lack of oxygen to the developing brain. Speech and language disorders.

Speech and language disorders, such as difficulty forming words and speaking clearly, are present in more than a third of persons with CP. Poor speech impairs communication and is often interpreted as a sign of cognitive impairment, which can be very frustrating to children with CP, especially the majority who have average to above average intelligence,.

Some individuals with CP drool because they have poor control of the muscles of the throat, mouth, and tongue. A possible complication of CP is incontinence, caused by poor control of the muscles that keep the bladder closed.

Abnormal sensations and perceptions. Some individuals with CP experience pain or have difficulty feeling simple sensations, such as touch.

Children with CP may have difficulty processing particular types of spatial and auditory information. Brain damage may affect the development of language and intellectual functioning. Infections and long-term illnesses. Many adults with CP have a higher risk of heart and lung disease, and pneumonia often from inhaling bits of food into the lungs , than those without the disorder.

Swallowing, sucking, or feeding difficulties can make it difficult for many individuals with CP, particularly infants, to get proper nutrition and gain or maintain weight. Many children with CP are at risk of developing gum disease and cavities because of poor dental hygiene. Certain medications, such as seizure drugs, can exacerbate these problems.

Childhood inactivity is magnified in children with CP due to impairment of the motor centers of the brain that produce and control voluntary movement. While children with CP may exhibit increased energy expenditure during activities of daily living, movement impairments make it difficult for them to participate in sports and other activities at a level of intensity sufficient to develop and maintain strength and fitness.

Inactive adults with disability exhibit increased severity of disease and reduced overall health and well-being. Most children with cerebral palsy are diagnosed during the first 2 years of life. Although symptoms may change over time, CP is not progressive. If a child is continuously losing motor skills, the problem more likely is a condition other than CP—such as a genetic or muscle disease, metabolism disorder, or tumors in the nervous system.

Lab tests can identify other conditions that may cause symptoms similar to those associated with CP. Neuroimaging techniques that allow doctors to look into the brain such as an MRI scan can detect abnormalities that indicate a potentially treatable movement disorder. Changes in the normal electrical pattern may help to identify epilepsy. Some metabolic disorders can masquerade as CP. Most of the childhood metabolic disorders have characteristic brain abnormalities or malformations that will show up on an MRI.

Other types of disorders can also be mistaken for CP or can cause specific types of CP. For example, coagulation disorders which prevent blood from clotting or lead to excessive clotting can cause prenatal or perinatal strokes that damage the brain and produce symptoms characteristic of CP, most commonly hemiparetic CP.

Referrals to specialists such as a child neurologist, developmental pediatrician, ophthalmologist, or otologist aid in a more accurate diagnosis and help doctors develop a specific treatment plan. Many children go on to enjoy near-normal adult lives if their disabilities are properly managed.

In general, the earlier treatment begins, the better chance children have of overcoming developmental disabilities or learning new ways to accomplish the tasks that challenge them. There is no standard therapy that works for every individual with cerebral palsy. Physical therapy , usually begun in the first few years of life or soon after the diagnosis is made, is a cornerstone of CP treatment.

Specific sets of exercises such as resistive, or strength training programs and activities can maintain or improve muscle strength, balance, and motor skills, and prevent contractures. Special braces called orthotic devices may be used to improve mobility and stretch spastic muscles.

Occupational therapists help individuals address new ways to meet everyday activities such as dressing, going to school, and participating in day-to-day activities. They are also at risk for breathing food or fluid into the lungs, as well as for malnutrition, recurrent lung infections, and progressive lung disease.

Oral medications are most appropriate for children who need only mild reduction in muscle tone or who have widespread spasticity. BT-A relaxes contracted muscles by keeping nerve cells from over-activating muscle.

The relaxing effect of a BT-A injection lasts approximately 3 months. Undesirable side effects are mild and short-lived, consisting of pain upon injection and occasionally mild flu-like symptoms. BT-A injections are most effective when followed by a stretching program including physical therapy and splinting. BT-A injections work best for children who have some control over their motor movements and have a limited number of muscles to treat, none of which is fixed or rigid.

Baclofen decreases the excitability of nerve cells in the spinal cord, which then reduces muscle spasticity throughout the body. The pump can be adjusted if muscle tone is worse at certain times of the day or night. The baclofen pump is most appropriate for individuals with chronic, severe stiffness or uncontrolled muscle movement throughout the body. For many people with CP, improving the appearance of how they walk — their gait — is also important.

Surgeons can lengthen muscles and tendons that are proportionately too short, which can improve mobility and lessen pain. Tendon surgery may help the symptoms for some children with CP but could also have negative long-term consequences. Surgery can also correct or greatly improve spinal deformities in people with CP. Surgery to cut nerves. A surgeon locates and selectively severs overactivated nerves at the base of the spinal column. SDR is most commonly used to relax muscles and decrease chronic pain in one or both of the lower or upper limbs.

