Presidential Advisory Research Articles

Addressing the Gap in Physician Preparedness To Assess Cardiovascular Risk in Women: a Comprehensive Approach to Cardiovascular Risk Assessment in Women.

Increased recognition of risk factors and improved knowledge of sex-specific presentations has led to improved clinical outcomes for women with cardiovascular disease (CVD) compared to two decades ago. Yet, CVD remains the leading cause of death for women in the USA. Women have unique risk factors for CVD that continue to go under-recognized by their physicians. In a nationwide survey of primary care physicians (PCPs) and cardiologists, only 22% of PCPs and 42% of cardiologists reported being extremely well prepared to assess CVD risk in women. A presidential advisory from the American Heart Association (AHA) and American College of Obstetrics and Gynecologist (ACOG) recommends that cardiologists and obstetricians and gynecologists (Ob/Gyns) collaborate to promote CVD risk identification and reduction throughout a woman's lifetime. We suggest a comprehensive approach to identify unique and traditional risk factors for CVD in women, address the gap in physician knowledge, and improve cardiovascular care for women.

New and Emerging Tobacco Products and the Nicotine Endgame: The Role of Robust Regulation and Comprehensive Tobacco Control and Prevention: A Presidential Advisory From the American Heart Association.

The advent of new tobacco products such as electronic cigarettes and the dramatic rise in their use, especially by adolescents and young adults, are significant public health concerns. Electronic cigarettes have become the most popular tobacco products for youth and adolescents in the United States and are attracting youth to new avenues for nicotine addiction. Although these products may have benefit by helping some smokers quit or to move to a less harmful product, the long-term health effects of these products and the net public health effect associated with their use remain unclear and widely debated. There is increasing concern that the use of newer tobacco products may catalyze transition to the use of other tobacco products or recreational drugs, particularly in young adults. Therefore, there is urgent need for robust US Food and Drug Administration regulation of all tobacco products to avoid the significant economic and population health consequences of continued tobacco use. Although the American Heart Association acknowledges that the ultimate endgame would be an end to all tobacco and nicotine addiction in the United States, it supports first minimizing the use of all combustible tobacco products while ensuring that other products do not addict the next generation of youth and adolescents. The endgame strategy needs to be coordinated with the long-standing, evidence-based tobacco control strategies that have significantly reduced tobacco use and initiation in the United States.

Call to Action: Urgent Challenges in Cardiovascular Disease: A Presidential Advisory From the American Heart Association.

Although advances in care have spurred improvements in cardiovascular outcomes, cardiovascular disease remains the leading cause of death in the United States and around the world. Previous declines in cardiovascular disease mortality have slowed and even reversed for certain demographics. Further concerns exist with regard to cardiovascular drug innovation, quality of care, and healthcare costs. The Value in Healthcare Initiative-Transforming Cardiovascular Care, a collaboration of the American Heart Association and Duke University, Robert J. Margolis, MD, Center for Health Policy, aims to increase access to and affordability of cardiovascular treatment and to decrease barriers to care. The following Call to Action describes trends in cardiovascular care, identifies gaps in areas of cardiovascular disease prevention and treatment, highlights challenges with medical product innovation, and finally, outlines a series of learning collaboratives that will aid in the development of road maps for transforming cardiovascular care.

Cardiolipotoxicity, Inflammation, and Arrhythmias: Role for Interleukin-6 Molecular Mechanisms.

