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Accurate assessment of physical activity among coronary artery disease patients is important for assessing adherence to interventions. The study compared moderate-to-vigorous physical intensity activity and relationships with cardiometabolic health/fitness indicators using accelerometer cut-points developed for coronary artery disease patients versus those developed in younger and middle-aged adults. A total of 231 adults with coronary artery disease wore an Actigraph GT3X accelerometer for ≥4 days (≥10 hours/day). Moderate-to-vigorous intensity physical activity between cut-points was compared using Bland-Altman analyses. Partial spearman correlations assessed relationships between moderate-to-vigorous intensity physical activity from each cut-point with markers of cardiometabolic health and fitness while controlling for age and sex. Average time spent in bouts of moderate-to-vigorous intensity physical activity using coronary artery disease cut-points was significantly higher than the young (mean difference: 13.0±12.8 minutes/day) or middle-aged (17.0±15.2 minutes/day) cut-points. Young and middle-aged cut-points were more strongly correlated with body mass index, waist circumference and systolic blood pressure, while coronary artery disease cut-points had stronger relationships with triglycerides, high-density and low-density lipoproteins. All were similarly correlated with measures of fitness. Researchers need to exert caution when deciding on which cut-points to apply to their population. Further work is needed to validate which cut-points provide a true reflection of moderate-to-vigorous intensity physical activity and to examine relationships among patients with varying fitness.

The kingdom of Saudi Arabia, ruled by the Al Saud family since its founding in 1932, wields significant global influence through its administration of the birthplace of the Islamic faith and by virtue of its large oil reserves. Close U.S.-Saudi official relations have survived a series of challenges since the 1940s. In recent years, shared concerns over Sunni Islamist extremist terrorism and Iranian government policies have provided some renewed logic for continued strategic cooperation. Political upheaval and conflict in the Middle East and North Africa have created new challenges, and the Trump Administration has sought to strengthen U.S. ties to Saudi leaders as the kingdom implements a series of new domestic and foreign policy initiatives. Successive U.S. Administrations have referred to the Saudi government as an important partner, and U.S. arms sales and related security cooperation have continued with congressional oversight and amid some congressional opposition. The Trump Administration, like its recent predecessors, praises Saudi government counterterrorism efforts. Since 2009, the executive branch has notified Congress of proposed foreign military sales to Saudi Arabia of major defense articles and services with a potential aggregate value of nearly $139 billion. The United States and Saudi Arabia concluded arms sale agreements worth more than $65 billion, from FY2009 through FY2016. Since March 2015, the U.S.-trained Saudi military has used U.S.origin weaponry, U.S. logistical assistance, and shared intelligence in support of military operations in Yemen. Legislation has been proposed in the 115th Congress to condition or disapprove of some U.S. weapons sales and condition or direct the President to end U.S. support to Saudi operations without specific authorization (H.J.Res. 102, H.J.Res. 104, S.J.Res. 40, S.J.Res. 42, S.J.Res. 54, S. J. Res. 55). In parallel to close security ties, official U.S. reports describe restrictions on human rights and religious freedom in the kingdom. Some Saudi activists advocate for limited economic and political reforms, continuing decades-long trends that have seen Saudi liberals, moderates, and conservatives advance different visions for domestic change. Saudi leaders in 2018 reversed a long-standing ban on women's right to drive, amid some arrests of women's rights advocates and critics of social liberalization. While some limited protests and arrests have occurred since unrest swept the region in 2011, clashes involving Saudi security forces have not spread beyond certain predominantly Shia areas of the oil-rich Eastern Province. Since assuming the throne in 2015, King Salman bin Abd al Aziz (age 82) has made a series of appointments and reassignments that have altered the responsibilities and relative power of leading members of the next generation of the Al Saud family, who are the grandsons of the kingdom's founder. The king's son, Crown Prince Mohammed bin Salman (age 33), is the central figure in Saudi policymaking. He has asserted control over national security forces, sidelined potential rivals, proposed and begun implementing bold economic and social changes, and arrested prominent figures accused of corruption, including some fellow royal family members. Ambitious plans for the transformation of the kingdom's economy seek to provide opportunity for young Saudis and bolster nonoil sources of revenues for the state. Abroad, the kingdom pursues a multidirectional policy and has aggressively confronted perceived threats. Saudi decisionmaking long appeared to be risk-averse and rooted in rulers' concerns for maintaining consensus among different constituencies, including factions of the royal family, business elites, and conservative religious figures. Crown Prince Mohammed bin Salman's assertive and more centralized leadership has challenged this model of governance. The change is leading Saudis and outsiders alike to reexamine their assumptions about the kingdom's future. Congress may examine these developments when considering the scope, terms, and merits of U.S.-Saudi partnership, proposed arms sales and nuclear cooperation, and security commitments.