It is also sometimes used to correct an overactive bladder. Potential side effects include sensory loss, numbness, or uncomfortable sensations in limb areas once supplied by the severed nerve.

Assistive devices such devices as computers, computer software, voice synthesizers, and picture books can greatly help some individuals with CP improve communications skills. Other devices around the home or workplace make it easier for people with CP to adapt to activities of daily living. Orthotic devices help to compensate for muscle imbalance and increase independent mobility. Braces and splints use external force to correct muscle abnormalities and improve function such as sitting or walking.

Other orthotics help stretch muscles or the positioning of a joint. Braces, wedges, special chairs, and other devices can help people sit more comfortably and make it easier to perform daily functions. Wheelchairs, rolling walkers, and powered scooters can help individuals who are not independently mobile.

Vision aids include glasses, magnifiers, and large-print books and computer typeface. Some individuals with CP may need surgery to correct vision problems. Hearing aids and telephone amplifiers may help people hear more clearly. Many children and adolescents with CP use some form of complementary or alternative medicine.

Controlled clinical trials involving some of the therapies have been inconclusive or showed no benefit and the therapies have not been accepted in mainstream clinical practice. Although there are anecdotal reports of some benefit in some children with CP, these therapies have not been approved by the U. Food and Drug Administration for the treatment of CP. Such therapies include hyperbaric oxygen therapy, special clothing worn during resistance exercise training, certain forms of electrical stimulation, assisting children in completing certain motions several times a day, and specialized learning strategies.

Also, dietary supplements, including herbal products, may interact with other products or medications a child with CP may be taking or have unwanted side effects on their own. Families of children with CP should discuss all therapies with their doctor. Continuation on active duty. Continuation on active duty: The elements of such regulations shall include mechanisms to clarify the manner in which provisions of other subchapters of this chapter shall be used in the administration of this subchapter in accordance with the provisions of this subchapter.

A A detailed analysis and assessment of the manner in which the exercise of the authorities in subchapter VI of chapter 36 of title 10, United States Code as so added , will effect the career progression of commissioned officers in the Armed Forces.

B A description of the competitive categories of officers that are anticipated to be designated as competitive categories of officers for purposes of such authorities. C A plan for implementation of such authorities. D Such recommendations for legislative or administrative action as the Secretary of Defense considers appropriate to improve or enhance such authorities. Attending Physician to the Congress. Attending Physician to the Congress: A flag officer serving as Attending Physician to the Congress, while so serving, holds the grade of rear admiral upper half.

Matters relating to satisfactory service in grade for purposes of retirement grade of officers in highest grade of satisfactory service. Such grade is subject to resolution under subsection b 3.

The retired grade of an officer following such a conditional certification is subject to resolution under subsection b 3. C by adding at the end the following new paragraphs: If the retired grade of an officer is reduced, the retired pay of the officer under chapter 71 of this title shall be recalculated, and any modification of the retired pay of the officer shall go into effect on the effective date of the reduction in retired grade.

Grades of Chiefs of Chaplains. Repeal of original appointment qualification requirement for warrant officers in the regular Army. Reduction in number of years of active naval service required for permanent appointment as a limited duty officer.

Authority to designate certain reserve officers as not to be considered for selection for promotion. Section of title 10, United States Code, as amended by section , is further amended by adding at the end the following new subsection:. Any such officer may remain on the reserve active-status list. GAO review of surface warfare career paths. The Comptroller General shall submit a final report to the congressional defense committees as soon as practicable after such briefing.

Authorized strength and distribution in grade. Expansion of personnel subject to authority of the Chief of the National Guard Bureau in the execution of functions and missions of the National Guard Bureau. Authority to adjust effective date of promotion in the event of undue delay in extending Federal recognition of promotion.

National Guard Youth Challenge Program. Section h of title 32, United States Code, is amended—. Extension of authority for pilot program on use of retired senior enlisted members of the Army National Guard as Army National Guard recruiters. Enlistments vital to the national interest. C by adding at the end the following new subparagraphs: A The number of such persons who have entered into such contracts during the preceding calendar year. B How many such persons have successfully completed background investigations and vetting procedures.

C How many such persons have begun initial training. D The skills that are vital to the national interest that such persons possess. Assessment of Navy standard workweek and related adjustments. B based on the analysis carried out pursuant to subparagraph A , identify the manpower necessary to execute in-port workloads for all surface ship classes;.

Notification on manning of afloat naval forces. Qualification experience requirements for certain Navy watchstations. Inclusion of strangulation and suffocation in conduct constituting aggravated assault for purposes of the Uniform Code of Military Justice. Punitive article on domestic violence under the Uniform Code of Military Justice. Section of the Carl Levin and Howard P. In carrying out this paragraph, the department or agency shall take steps to prevent the unauthorized disclosure of personally identifiable information.

B the estimated number of additional personnel that would be required to accommodate such increase; and. C the ability of the military departments to fill any additionally authorized billets for SVC programs with qualified judge advocates who possess military justice experience. Uniform command action form on disposition of unrestricted sexual assault cases involving members of the Armed Forces.

