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

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 between-group 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. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)