Iraq's government declared military victory against the Islamic State organization (IS, aka ISIS/ISIL) in December 2017, but insurgent attacks by remaining IS fighters threaten Iraqis as they shift their attention toward recovery and the country's political future. Security conditions have improved since the Islamic State's control of territory was disrupted, but IS fighters are active in some areas and security conditions are fluid. Meanwhile, daunting resettlement, reconstruction, and reform needs occupy citizens and leaders. Internally displaced Iraqis are returning home in greater numbers, but stabilization and reconstruction needs in liberated areas are extensive. An estimated 1.9 million Iraqis remain as internally displaced persons (IDPs), and Iraqi authorities have identified $88 billion in reconstruction needs over the next decade. Large protests in southern Iraq during August and September 2018 highlighted some citizens' outrage with poor service delivery and corruption. National legislative elections were held in May 2018, but results were not certified until August, delaying the formal start of required steps to form the next government. Iraqi Prime Minister Haider al Abadi sought reelection, but his electoral list's third-place showing and lack of internal cohesion undermined his chances for a second term. On October 2, Iraq's Council of Representatives (COR) chose former Kurdistan Regional Government Prime Minister and former Iraqi Deputy Prime Minister Barham Salih as Iraq's President. Salih, in turn, named former Oil Minister Adel Abd al Mahdi as Prime Minister-designate and directed him to assemble a slate of cabinet officials for COR approval within 30 days. Paramilitary forces have grown stronger and more numerous since 2014, and have yet to be fully integrated into national security institutions. Some figures associated with the Popular Mobilization Forces (PMF) that were organized to fight the Islamic State participated in the 2018 election campaign and won seats in the Council of Representatives, including individuals with ties to Iran. Iraqi politicians have increasingly employed cross-sectarian political and economic narratives in an attempt to appeal to disaffected citizens, but identity-driven politics continue to influence developments. Iraq's neighbors and other outsiders, including the United States, are pursuing their respective interests in Iraq, at times in competition. The Kurdistan Region of northern Iraq (KRI) enjoys considerable administrative autonomy under the terms of Iraq's 2005 constitution, and the Kurdistan Regional Government (KRG) held legislative elections on September 30, 2018. The KRG had held a controversial advisory referendum on independence in September 2017, amplifying political tensions with the national government, which moved to reassert security control of disputed areas that had been secured by Kurdish forces after the Islamic State's mid-2014 advance. Iraqi and Kurdish security forces remain deployed across from each other along contested lines of control, while their respective leaders are engaged in negotiations over a host of sensitive issues. In general, U.S. engagement with Iraqis since 2011 has sought to reinforce Iraq's unifying tendencies and avoid divisive outcomes. At the same time, successive U.S. Administrations have sought to keep U.S. involvement and investment minimal relative to the 2003-2011 era, pursuing U.S. interests through partnership with various entities in Iraq and the development of those partners' capabilities-rather than through extensive deployment of U.S. military forces. The Trump Administration has sustained a cooperative relationship with the Iraqi government and plans to continue security training for Iraqi security forces. To date, the 115th Congress has appropriated funds for U.S. military operations against the Islamic State and for security assistance, humanitarian relief, and foreign aid for Iraq. For background on Iraq and its relations with the United States, see CRS Report R45025, Iraq: Background and U.S. Policy.