The Secretary of Defense shall establish a uniform command action form, applicable across the Armed Forces, for reporting the final disposition of cases of sexual assault in which—. Standardization of policies related to expedited transfer in cases of sexual assault or domestic violence.

Clarification of expiration of term of appellate military judges of the United States Court of Military Commission Review. Security clearance reinvestigation of certain personnel who commit certain offenses. Development of oversight plan for implementation of Department of Defense harassment prevention and response policy.

The report shall include, for each military service and component of the Department of Defense, the implementation status of each element of the oversight plan. Oversight of registered sex offender management program. Development of resource guides regarding sexual assault for the military service academies. D Clearly described complaint process, including to whom a complaint may be filed.

E Explanations of restricted and unrestricted reporting. H Assurance that leadership will take appropriate corrective action. A The Sexual Assault Prevention and Response Victim Advocate or other equivalent advocate or counselor available to students in cases of sexual assault.

G Chaplain or other spiritual representatives. The tracking process shall, to the maximum extent possible, standardize and automate reporting and increase the ability of the Department to track such submissions. Report on victims of sexual assault in reports of military criminal investigative organizations. Permanent career intermission program. Career flexibility to enhance retention of members. At a minimum, the Secretary shall prescribe the procedures and standards to be used to instruct a member on the obligations to be assumed by the member under paragraph 2 of such subsection while the member is released from active service.

Improvements to Transition Assistance Program. C by redesignating subsection c as subsection d ;. D by inserting after subsection b the following new subsection c: The Secretaries shall design the pathways to address the needs of members, based on the following factors: E by adding at the end the following new subsection: B by amending subsection f to read as follows: B details how the Secretary, in consultation with the Secretaries of Veterans Affairs and Labor, shall establish standardized performance metrics to measure Transition Assistance Program participation and outcome-based objective benchmarks in order to— i provide feedback to the Departments of Defense, Veterans Affairs, and Labor;.

The report shall detail the following: A The total number of members who attended Transition Assistance Program counseling. B The number of members who attended Transition Assistance Program counseling under paragraph 1 of section f of title 10, as amended by paragraph 1. C The number of members who attended Transition Assistance Program counseling under paragraph 2 of such section. D The number of members who elected to attend each two-day instruction under paragraph 1 D of such section.

Repeal of program on encouragement of postseparation public and community service. B by redesignating paragraphs 9 , 10 , and 11 as paragraphs 8 , 9 , and 10 , respectively. Clarification of application and honorable service requirements under the Troops-to-Teachers Program to members of the Retired Reserve. Employment and compensation of civilian faculty members at the Joint Special Operations University.

Section c of title 10, United States Code, is amended by adding at the end the following new paragraph:. Program to assist members of the Armed Forces in obtaining professional credentials.

Flexibility in authorities for management of programs and units. Such actions shall include a requirement for the use of the National Center for Education Statistics NCES identification code for each school with a unit under a Junior Reserve Officers' Training Corps program in order to facilitate identification of such schools and their units under the Junior Reserve Officers' Training Corps programs.

Expansion of period of availability of Military OneSource program for retired and discharged members of the Armed Forces and their immediate families. Prohibition on use of funds for attendance of enlisted personnel at senior level and intermediate level officer professional military education courses.

Assistance to schools with military dependent students. Department of Defense Education Activity policies and procedures on sexual harassment of students of Activity schools. Such policies and procedures shall afford protections at least comparable to the protections afforded under title IX. B such a student or parent may appeal the decision of the school regarding such complaint.

B appropriate members of the local leadership of military communities are held accountable for acting upon complaints of sexual harassment at schools of the Activity. Department of Defense Education Activity misconduct database. The comprehensive database shall include all unresolved and all substantiated allegations of juvenile-on-juvenile sexual misconduct. Assessment and report on active shooter threat mitigation at schools located on military installations.

B by striking clause ii and inserting the following new clause ii: Enhancement and clarification of family support services for family members of members of special operations forces. Temporary expansion of authority for noncompetitive appointments of military spouses by Federal agencies.

B by redesignating paragraph 6 as paragraph 3 ;. B shall require the head of each agency with authority to make such appointments under such section to submit an annual report to the Director on such appointments, including information on the number of individuals so appointed, the types of positions filled, and the effectiveness of the authority for such appointments; and.

C not later than 18 months after the date of the enactment of this Act, shall submit a report to the Committee on Oversight and Government Reform of the House of Representatives and the Committee on Homeland Security and Government Affairs of the Senate on the use and effectiveness of such authority. B may limit the number of such appointments. Improvement of My Career Advancement Account program for military spouses.

Assessment and report on the effects of permanent changes of station on employment among military spouses. Provisional or interim clearances to provide childcare services at military childcare centers. Multidisciplinary teams for military installations on child abuse and other domestic violence. A One or more judge advocates. B Appropriate personnel of one or more military criminal investigation services. C Appropriate mental health professionals. F Such other personnel as the Secretary or Secretaries concerned consider appropriate.