Fatty acid infiltration of the myocardium, acquired in metabolic disorders (obesity, type-2 diabetes, insulin resistance, and hyperglycemia) is critically associated with the development of lipotoxic cardiomyopathy. According to a recent Presidential Advisory from the American Heart Association published in 2017, the current average dietary intake of saturated free-fatty acid (SFFA) in the US is 11–12%, which is significantly above the recommended <10%. Increased levels of circulating SFFAs (or lipotoxicity) may represent an unappreciated link that underlies increased vulnerability to cardiac dysfunction. Thus, an important objective is to identify novel targets that will inform pharmacological and genetic interventions for cardiomyopathies acquired through excessive consumption of diets rich in SFFAs. However, the molecular mechanisms involved are poorly understood. The increasing epidemic of metabolic disorders strongly implies an undeniable and critical need to further investigate SFFA mechanisms. A rapidly emerging and promising target for modulation by lipotoxicity is cytokine secretion and activation of pro-inflammatory signaling pathways. This objective can be advanced through fundamental mechanisms of cardiac electrical remodeling. In this review, we discuss cardiac ion channel modulation by SFFAs. We further highlight the contribution of downstream signaling pathways involving toll-like receptors and pathological increases in pro-inflammatory cytokines. Our expectation is that if we understand pathological remodeling of major cardiac ion channels from a perspective of lipotoxicity and inflammation, we may be able to develop safer and more effective therapies that will be beneficial to patients.

A Study on the Directions for Policy Deliberation of Presidential Advisory Council on Science and Technology(S&amp;T): Approach to the Analysis of the Deliberation Trends of Agendas Related National S&amp;T

A Study on the Directions for Policy Deliberation of Presidential Advisory Council on Science and Technology(S&amp;T): Approach to the Analysis of the Deliberation Trends of Agendas Related National S&amp;T

Promoting Risk Identification and Reduction of Cardiovascular Disease in Women Through Collaboration With Obstetricians and Gynecologists: A Presidential Advisory From the American Heart Association and the American College of Obstetricians and Gynecologists

(Abstracted from Circulation 2018;137(24):e843–e852) Many traditional atherosclerotic cardiovascular disease (ASCVD) risk factors, such as hypertension, diabetes mellitus, hypercholesterolemia, and obesity, may affect women more than men and in many cases more severely. Cardiovascular mortality is greater in women than in men.

ω-6 Polyunsaturated Fatty Acids and Cardiometabolic Health: Current Evidence, Controversies, and Research Gaps.

ABSTRACTThe 2015 Dietary Guidelines for Americans recommend limiting the intake of saturated fatty acids (SFAs) to <10% of energy/d and replacing dietary SFAs with unsaturated fatty acids. A Presidential Advisory from the American Heart Association recently released its evaluation of the relation between dietary fats and cardiovascular disease (CVD), and also recommended a shift from SFAs to unsaturated fatty acids, especially polyunsaturated fatty acids (PUFAs), in conjunction with a healthy dietary pattern. However, the suggestion to increase the intake of PUFAs in general, and omega-6 (n–6) PUFAs in particular, continues to be controversial. This review was undertaken to provide an overview of the evidence and controversies regarding the effects of ω-6 PUFAs on cardiometabolic health, with emphasis on risks and risk factors for CVD (coronary heart disease and stroke) and type 2 diabetes mellitus (T2D). Results from observational studies show that higher intake of ω-6 PUFAs, when compared with SFAs or carbohydrate, is associated with lower risks for CVD events (10–30%), CVD and total mortality (10–40%), and T2D (20–50%). Findings from intervention studies on cardiometabolic risk factors suggest that ω-6 PUFAs reduce concentrations of LDL cholesterol and non-HDL cholesterol in a dose-dependent manner compared with dietary carbohydrate, and have a neutral effect on blood pressure. Despite the concern that ω-6 fatty acids increase inflammation, current evidence from studies in humans does not support this view. In conclusion, these findings support current recommendations to emphasize consumption of ω-6 PUFAs as a replacement of SFAs; additional randomized controlled trials with cardiometabolic disease outcomes will help to more clearly define the benefits and risks of this policy.

