The National Dialogue on the Quadrennial Homeland Security Review

Six years after its creation, the Department of Homeland Security (DHS) undertook the first Quadrennial Homeland Security Review (QHSR) to inform the design and implementation of actions to ensure the safety of the United States and its citizens. This review, mandated by the Implementing the 9/11 Commission Recommendations Act of 2007, represents the first comprehensive examination of the homeland security strategy of the nation. The QHSR includes recommendations addressing the long-term strategy and priorities of the nation for homeland security and guidance on the programs, assets, capabilities, budget, policies, and authorities of the department.Rather than set policy internally and implement it in a top-down fashion, DHS undertook the QHSR in a new and innovative way by engaging tens of thousands of stakeholders and soliciting their ideas and comments at the outset of the process. Through a series of three-week-long, web-based discussions, stakeholders reviewed materials developed by DHS study groups, submitted and discussed their own ideas and priorities, and rated or "tagged" others' feedback to surface the most relevant ideas and important themes deserving further consideration.Key FindingsThe recommendations included: (1) DHS should enhance its capacity for coordinating stakeholder engagement and consultation efforts across its component agencies, (2) DHS and other agencies should create special procurement and contracting guidance for acquisitions that involve creating or hosting such web-based engagement platforms as the National Dialogue, and (3) DHS should begin future stakeholder engagements by crafting quantitative metrics or indicators to measure such outcomes as transparency, community-building, and capacity

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

Developing and Sustaining Police–researcher Partnerships

Abstract Developing and sustaining partnerships between the police and researchers has long been a challenge. There have been national federal grant programmes aimed at developing these partnerships and they have been helpful. In most cases, the partnerships lapsed when the funds are expended. Nevertheless, progress has been made over the years and there are examples of police–researcher partnerships but relatively few are sustained long-term relationships. These partnerships have become increasingly important as community advocates make demands for police reforms; many of which are not evidence based. This article identifies and discusses some of the challenges the police face and various reform proposals. It also identifies several long-term successful partnerships and includes a more detailed description of two of them—University of Cincinnati/Cincinnati Police and Arizona State University/Phoenix Police. The article discusses the author’s experience with police–researcher partnerships as a police chief and researcher over his 53-year career in policing. Finally, the article encourages police and researchers to think more deeply about three areas: funding, community engagement, and communications strategy. Funding is fundamental to sustaining the partnerships and supporting them without a total reliance on external resources is crucial. Transparency has become an essential part of establishing public trust and researchers must begin engaging the community in the process. Finally, a communications strategy as a part of the study would enhance the understanding of findings and reinforce the value of investing in research.</jats:p

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of −18%. There were no significant betweengroup differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo.</p