The training and expertise so specified shall include training and expertise on special victims' crimes, including child abuse and other domestic violence. Each report shall set forth, for the period covered by such report, the following: Pilot program for military families: B identify and assess risk factors for child abuse in covered households; and.

C facilitate connections between covered households and community resources. E High incidence of child abuse, neglect, or both. F Low incidence of child abuse, neglect, or both. A Postnatal services, including screening to identify family needs and potential risk factors, and make referrals to appropriate community services with the use of the electronic data described in subparagraphs F and G. B The Secretary shall identify at least three approaches to screening, identification, and referral under subparagraph A that empirically improve outcomes for parents and infants.

C Services and resources designed for a covered household by the Secretary after considering the information gained from the screening and identification under subparagraph A. Such services and resources may include or address the following: D Home visits to provide support, screening and referral services shall be offered as needed. The number of visits offered shall be guided by parental interest and family need, but in general is expected to be no more than three.

E If a parent is deployed at the time of birth— i the first in-home visit under subparagraph D shall, to the extent practicable, incorporate both parents, in person with the local parent and by electronic means with the deployed parent; and. F An electronic directory of community resources available to covered households and pilot program personnel to help covered households access such resources. G An electronic integrated data system to— i help pilot program personnel refer eligible covered beneficiaries to services and resources under the pilot program;.

A Success in contacting covered households for participation in the pilot. B The percentage of covered households that elect to participate in the pilot program. C The extent to which covered households participating in the pilot program are connected to services and resources under the pilot program. D The extent to which covered households participating in the pilot program use services and resources under the pilot program.

E Compliance of pilot program personnel with pilot program protocols. The report shall include a comprehensive description of the assessments under subsection d , as well as the following: A Which installations the Secretary selected for the pilot program under subsection a 2. B Why the Secretary selected the installations described in subparagraph A.

C Names of the installations the Secretary selected as comparison installations under subsection d 2. D How the pilot program is carried out, including strategy and metrics for evaluating effectiveness of the pilot program. The report shall include the following: A A comprehensive description of, and findings of, the assessments under subsection d. B A comprehensive description and assessment of the pilot.

C Such recommendations for legislative or administrative action the Secretary determines appropriate, including whether to— i extend the term of the pilot program;. B is located at a location selected by the Secretary for the pilot program. Assessment and report on small business activities of military spouses on military installations in the United States. Atomic veterans service certificate.

Award of medals or other commendations to handlers of military working dogs. The Secretary concerned may use an existing award to carry out such program. Authorization for award of distinguished-service cross to Justin T. Gallegos for acts of valor during Operation Enduring Freedom.

Gallegos for the acts of valor described in subsection b. Annual defense manpower requirements report matters. Standardization of frequency of academy visits of the Air Force Academy Board of Visitors with academy visits of boards of other military service academies.

Section of title 10, United States Code, is amended by striking subsection d and inserting the following new subsection:. With the approval of the Secretary of the Air Force, the Board or its members may make other visits to the Academy in connection with the duties of the Board or to consult with the Superintendent of the Academy.

Board members shall have access to the Academy grounds and the cadets, faculty, staff, and other personnel of the Academy for the purposes of the duties of the Board. In addition, the Commission shall not be subject to the requirements of section c 2 A of such title. Public availability of top-line numbers of deployed members of the Armed Forces. B members of the Armed Forces are deployed for a period that does not exceed 30 days. B the reasons for the determination to issue the waiver.

Report on general and flag officer costs. Begun and held at the City of Washington on Wednesday, the third day of January, two thousand and eighteen.

Subtitle A—Authorization Of Appropriations. Subtitle D—Air Force Programs. Subtitle A—Authorization of appropriations. Subtitle B—Program requirements, restrictions, and limitations. Subtitle C—Reports and other matters.

Subtitle A—Authorization of Appropriations. Subtitle B—Energy and Environment. Subtitle C—Logistics and Sustainment.

Subtitle C—Authorization of Appropriations. Subtitle A—Officer Personnel Policy. Subtitle B—Reserve Component Management. Subtitle E—Other Legal Matters. Subtitle I—Decorations and Awards. Subtitle A—Pay and Allowances. Subtitle B—Health Care Administration. Subtitle C—Reports and Other Matters.

Subtitle E—Industrial Base Matters. Subtitle F—Small Business Matters. Subtitle B—Naval Vessels and Shipyards. Subtitle D—Miscellaneous Authorities and Limitations. Subtitle E—Studies and Reports. Subtitle A—Assistance and training. Subtitle B—Matters relating to Afghanistan and Pakistan. Subtitle D—Matters relating to the Russian Federation. Subtitle E—Matters relating to the Indo-Pacific region. Subtitle F—Reports and other matters.