Redes de políticas públicas de familia: Una propuesta analítica desde Pierre Bourdieu

La comparación entre el análisis tradicional de redes de políticas públicas (RPP) con algunos de los elementos del entramado teórico-metodológico que Pierre Bourdieu desarrolló para el estudio de los campos sociales, permitió formular una propuesta de análisis complementaria al enfoque con el cual se estudia habitualmente este tipo de redes. Se desarrolla dicha propuesta de análisis tomando como caso de estudio el trabajo que durante el año 2010 realizó la Comisión Asesora Presidencial “Mujer,Trabajo y Maternidad”,constituida en Chile por el Presidente Sebastián Piñera mediante decreto.Mientras el análisis tradicional de RPP pone el acento en la interacción generada entre los distintos actores (acuerdos, cooperación, solidaridad) y los recursos que circulan en ella (conocimiento, información, dinero), la propuesta teórica de Pierre Bourdieu centra su análisis en la estructura que subyace a la interacción, y que opera de una manera permanente e invisible. Para que esta estructura emerja, se hace necesario el estudio de la distribución de las distintas formas de capital que poseen los agentes que participan en una red y que configuran un campo que es reproducido o reestructurado por las prácticas sociales que genera el habitus.La perspectiva de análisis que proporcionan las nociones teóricas de campo, agente, capital y habitus, sumado a la capacidad del Análisis de Correspon129dencias Múltiples (ACM) para hacer emerger la estructura social que subyace a la interacción, busca contribuir a una mayor y mejor comprensión de las RPP como nueva forma de coordinación entre el Estado y la sociedad civil, y a la superación de las deficiencias del análisis tradicional de RPP.

Promoting Risk Identification and Reduction of Cardiovascular Disease in Women Through Collaboration With Obstetricians and Gynecologists: A Presidential Advisory From the American Heart Association and the American College of Obstetricians and Gynecologists.

In 2001, the Institute of Medicine (now known as the National Academy of Science) published a seminal monograph, Exploring the Biological Contributions to Human Health: Does Sex Matter ?,1 describing the importance of both sex and gender on human biology and physiology. Gender-specific medicine, which recognizes gender differences and similarities in cardiovascular disease recognition, prevention, and management, has exerted a powerful salutatory effect on women. Significant improvement in mortality and morbidity rates in women have been seen over the past 2 decades, in part as a result of initiatives such as the American Heart Association’s (AHA’s) Go Red For Women movement. Go Red For Women initially focused on raising awareness of heart disease as the No. 1 killer of women. This campaign expanded gender-focused research and the development of gender-based guidelines that led to a significant reduction in the rates of death among women. Despite these advances, gender-based inequalities continue, with women being less likely to receive guideline-recommended diagnostic testing and therapies. Furthermore, despite the above-stated declines in mortality, more recently there has been an increase in mortality rates in women.2 Despite significant efforts to raise awareness about heart disease, the most recent data show that only 45% of women identify heart disease as their leading cause of death and that fewer than half of primary care physicians consider cardiovascular disease to be a top concern in women, after breast health and weight.3 A majority of women consider their obstetrician/gynecologist (OB/GYN) to be their primary care physician, particularly women during their childbearing years, and we know that many of the life-span milestones for women impart unique effects on cardiovascular health, particularly pregnancy and menopause. Shaw et al4 use the term healthcare team for women to describe the importance of collaboration among clinicians who care for women …

«Домініканський проект» в історії американської політики допомоги європейським біженцям (кінець 1930-х – початок 1940-х років).

The article analyzes one of the episodes of the international response to the situation with German refugees which arose in the late 1930s. Representatives of the delegation during the negotiations at the Eivan Conference in 1938 declared the country's readiness to host one hundred thousand forced migrants from Central Europe. This proposal was of interest to the Intergovernmental Committee on Refugees and the American Presidential Advisory Committee on Political Refugees. The purpose of the article is to investigate the practical implementation of the humanitarian initiative of the Republic on the establishment of an agrarian colony for Jewish escapees from Nazi persecution. During the research and preparation of the given article general scientific (of systematic analysis) and special historical (historical-systematic, historicaldescriptive, historical-comparative, periodization) methods of scientific systematization and analysis were used. It should also be noted that the article is based on the scientific principles, systemicity and historicism.The results of the paper can be significant for specialists in conducting studies on the world history of the mid-twentieth century, as well as for the development and teaching of normative and special courses on contemporary history of the USA and the history of Latin America. Prospects for further research should be linked to the study of the impact of the Dominican project on the implementation of American assistance policies in other countries of the region.