This product provides an overview of the role Congress has played in shaping U.S. policy toward the conflict in Yemen. Summary tables provide information on legislative proposals considered in the 115th and 116th Congresses. Various legislative proposals have reflected a range of congressional perspectives and priorities, including with regard to* the authorization of the activities of the U.S. Armed Forces related to the conflict;* the extent of U.S. logistical, material, advisory, and intelligence support for the coalition led by Saudi Arabia;* the approval, disapproval, or conditioning of U.S. arms sales to Saudi Arabia;* the appropriation of funds for U.S. operations in support of the Saudi-led coalition;* the conduct of the Saudi-led coalitions air campaign and its adherence to international humanitarian law and the laws of armed conflict;* the demand for greater humanitarian access to Yemen;* the call for a wider government assessment of U.S. policy toward Yemen and U.S. support to parties to the conflict;* the nature and extent of U.S.-Saudi counterterrorism and border security cooperation; and* the role of Iran in supplying missile technology and other weapons to the forces of the Houthi movement.

Since the mid-1990s, Qatari leaders have overseen a course of major economic growth, increased diplomatic engagement, and limited political liberalization. According to the 2013 U.S. State Department Country Report on Human Rights in Qatar, principal U.S. human rights concerns included the \"inability of citizens to change their government peacefully, restriction of fundamental civil liberties, and pervasive denial of noncitizen workers' rights.\" \"33 He also said, \"I salute the steadfastness of the resistance of the Palestinian people in Gaza in the face of occupation and in insisting on regaining its legitimate rights,\" vowing that \"the State of Qatar will spare no effort to provide assistance for the reconstruction of the Gaza Strip.\" Since 2013, Qatar reportedly has provided several million dollars for construction projects in the Hamas-controlled Gaza Strip and financed the Palestinian Authority's purchase of a fuel shipment for the Gaza electricity generation plant that Israel approved in December 2013.34 Though Qatar has claimed to maintain control over its Gaza construction projects, some allege that these projects and Qatari-aided shipments of fuel into Gaza aid Hamas's military or logistical efforts, while others deny this.35 A Qatari official has reportedly indicated that any money it would contribute to Gaza going forward for humanitarian purposes would not go directly to Hamas.36 Some Members of Congress, including then-Senator and now Secretary of State John Kerry, have criticized Qatar for providing financial and political support to Hamas.37 Qatari officials deny that their government supports Hamas financially and argue that their policy is to support the Palestinian people. According to a May 2014 International Monetary Fund (IMF) report, GDP growth averaged 14% over the last decade and the country's per capita GDP is the highest in the world.41 Hydrocarbon exports have led the way, but non-oil and gas sector growth reached 9% in 2012.

The Islamic State (IS, aka the Islamic State of Iraq and the Levant, ISIL/ISIS, or the Arabic acronym Da'esh) is a transnational Sunni Islamist insurgent and terrorist group that controlled large areas of Iraq and Syria from 2014 through 2017. The group attracted a network of global supporters and its leader, Abu Bakr al Baghdadi, received pledges of affiliation from groups in several other countries. A series of terrorist attacks attributed to the group or to individuals it has inspired have claimed hundreds of lives on four continents since November 2015, including in the United States. While U.S. and allied forces in 2017 and 2018 successfully liberated most of the territory formerly held by the group in Syria and Iraq, IS leadership remains at large and IS fighters appear to be evolving into an insurgent force. The group's international affiliates continue to operate, and individuals inspired by the group continue to attempt attacks in Europe and elsewhere. The stabilization of areas recovered from the group in Iraq and Syria remains an ongoing challenge, and a U.S. military spokesperson for the counter-IS campaign warned in August 2018 that, \"We cannot emphasize enough that the threat of losing the gains we have made is real, especially if we are not able to give the people a viable alternative to the ISIS problem.\" Members of Congress, executive branch officials, and their international counterparts continue to debate a range of proposals for consolidating battlefield gains made to date and preventing the Islamic State from succeeding in its stated objectives of remaining and expanding. President Obama's goals for U.S. strategy were to degrade and ultimately defeat the Islamic State through U.S. direct military action and support for local partner forces. President Donald Trump directed his Administration to develop a comprehensive plan to defeat the group and has accelerated U.S. military operations while augmenting U.S. contributions to stabilization in liberated areas. The U.S. military continues to conduct operations against the group in Iraq, Syria, and Afghanistan, while monitoring and occasionally striking its affiliates and personnel elsewhere. Parallel U.S. assistance efforts support stabilization in areas once held by the group, and diplomatic efforts have promoted political reconciliation among local factions in countries where Islamic State supporters are active. The United States also provides security assistance to partner governments in support of operations against Islamic State affiliates and to strengthen the ability of partners to deter and respond to Islamic State attacks. Evolving counterterrorism cooperation and intelligence sharing efforts among a wider network of concerned governments seek to further limit the ability of IS supporters to carry out transnational terrorist attacks. Interrelated conflicts and political crises in Iraq, Syria, and other countries where the Islamic State operates complicate efforts to address and durably eliminate the threats posed by the group. Military operations may reduce the numbers of IS fighters and liberate IS-held territory, but the underlying political disputes and development challenges that the Islamic State has exploited may create ongoing openings for the group if governance and reconstruction needs go unmet. Governments may continue to face difficult decisions about the potential risks and rewards of various military, law enforcement, surveillance, intelligence sharing, financial, border security, refugee admission, and consular countermeasures. This chapter provides background on the Islamic State organization, discusses its goals, operations, and affiliates, reviews U.S. legislative and policy debates, and reviews relevant legislation from the 114th and 115th Congresses.