Subtitle B—Armed forces retirement home. Subtitle E—Missile Defense Programs. Subtitle B—Export Control Reform. Subtitle B—Host country in-kind contributions. Subtitle C—Plans and Reports. Subtitle B—Army Programs Sec. Subtitle C—Navy Programs Sec. Subtitle B—Program requirements, restrictions, and limitations Sec. Subtitle C—Reports and other matters Sec. Subtitle B—Energy and Environment Sec.

Subtitle C—Logistics and Sustainment Sec. Subtitle E—Other Matters Sec. Subtitle B—Reserve Forces Sec. Subtitle C—Authorization of Appropriations Sec. Subtitle D—Military Justice Sec. Subtitle I—Decorations and Awards Sec.

Study on active service obligations for medical training with other service obligations for education or training and health professional recruiting. Criteria for interment at Arlington National Cemetery. Limitation on use of funds pending submittal of report on Army Marketing and Advertising Program. Proof of period of military service for purposes of interest rate limitation under the Servicemembers Civil Relief Act. Repeal of authority for payment of personal money allowances to Navy officers serving in certain positions.

Eligibility of reserve component members for high-deployment allowance for lengthy or numerous deployments and frequent mobilizations. Prohibition on per diem allowance reductions based on the duration of temporary duty assignment or civilian travel. Extension of parking expenses allowance to civilian employees at recruiting facilities. Eligibility of reserve component members for nonreduction in pay while serving in the uniformed services or National Guard.

Military Housing Privatization Initiative. One-year extension of certain expiring bonus and special pay authorities. Report on imminent danger pay and hostile fire pay. Subtitle C—Other Matters Sec.

Extension of certain morale, welfare, and recreation privileges to certain veterans and their caregivers. Technical corrections in calculation and publication of special survivor indemnity allowance cost of living adjustments. Authority to award damaged personal protective equipment to members separating from the Armed Forces and veterans as mementos of military service. Space-available travel on Department of Defense aircraft for veterans with service-connected disabilities rated as total.

Access to military installations for certain surviving spouses and other next of kin of members of the Armed Forces who die while on active duty or certain reserve duty. Study and report on development of a single defense resale system. Cessation of requirement for mental health assessment of members after redeployment from a contingency operation upon discharge or release from the Armed Forces.

Pilot program on treatment of members of the Armed Forces for post-traumatic stress disorder related to military sexual trauma. Improvement of administration of the Defense Health Agency and military medical treatment facilities. Organizational framework of the military healthcare system to support the medical requirements of the combatant commands. Sharing of information with State prescription drug monitoring programs.

Pilot program on opioid management in the military health system. Wounded warrior policy review. Medical simulation technology and live tissue training within the Department of Defense. Improvements to trauma center partnerships. Improvement to notification to Congress of hospitalization of combat-wounded members of the Armed Forces. Joint forces medical capabilities development and standardization.

Inclusion of gambling disorder in health assessments of members of the Armed Forces and related research efforts. Pilot program on earning by special operations forces medics of credit toward a physician assistant degree.

Strategic medical research plan. Comptroller General study on availability of long-term care options for veterans from Department of Veterans Affairs. Increase in number of appointed members of the Henry M.

Jackson Foundation for the Advancement of Military Medicine. Effective dates; coordination of amendments. Framework for new part V of subtitle A. Cross references to redesignated sections and chapters. Amendment to and repeal of statutory requirements for certain positions or offices in the Department of Defense.

Repeal of certain defense acquisition laws. Repeal of certain Department of Defense reporting requirements. Modification of limitations on single source task or delivery order contracts. Preliminary cost analysis requirement for exercise of multiyear contract authority.

Revision of requirement to submit information on services contracts to Congress. Data collection and inventory for services contracts. Report on clarification of services contracting definitions.

Increase in micro-purchase threshold applicable to Department of Defense. Department of Defense contracting dispute matters. Inclusion of best available information regarding past performance of subcontractors and joint venture partners. Subcontracting price and approved purchasing systems. Modification of criteria for waivers of requirement for certified cost and price data. Revisions in authority relating to program cost targets and fielding targets for major defense acquisition programs.

Comptroller General assessment of acquisition programs and related initiatives. Revision of definition of commercial item for purposes of Federal acquisition statutes.

Limitation on applicability to Department of Defense commercial contracts of certain provisions of law. Modifications to procurement through commercial e-commerce portals. Review of Federal acquisition regulations on commercial products, commercial services, and commercially available off-the-shelf items.

Report on limited sourcing of specific components for Naval vessels. Removal of national interest determination requirements for certain entities. Pilot program to test machine-vision technologies to determine the authenticity and security of microelectronic parts in weapon systems. Limitation on certain procurements application process. Report on defense electronics industrial base. Support for defense manufacturing communities to support the defense industrial base.

Limitation on procurement of certain items for T—AO— program. Department of Defense small business strategy. Prompt payments of small business contractors. Increased participation in the Small Business Administration microloan program. Comptroller General study of impact of broadband speed and price on small businesses. Funding for procurement technical assistance program. Authorization for payment of certain costs relating to procurement technical assistance centers.