The Warning on Saturated Fat: From Defective Experiments to Defective Guidelines

Coconut oil has been adversely affected by the current dietary guidelines that advocate a lowering of total fat and the replacement of saturated fat with polyunsaturated fat. This recommendation has its origins in the saturated fat-cholesterol-heart disease hypothesis that Ancel Keys first proposed in 1957. This hypothesis became an official recommendation with the publication of the Dietary Guidelines for Americans in 1980 and has been adopted by many other countries and international agencies. The dietary recommendations also warn against coconut oil. Recently, the American Heart Association re-issued this warning in its 2017 Presidential Advisory. However, a critical review of the experiments that Keys conducted has revealed experimental errors and biases that cast serious doubt on the correctness of his hypothesis and the warnings against coconut oil. Further, the recommendation to decrease saturated fat recommendation effectively means an increase in unsaturated fat in the diet. The actual result has been an increase in omega-6 fats and a high omega-6 to omega-3 fat ratio. This unhealthy ratio has been linked to heart disease, the very disease that the AHA wants to target, as well as cancer and inflammatory diseases. Defective experiments have led to defective guidelines. This first paper in this series of papers will present these errors and biases and address the points raised by the AHA.

A Half-Truth is Not the Whole Truth: The AHA Position on Saturated Fat

This second in this series of papers will present the biases in the American Heart Association’s 2017 Presidential Advisory with respect to saturated fat. Although important differences in the metabolic properties of specific SFA have been known since the 1960s, the AHA still considers all SFA as one group having the same properties. There is abundant research available that supports the designation of C6 to C12 fatty acids as medium-chain fatty acids (MCFA). This is particularly relevant to coconut oil, which is made up of about 65% MCFA. Ignoring the evidence, AHA simply labels coconut oil as SFA. The AHA promotes half-truths, not the whole truth.

Defining Optimal Brain Health in Adults: A Presidential Advisory From the American Heart Association/American Stroke Association.

Cognitive function is an important component of aging and predicts quality of life, functional independence, and risk of institutionalization. Advances in our understanding of the role of cardiovascular risks have shown them to be closely associated with cognitive impairment and dementia. Because many cardiovascular risks are modifiable, it may be possible to maintain brain health and to prevent dementia in later life. The purpose of this American Heart Association (AHA)/American Stroke Association presidential advisory is to provide an initial definition of optimal brain health in adults and guidance on how to maintain brain health. We identify metrics to define optimal brain health in adults based on inclusion of factors that could be measured, monitored, and modified. From these practical considerations, we identified 7 metrics to define optimal brain health in adults that originated from AHA's Life's Simple 7: 4 ideal health behaviors (nonsmoking, physical activity at goal levels, healthy diet consistent with current guideline levels, and body mass index <25 kg/m2) and 3 ideal health factors (untreated blood pressure <120/<80 mm Hg, untreated total cholesterol <200 mg/dL, and fasting blood glucose <100 mg/dL). In addition, in relation to maintenance of cognitive health, we recommend following previously published guidance from the AHA/American Stroke Association, Institute of Medicine, and Alzheimer's Association that incorporates control of cardiovascular risks and suggest social engagement and other related strategies. We define optimal brain health but recognize that the truly ideal circumstance may be uncommon because there is a continuum of brain health as demonstrated by AHA's Life's Simple 7. Therefore, there is opportunity to improve brain health through primordial prevention and other interventions. Furthermore, although cardiovascular risks align well with brain health, we acknowledge that other factors differing from those related to cardiovascular health may drive cognitive health. Defining optimal brain health in adults and its maintenance is consistent with the AHA's Strategic Impact Goal to improve cardiovascular health of all Americans by 20% and to reduce deaths resulting from cardiovascular disease and stroke by 20% by the year 2020. This work in defining optimal brain health in adults serves to provide the AHA/American Stroke Association with a foundation for a new strategic direction going forward in cardiovascular health promotion and disease prevention.

Correction to: Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association.