On January 3, 2019, Senator Marco Rubio and three cosponsors introduced S. 1, the Strengthening America's Security in the Middle East Act of 2019 (or SASME). The bill combines four legislative proposals, three of which were passed in some form by at least one chamber during the 115th Congress. While significant portions of SASME received broad bipartisan support during the 115th Congress, Members differ over whether S. 1 should be considered amidst a partial government shutdown. On January 8, cloture on the motion to proceed to Senate floor consideration of S. 1 was rejected by a vote of 56-44.

\"3 After just weeks in his interim position, acting Prime Minister Abdullah al Thinni offered his resignation and declined to appoint a new cabinet in the wake of Zeidan's departure, citing threats to his life and his family by armed groups; his doubts about the GNC's ability to promptly confirm new nominees; and what he reportedly sees as a lack of sufficient decision-making authority granted by the GNC to executive offices. According to the 2011 interim constitutional declaration, the CDA is scheduled to have four months from its first session to produce a draft constitution for consideration, a timeline which many outside observers viewed as ambitious and potentially problematic even prior to recent events.

The Islamic State (IS, aka the Islamic State of Iraq and the Levant, ISIL/ISIS, or the Arabic acronym Da'esh) is a transnational Sunni Islamist insurgent and terrorist group that controls large areas of Iraq and Syria, has adherents in several other countries, and disrupts regional and international security with violence and terrorism. A series of terrorist attacks attributed to the group outside of Iraq and Syria has demonstrated IS supporters' ability to threaten societies in the Middle East, Africa, Europe, and the United States, including in countries with sophisticated and capable intelligence and security forces. The U.S.-led campaign to degrade and ultimately destroy the Islamic State organization in Iraq and Syria (IS, aka ISIL/ISIS or the Arabic acronym Da'esh) appears to be entering a new phase in early 2016, as Administration officials implement planned changes in military strategy and tactics, pursue new diplomatic and coalition building initiatives, and consider alternative proposals. The conflicts in Iraq and Syria remain focal points in this regard, but a series of terrorist attacks inspired or directed by the Islamic State have claimed hundreds of lives on four continents since November 2015, creating a more global sense of urgency about combatting the group and reversing its spread. The group has stated its intent to attack inside the United States, and the December 2015 shootings in San Bernardino, California, have been attributed to IS supporters who did not have apparent links to the organization but were praised by the group. Debate continues over whether IS elements overseas have the capability to direct, support, and/or carry out further attacks in the United States. The group's statements suggest it seeks to provoke reactions from targeted populations and spur confrontations between various Muslim sects and between Muslims and non-Muslims. The interdependent nature of the conflicts and political crises in Iraq, Syria, and other countries where IS fighters operate complicate efforts to address and eliminate the IS threat. President Obama has stated that the goals of U.S. strategy are to \"degrade and ultimately defeat\" the Islamic State using various means including U.S. direct military action and support for local partner forces. U.S. military operations against the group and its adherents in several countries, as well as U.S. diplomatic efforts to reconcile Syrian and Iraqi factions, are ongoing. Parallel U.S. political and security efforts in North Africa, West Africa, and South Asia also seek to mitigate local IS-related threats. This report provides background on the Islamic State organization, discussing its goals, operations, and affiliates, as well as analyzing related U.S. legislative and policy debates.