Commercialization Assistance Pilot Program. Opportunities for employee-owned business concerns through Small Business Administration loan programs. Validation of proprietary and technical data.

Continuation of technical data rights during challenges. Requirement for negotiation of technical data price before sustainment of major weapon systems. Implementation of pilot program to use agile or iterative development methods required under section of the National Defense Authorization Act for Fiscal Year Report on requiring access to digital technical data in future acquisitions of combat, combat service, and combat support systems.

Subtitle H—Other Matters Sec. Prohibition on acquisition of sensitive materials from non-allied foreign nations. Extension of prohibition on providing funds to the enemy. Data, policy, and reporting on the use of other transactions. Standardization of formatting and public accessibility of Department of Defense reports to Congress. Promotion of the use of Government-wide and other interagency contracts. Increasing competition at the task order level.

Individual acquisition for commercial leasing services. Procurement administrative lead time definition and plan. Briefing on funding of product support strategies. Use of lowest price technically acceptable source selection process. Review of market research. Establishment of integrated review team on defense acquisition industry-government exchange. Exchange program for acquisition workforce employees.

Process to limit foreign access to technology. Procurement of telecommunications supplies for experimental purposes. Access by developmental and operational testing activities to data regarding modeling and simulation activity. Instruction on pilot program regarding employment of persons with disabilities. Prohibition on certain telecommunications and video surveillance services or equipment. Pilot program to accelerate contracting and pricing processes. Report on allocation of former responsibilities of the Under Secretary of Defense for Acquisition, Technology, and Logistics.

Modification of responsibilities of the Under Secretary of Defense for Policy. Clarification of responsibilities and duties of the Chief Information Officer of the Department of Defense. Specification of certain duties of the Defense Technical Information Center.

Comprehensive review of operational and administrative chains-of-command and functions of the Department of the Navy. Modification of certain responsibilities of the Chairman of the Joint Chiefs of Staff relating to joint force concept development. Clarification of certain risk assessment requirements of the Chairman of the Joint Chiefs of Staff in connection with the National Military Strategy.

Qualifications for appointment as Deputy Chief Management Officer of a military department. Deadline for completion of full implementation of requirements in connection with organization of the Department of Defense for management of special operations forces and special operations. Cross-functional teams in the Department of Defense. Analysis of Department of Defense business management and operations datasets to promote savings and efficiencies. Actions to increase the efficiency and transparency of the Defense Logistics Agency.

Review and improvement of the operations of the Defense Finance and Accounting Service. Assessment of chief information officer functions in connection with transition to enterprise-wide management of information technology and computing. Limitation on availability of funds for major headquarters activities of the Department of Defense. Performance of civilian functions by military personnel.

Report on implementation of requirements on estimation and comparison of costs of civilian and military manpower and contract support for the Department of Defense. Review of foreign currency exchange rates and analysis of Foreign Currency Fluctuations, Defense appropriation. Responsibility for policy on civilian casualty matters. Additional matters in connection with background and security investigations for Department of Defense personnel.

Research and development to advance capabilities of the Department of Defense in data integration and advanced analytics in connection with personnel security.

Trusted information provider program for national security positions and positions of trust. Report on expedited processing of security clearances for mission-critical positions. Report on clearance in person concept.

Expertise in audit remediation. Audit of financial systems of the Department of Defense. Report on auditable financial statements. Transparency of accounting firms used to support Department of Defense audit.

Inclusion of operation and sustainment costs in annual naval vessel construction plans. Purchase of vessels using funds in National Defense Sealift Fund.

Purchase of vessels built in foreign shipyards with funds in National Defense Sealift Fund. Date of listing of vessels as battle force ships in the Naval Vessel Register and other fleet inventory measures.

Technical corrections and clarifications to chapter of title 10, United States Code, and other provisions of law regarding naval vessels. Dismantlement and disposal of nuclear-powered aircraft carriers. Limitation on use of funds for retirement of hospital ships. Inclusion of aircraft carrier refueling overhaul budget request in annual budget justification materials.

Business case analysis of Ready Reserve Force recapitalization options. Transfer of excess naval vessel to Bahrain. Definition of sensitive military operation. Prohibition on use of funds to construct or modify facilities in the United States to house detainees transferred from United States Naval Station, Guantanamo Bay, Cuba.

Prohibition on use of funds for transfer or release of individuals detained at United States Naval Station, Guantanamo Bay, Cuba, to certain countries. Strategic guidance documents within the Department of Defense. Notification on the provision of defense sensitive support. Coordinating United States response to malign foreign influence operations and campaigns. Clarification of reimbursable allowed costs of FAA memoranda of agreement.

Workforce issues for military realignments in the Pacific. Mitigation of operational risks posed to certain military aircraft by automatic dependent surveillance-broadcast equipment.