HomeCirculationVol. 136, No. 10Correction to: Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association Free AccessCorrectionPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCorrectionPDF/EPUBCorrection to: Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association Originally published5 Sep 2017https://doi.org/10.1161/CIR.0000000000000529Circulation. 2017;136:e195This article corrects the followingDietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart AssociationIn the article by Sacks et al, “Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association,” which published ahead of print June 15, 2017, and appeared in the July 18, 2017, issue of the journal (Circulation. 2017;136:e1–e23. DOI: 10.1161/CIR.0000000000000510), several corrections were needed.1. On page e18, in the Writing Group Disclosures table, the employment for Jason H.Y. Wu read, “University of Sydney/George Institute for Global Health.” It has been updated to read, “The George Institute for Global Health, the University of New South Wales.”2. On page e18, in the Writing Group Disclosures table, for Jason H.Y. Wu, under “Other Research Support,” the entry read “None.” It has been updated to read, “Unilever†.”These corrections have been made to the current online version of the article, which is available at http://circ.ahajournals.org/content/136/3/e1.FootnotesCirculation is available at http://circ.ahajournals.org. Previous Back to top Next FiguresReferencesRelatedDetailsCited By Kiczorowska B, Samolińska W, Klebaniuk R and Szczygielska M (2019) Fats in women’s diet and everyday life, Polish Journal of Public Health, 10.2478/pjph-2018-0030, 128:4, (152-155), Online publication date: 1-Dec-2018., Online publication date: 1-Dec-2018. Cucuzzella M, Tondt J, Dockter N, Saslow L and Wood T (2017) A low-carbohydrate survey: Evidence for sustainable metabolic syndrome reversal, Journal of Insulin Resistance, 10.4102/jir.v2i1.30, 1:1 Related articlesDietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart AssociationFrank M. Sacks, et al. Circulation. 2017;136:e1-e23 September 5, 2017Vol 136, Issue 10 Advertisement Article InformationMetrics © 2017 American Heart Association, Inc.https://doi.org/10.1161/CIR.0000000000000529PMID: 28874427 Originally publishedSeptember 5, 2017 PDF download Advertisement

International Conference on Green and Renewable Energy Resources (ICGRER 2016)

PrefaceThe International Conference on Green and Renewable Energy (ICGRER 2016) was held November 14-15th, 2016 at Solo Paragon Hotel, Surakarta, Central Java, Indonesia. This conference is organized by Faculty of Mathematics & Natural Science, Sebelas Maret University.The scope of parallel classes are solar energy/solar cells, biomass and bio energy, and miscellaneous product. There are 60 presenters were presented and discussed in plenary and parallel session, therefore, a total 28 manuscripts have been peer reviewed with good quality.We are pleased to have Prof. Dr. Sri Adiningsih, M.Sc., Ph.D (Chairman of the Presidential Advisory Council) as our outstanding keynote speaker. We also glad ti have our invited speakers Prof. Renate Egan (University of New South Wales Australian PV Institute, Solinno Pty, Ltd), Dr. Adhi Wibowo (Direktur PPTEK R&D EBTKE Kementerian ESDM), Ir. Hj. Sripeni Inten Chayani, M (President Director PT. Indonesia Power), Prof. Dr. Ir. Kamaruddin Abdullah (Universitas Darma Persada), and William Papet (Business Development at MPS Consortium).We express our gratitude to participants from all researchers and students for join this conference. We also appreciate for sponsors, reviewers, and all member of the organizing committee which prepare this conference. Our gratitude also goes to the IOP Publisher for cooperation in prepare this proceeding. We do realize that the success of the conference depends on both participants and who have worked with us.Prof. Ari Handono RamelanChairman of ICGRER 2016Dean of Faculty Mathematics & Natural Sciences

Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association.

