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A return to principled realism
Joined by Vice President Mike Pence and members of the Cabinet, President Donald J. Trump formally unveiled his Administration’s National Security Strategy (NSS) at the Ronald Reagan Building and International Trade Center yesterday.

This NSS is an expression of the President’s belief that putting America first is the key to renewing confidence in our leadership. “Our new strategy is based on a principled realism, guided by our vital national interests, and rooted in our timeless values,” President Trump said. “Whether we like it or not, we are engaged in a new era of competition.”

Those vital national interests take four specific forms:

1. Protect the homeland, the American people, and the American way of life

2. Promote American prosperity

3. Preserve peace through strength

4. Advance American influence

At 65 pages, the NSS will serve as the foundation for more granular security plans, including the National Counterterrorism Strategy, the Nuclear Posture Review, and the Ballistic Missile Defense Review.

Read: A New National Security Strategy for a New Era


‘Base it on love of our country’
Last week, as Americans went about preparing for the Christmas season, they were jarred by a sight seldom witnessed in a U.S. city: a terrorist exploding a pipe bomb on a busy subway passage.

The suspect arrived through chain migration, an outdated entry system for immigrants based on family ties rather than any merit-driven criteria. In addition to undermining national security, chain migration tends to cause more lower-skilled immigration, which puts greater strain on federal welfare.

“It is time to create a merit-based immigration system that makes sense for a modern economy,” President Trump said. “Base it on love of our country. We want people that come in, that can love our country.”

Watch—or read—the President’s Weekly Address on chain migration here.

Bonus: 15 graphics show why it’s time to replace chain migration with a merit-based system


Six days and counting

As we count down to Christmas next week, Second Lady Karen Pence offers a glimpse of her and Vice President Mike Pence’s favorite tree this holiday season—one adorned with red, white, and blue ornaments made by children of U.S. military families.

“We honor military service members and their families,” the Second Lady said. “We appreciate the sacrifices you make to protect our freedoms, especially around this time of year.”

Watch the Second Lady’s video here.
PHOTO OF THE DAY

President Donald J. Trump delivers remarks regarding the Administration’s National Security Strategy | December 18, 2017 (Official White House Photo by Joyce N. Boghosian)
POTUS TODAY

President Trump will meet with Secretary of Defense James Mattis. Vice President Pence will participate in the Senate Republican Policy lunch, followed by a series of meetings with lawmakers at the U. S. Capitol.

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GSA Announces New, Consolidated Lease Agreement for Pension Benefit Guaranty Corporation (PBGC) 12/31/2017 12:12 PM EST December 19, 2017New 15-year lease will consolidate three PBGC locations, reduce footprint and reduce annual lease cost by $4.5 millionWashington, D.C. - The U.S. General Services Administration (GSA) MedWatch - The FDA Safety Information and Adverse Event Reporting Program Gadolinium-based Contrast Agents (GBCAs): Drug Safety Communication - Retained in Body; New Class Warnings AUDIENCE: Radiology, Health Care Professional, Patient ISSUE: FDA is requiring a new class warning and other safety measures for all gadolinium-based contrast agents (GBCAs) for magnetic resonance imaging (MRI) concerning gadolinium remaining in patients’ bodies, including the brain, for months to years after receiving these drugs. Gadolinium retention has not been directly linked to adverse health effects in patients with normal kidney function, and FDA has concluded that the benefit of all approved GBCAs continues to outweigh any potential risks. However, after additional review and consultation with the Medical Imaging Drugs Advisory Committee, FDA is requiring several actions to alert health care professionals and patients about gadolinium retention after an MRI using a GBCA, and actions that can help minimize problems. These include requiring a new patient Medication Guide, providing educational information that every patient will be asked to read before receiving a GBCA. FDA is also requiring manufacturers of GBCAs to conduct human and animal studies to further assess the safety of these contrast agents.  To date, the only known adverse health effect related to gadolinium retention is a rare condition called nephrogenic systemic fibrosis (NSF) that occurs in a small subgroup of patients with pre-existing kidney failure. FDA received reports of adverse events involving multiple organ systems in patients with normal kidney function. A causal association between these adverse events and gadolinium retention could not be established. BACKGROUND: This is an update to the May 22, 2017 MedWatch safety alert "Gadolinium-based Contrast Agents for Magnetic Resonance Imaging (MRI): Drug Safety Communication - No Harmful Effects Identified With Brain Retention". GBCAs are used with medical imaging devices called MRI scanners to examine the body for problems such as cancer, infections, or bleeding. GBCAs contain gadolinium, a heavy metal. These contrast agents are injected into a vein to improve visualization of internal organs, blood vessels, and tissues during an MRI, which helps health care professionals diagnose medical conditions. After being administered, GBCAs are mostly eliminated from the body through the kidneys. However, trace amounts of gadolinium may stay in the body long-term. Many GBCAs have been on the market for more than a decade. There are two types of GBCAs based on their chemical structures: linear and macrocyclic (see Table 1 in Drug Safety Communication). Linear GBCAs result in more retention and retention for a longer time than macrocyclic GBCAs. Gadolinium levels remaining in the body are higher after administration of Omniscan (gadodiamide) or OptiMARK (gadoversetamide) than after Eovist (gadoxetate disodium), Magnevist (gadopentetate dimeglumine), or MultiHance (gadobenate dimeglumine). Gadolinium levels in the body are lowest after administration of Dotarem (gadoterate meglumine), Gadavist (gadobutrol), and ProHance (gadoteridol); the gadolinium levels are also similar across these agents.  RECOMMENDATION: Health care professionals should consider the retention characteristics of each agent when choosing a GBCA for patients who may be at higher risk for gadolinium retention (see Table 1 listing GBCAs). These patients include those requiring multiple lifetime doses, pregnant women, children, and patients with inflammatory conditions. Minimize repeated GBCA imaging studies when possible, particularly closely spaced MRI studies. However, do not avoid or defer necessary GBCA MRI scans. Patients, parents, and caregivers should carefully read the new patient Medication Guide that will be given to you before receiving a GBCA. The Medication Guide explains the risks associated with GBCAs. Also tell your health care professional about all your medical conditions, including: If you are pregnant or think you might be pregnant The date of your last MRI with gadolinium and if you have had repeat scans with gadolinium If you have kidney problems Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program: Complete and submit the report Online: www.fda.gov/MedWatch/report Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178 Read the MedWatch Safety Alert, including a link to the FDA Drug Safety Communication, at: https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm589580.htm