Limitation on availability of funds for unmanned surface vehicles. Pilot program for Department of Defense controlled unclassified information in the hands of industry. National Security Commission on Artificial Intelligence. Authority to transfer funds for Bien Hoa dioxin cleanup. Guidance on the electronic warfare mission area and joint electromagnetic spectrum operations. Subtitle E—Studies and Reports Sec. Improvement of annual report on civilian casualties in connection with United States military operations.

Report on capabilities and capacities of Armored Brigade Combat Teams. Comprehensive review of professionalism and ethics programs for special operations forces. Munitions assessments and future-years defense program requirements. Report on establishment of Army Futures Command. Report on cyber-enabled information operations. Report on unmanned aircraft in Arlington National Cemetery. Report on an updated Arctic strategy. Report on use and availability of military installations for disaster response.

Report on Department of Defense participation in Export Administration Regulations license application review process. Military aviation readiness review in support of the National Defense Strategy.

Report on highest-priority roles and missions of the Department of Defense and the Armed Forces. Subtitle F—Other Matters Sec. Technical, conforming, and clerical amendments. Modification of authority to transfer aircraft to other departments for wildfire suppression purposes.

Improvement of database on emergency response capabilities. Disclosure requirements for United States-based foreign media outlets. United States policy with respect to freedom of navigation and overflight. National Commission on Military Aviation Safety. Sense of Congress regarding the international borders of the United States. Policy on response to juvenile-on-juvenile problematic sexual behavior committed on military installations. Prohibition of funds for Chinese language instruction provided by a Confucius Institute.

Department of Defense engagement with certain nonprofit entities in support of missions of deployed United States personnel around the world. Direct hire authority for the Department of Defense for certain competitive service positions. Modification of direct hire authority for the Department of Defense for post-secondary students and recent graduates.

Extension of overtime rate authority for Department of the Navy employees performing work aboard or dockside in support of the nuclear-powered aircraft carrier forward deployed in Japan. One-year extension and expansion of authority to waive annual limitation on premium pay and aggregate limitation on pay for Federal civilian employees working overseas.

Extension of authority to conduct telework travel expenses test programs. Expanded flexibility in selecting candidates from referral lists. Expedited hiring authority for college graduates and post secondary students. Inapplicability of certification of executive qualifications by qualification review boards of Office of Personnel Management for initial appointments to Senior Executive Service positions in Department of Defense.

Engagement with Historically Black Colleges and Universities and minority-serving institutions for the purposes of technical workforce enhancement.

Inclusion of Strategic Capabilities Office and Defense Innovation Unit Experimental of the Department of Defense in personnel management authority to attract experts in science and engineering. Enhancement of flexible management authorities for science and technology reinvention laboratories of the Department of Defense. Inclusion of Office of Secretary of Defense among components of the Department of Defense covered by direct hire authority for financial management experts.

Alcohol testing of civil service mariners of the Military Sealift Command assigned to vessels. One-year extension of temporary authority to grant allowances, benefits, and gratuities to civilian personnel on official duty in a combat zone. Modification of authority to build the capacity of foreign security forces.

Clarification of authority for use of advisors and trainers for training of personnel of foreign ministries with security missions under defense institution capacity building authorities. Increase in cost limitation and additional notification required for small scale construction related to security cooperation. Technical corrections relating to defense security cooperation statutory reorganization. Review and report on processes and procedures used to carry out section of title 10, United States Code.

Report on the use of security cooperation authorities. Participation in and support of the Inter-American Defense College. Assessment, monitoring, and evaluation of security cooperation. Legal and policy review of advise, assist, and accompany missions. Extension and modification of authority to support border security operations of certain foreign countries.

Framework for obtaining concurrence for participation in activities of regional centers for security studies. Extension of authority to transfer defense articles and provide defense services to the military and security forces of Afghanistan. Extension and modification of reporting requirements for special immigrant visas for Afghan allies program.

Afghanistan Security Forces Fund. Extension and modification of authority for reimbursement of certain coalition nations for support provided to United States military operations.

Extension and modification of authority to provide assistance to the vetted Syrian opposition. Syrian war crimes accountability. Extension of authority to provide assistance to counter the Islamic State of Iraq and Syria.

Limitation on assistance to the Government of Iraq. Extension and modification of authority to support operations and activities of the Office of Security Cooperation in Iraq.

Modification of annual report on military power of Iran. Strategy to counter destabilizing activities of Iran. Prohibition on availability of funds relating to sovereignty of the Russian Federation over Crimea. Limitation on availability of funds relating to implementation of the Open Skies Treaty. Modification and extension of Ukraine Security Assistance Initiative. Extension of limitation on military cooperation between the United States and the Russian Federation.

Sense of Congress on enhancing deterrence against Russian aggression in Europe. Redesignation and modification of sense of Congress and initiative for the Indo-Asia-Pacific region. Assessment of and report on geopolitical conditions in the Indo-Pacific region. Sense of Congress on extended nuclear deterrence in the Indo-Pacific region.