Cardiovascular disease (CVD) is the leading global cause of death, accounting for 17.3 million deaths per year. Preventive treatment that reduces CVD by even a small percentage can substantially reduce, nationally and globally, the number of people who develop CVD and the costs of caring for them. This American Heart Association presidential advisory on dietary fats and CVD reviews and discusses the scientific evidence, including the most recent studies, on the effects of dietary saturated fat intake and its replacement by other types of fats and carbohydrates on CVD. In summary, randomized controlled trials that lowered intake of dietary saturated fat and replaced it with polyunsaturated vegetable oil reduced CVD by ≈30%, similar to the reduction achieved by statin treatment. Prospective observational studies in many populations showed that lower intake of saturated fat coupled with higher intake of polyunsaturated and monounsaturated fat is associated with lower rates of CVD and of other major causes of death and all-cause mortality. In contrast, replacement of saturated fat with mostly refined carbohydrates and sugars is not associated with lower rates of CVD and did not reduce CVD in clinical trials. Replacement of saturated with unsaturated fats lowers low-density lipoprotein cholesterol, a cause of atherosclerosis, linking biological evidence with incidence of CVD in populations and in clinical trials. Taking into consideration the totality of the scientific evidence, satisfying rigorous criteria for causality, we conclude strongly that lowering intake of saturated fat and replacing it with unsaturated fats, especially polyunsaturated fats, will lower the incidence of CVD. This recommended shift from saturated to unsaturated fats should occur simultaneously in an overall healthful dietary pattern such as DASH (Dietary Approaches to Stop Hypertension) or the Mediterranean diet as emphasized by the 2013 American Heart Association/American College of Cardiology lifestyle guidelines and the 2015 to 2020 Dietary Guidelines for Americans.

American College of Cardiology and American Heart Association: Setting a New Standard for Hospital Accreditation-Together.

In today’s healthcare environment, terms such as value-based, transparent, efficient, evidence-based, accountable, and cost-effective are used frequently when talking about new care delivery models and models of physician and hospital reimbursement. Within the context of this environment, accreditation is increasingly being looked to as a means of helping hospitals and physicians successfully prepare for and participate in these new models. “Organizations that participate in accreditation confirm their commitment to quality improvement, risk mitigation, patient safety, improved efficiency, and accountability; it sends a powerful message to key decision-makers and the public. This performance measure contributes to the sustainability of the health care system,” wrote Wendy Nicklin, president and chief executive officer of Accreditation Canada, in an updated 2015 review of scholarly papers related to hospital accreditation.1 In a 2010 Presidential Advisory, the American Heart Association (AHA) identified the need, opportunity, and responsibility for the cardiovascular community to provide greater leadership in the design, development, and offering of accreditation services with the potential to provide clinical care. As stated in …

Is the Presidential Advisory Council on Combating Antibiotic Resistance missing opportunities?

Is the Presidential Advisory Council on Combating Antibiotic Resistance missing opportunities?

ANALISIS KRITIS UU NOMOR 19 TAHUN 2006 TENTANG DEWAN PERTIMBANGAN PRESIDEN

President as the state organizer can establish a state institution which can give the president advice, although the institution is not in the state government. The amendment of Constitution of 1945 has eliminated Supreme Advisory Council, which was the permanent state institution. In the state governance practice there is Presidential Advisory Council. This institution is not set in the Constitution of 1945 (called as non-permanent state institution). The existence of this institution become problematic. It is due to the fact that non-permanent institution is the same as the permanent one.

New Societal Approaches to Empowering Antibiotic Stewardship.

Substantial concern regarding the ever-worsening crisis of antibiotic resistance has been raised by the World Health Organization, US Centers for Disease Control and Prevention (CDC), European Centre for Disease Prevention and Control, European Medicines Agency, Institute of Medicine, World Economic Forum, and the US Presidential Advisory Council on Science and Technology. The question is no longer whether to act, but how. Antibiotic stewardship is the term used to describe efforts to optimize selection of antibiotic therapy. Formal antibiotic stewardship programs are essential to help society address antimicrobial resistance by reducing the estimated more than 50% of antibiotic use that is unnecessary or inappropriate.1 The US government has recently emphasized the need for implementation of antibiotic stewardship programs at all hospitals.2 To be effective, antibiotic stewardship programs must incorporate best practices, which include dedicating sufficient resources to the program, appointing a single leader to be accountable for performance, having appropriate antibiotic expertise, implementing action plans, monitoring bacterial resistance, reporting antibiotic usage to staff, and providing education