Reinstatement of reporting requirements with respect to United States-Hong Kong relations. Sense of Congress on Taiwan.

United States strategy on China. Limitation on use of funds to reduce the total number of members of the Armed Forces serving on active duty who are deployed to the Republic of Korea. Modification of report required under enhancing defense and security cooperation with India. Subtitle F—Reports and other matters Sec.

Modification of authorities relating to acquisition and cross-servicing agreements. United States-Israel countering unmanned aerial systems cooperation. Review to determine whether the Armed Forces or coalition partners of the United States violated Federal law or Department of Defense policy while conducting operations in Yemen. Report on United States Government security cooperation and assistance programs with Mexico.

Report on Department of Defense missions, operations, and activities in Niger. Report on the security relationship between the United States and the Republic of Cyprus. Report on permanent stationing of United States forces in the Republic of Poland. Report on strengthening NATO cyber defense. Report on status of the United States relationship with the Republic of Turkey. Sense of the Congress concerning military-to-military dialogues. Modifications to Global Engagement Center.

Sense of Congress on countering hybrid threats and malign influence. Initiative to support protection of national security academic researchers from undue influence and other security threats. Report on Honduras, Guatemala, and El Salvador. Modification of freedom of navigation reporting requirements. Coordination of efforts to negotiate free trade agreements with certain sub-Saharan African countries. Limitation on availability of funds to implement the Arms Trade Treaty.

Prohibition on provision of weapons and other forms of support to certain organizations. Rule of construction relating to the use of force. Specification of cooperative threat reduction funds. Chemical agents and munitions destruction, defense. Drug interdiction and counter-drug activities, defense-wide. Subtitle B—Armed forces retirement home Sec. Authorization of appropriations for Armed Forces Retirement Home. Expansion of eligibility for residence at the Armed Forces Retirement Home.

Oversight of health care provided to residents of the Armed Forces Retirement Home. Modification of authority on acceptance of gifts for the Armed Forces Retirement Home. Relief for residents of the Armed Forces Retirement Home impacted by increase in fees. Limitation on applicability of fee increase for residents of the Armed Forces Retirement Home. Subtitle C—Other matters Sec.

Lovell Health Care Center, Illinois. Economical and efficient operation of working capital fund activities. Quarterly briefing on progress of chemical demilitarization program. Research, development, test, and evaluation. Subtitle B—Financial matters Sec. Treatment as additional authorizations. Joint Improvised-Threat Defeat Organization. Enduring costs funded through overseas contingency operations. Comptroller General report on use of funds provided by overseas contingency operations.

Improvements to acquisition system, personnel, and organization of space forces. Modifications to Space Rapid Capabilities Office.

Rapid, responsive, and reliable space launch. Provision of space situational awareness services and information. Budget assessments for national security space programs. Improvements to commercial space launch operations.

Space warfighting policy, review of space capabilities, and plan on space warfighting readiness. Use of small- and medium-size buses for strategic and tactical satellite payloads. Enhancement of positioning, navigation, and timing capacity. Designation of component of Department of Defense responsible for coordination of modernization efforts relating to military-code capable GPS receiver cards.

Designation of component of Department of Defense responsible for coordination of hosted payload information. Limitation on availability of funds for Joint Space Operations Center mission system. Evaluation and enhanced security of supply chain for protected satellite communications programs and overhead persistent infrared systems. Report on protected satellite communications.

Report on persistent weather imagery for United States Central Command. Study on space-based radio frequency mapping. Independent study on space launch locations. Briefing on commercial satellite servicing capabilities. Role of Under Secretary of Defense for Intelligence.

Security vetting for foreign nationals. Department of Defense Counterintelligence polygraph program. Defense intelligence business management systems. Modification to annual briefing on the intelligence, surveillance, and reconnaissance requirements of the combatant commands. Framework on governance, mission management, resourcing, and effective oversight of combat support agencies that are also elements of the intelligence community.

Reorganization and consolidation of certain cyber provisions. Affirming the authority of the Secretary of Defense to conduct military activities and operations in cyberspace. Department of Defense Cyber Scholarship Program scholarships and grants.

Amendments to pilot program regarding cyber vulnerabilities of Department of Defense critical infrastructure. Policy of the United States on cyberspace, cybersecurity, cyber warfare, and cyber deterrence. Budget display for cyber vulnerability evaluations and mitigation activities for major weapon systems of the Department of Defense. Determination of responsibility for the Department of Defense Information Networks. Procedures and reporting requirement on cybersecurity breaches and loss of personally identifiable information and controlled unclassified information.

Program to establish cyber institutes at institutions of higher learning. Matters pertaining to the SharkSeer cybersecurity program. Designation of official for matters relating to integrating cybersecurity and industrial control systems within the Department of Defense. Assistance for small manufacturers in the defense industrial supply chain and universities on matters relating to cybersecurity. Email and Internet website security and authentication.

Nutrition Landscape Information System (NLiS)