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A Review of Potential National Chronic Pain Surveillance Systems in the United States
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Developing a surveillance system of sub-county data: Finding suitable population thresholds for geographic aggregations
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Solar Surveillance System (SolarSurveillance)
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Mini-cell: Compact all optical gas monitoring sensor for persistent surveillance of complex system
Persistent surveillance of complex systems by embedded sensing is the new paradigm of aging awareness and monitoring. In any complex system with a long-term lifespan plan, the persistent surveillance of critical parameters warrants the reliability and safety/security of the system by the continuous monitoring of the state of health and aging conditions. Therefore, embedded sensors of physical, chemical, and structural features/traits are critical for uncovering occurrences of undesired/unexpected events. Gas sensing can provide early detection of a broad range of problems such as decomposing components, corrosion, failures, and leaks. For the application of interest, the sensors must be: 1/highly selective and sensitive for a broad range of gas molecules, 2/compact, 3/minimally invasive, 4/rugged for vibration and thermal excursions, and 5/ environmentally inert.
Accessible Real-Time Surveillance Radar System for Object Detection
As unmanned ground and aerial vehicles become more accessible and their usage covers a wider area of application, including for threatening purposes which can cause connected catastrophe, a surveillance system for the public places is being considered more essential to respond to those possible threats. We propose an inexpensive, lighter, safer, and smaller radar system than military-grade radar systems while keeping reasonable capability for use in monitoring public places. The paper details the iterative process on the system design and improvements with experiments to realize the system used for surveillance. The experiments show the practical use of the system and configuration for a better understanding of using the system. Cyber-physical systems for outdoor environments can benefit from the system as a sensor for sensing objects as well as monitoring.
Population-level incidence of human papillomavirus–positive oropharyngeal, cervical, and anal cancers, by smoking status
Abstract We estimated the population-level incidence of human papillomavirus (HPV)–positive oropharyngeal, cervical, and anal cancers by smoking status. We combined HPV DNA genotyping data from the Centers for Disease Control and Prevention’s Cancer Registry Sentinel Surveillance System with data from the Kentucky Cancer Registry and Behavioral Risk Factor Surveillance System across smoking status. During 2004-2005 and 2014-2015 in Kentucky, most cases of oropharyngeal (63.3%), anal (59.7%), and cervical (54.9%) cancer were among individuals who ever smoked. The population-level incidence rate was higher among individuals who ever smoked than among those who never smoked for HPV-positive oropharyngeal (7.8 vs 2.1; adjusted incidence rate ratio = 2.6), cervical (13.7 vs 6.8; adjusted incidence rate ratio = 2.0), and anal (3.9 vs 1.6; adjusted incidence rate ratio = 2.5) cancers. These findings indicate that smoking is associated with increased risk of HPV-positive oropharyngeal, cervical, and anal cancers, and the population-level burden of these cancers is higher among individuals who ever smoked.
The Field Epidemiology Training Program’s Contribution to Essential Public Health Functions in Seven National Public Health Institutes
Objective: This study explores how Field Epidemiology Training Programs (FETP) whose National Public Health Institutes (NPHI) are supported by U.S. Centers for Disease Control and Prevention (CDC) have contributed to strengthening essential public health functions. Methods: We conducted 96 semi-structured interviews with public health experts including NPHI staff, non-NPHI government staff, and staff from non-governmental and international organizations in Cambodia, Colombia, Liberia, Mozambique, Nigeria, Rwanda, and Zambia. We managed data using MAXQDA and employed direct content analysis to derive themes. Results: Three overarching themes emerged in relation to FETPs’ role within the NPHIs’ public health functions. These themes included contribution to improving country surveillance systems, role in providing leadership in outbreak responses, and strengthening countries’ and the NPHIs’ surveillance workforce capacity. Participants also shared challenges around FETPs’ implementation and suggestions for improvement. Conclusion: The results demonstrate the value of FETPs in strengthening public health systems through building workforce capacity and improving surveillance systems. By identifying the successes of FETPs in contributing to essential public health functions, our findings might inform current and future FETP implementation and its integration into NPHIs.
The Role of Nuclear-Conventional Intermingling on State Decision-making and the Risk of Inadvertent Escalation
The questions answered by this report are: What are the implications of nuclear and conventional intermingling on crisis stability and the potential risk of miscalculation?, and Specifically, how might entanglement influence US and competitor decision making during crisis and conflict? In practice, there are three main forms of nuclear-conventional intermingling. First, intermingling between nuclear and non-nuclear weapon systems can occur via the fielding of dual capable delivery systems like missiles or aircraft. Second, intermingling can happen due to the co-location of nuclear and non-nuclear forces and their support structures—for example, the co-location of strategic bombers and general-purpose aircraft, or the co-location of strategic submarines and general-purpose vessels. Third, intermingling can occur via convolving nuclear and conventional military command and control systems, to include ballistic missile early warning and potentially space surveillance systems as well. All three forms of nuclear-conventional intermingling have significantly increased since the end of the Cold War, driven by both technological and doctrinal changes. However, there are important differences in the rationale behind, and also the risks associated with these three different forms of intermingling. The mere existence of dual capable systems is not new— deploying such systems can increase the effectiveness of forces, and it can also provide more flexibility. The major powers have both employed and threatened with dual capable systems for decades, and they have done so without nuclear escalation. Similarly, the major powers co-located nuclear and conventional systems in the Cold War, and they did so for variety of reasons that had nothing to do with complicating the adversary’s risk calculus. The Soviet Union, for example, decided to co-locate its nuclear and conventional forces for economic and administrative reasons. Although today it might be recognized as a useful deterrent tool, it was not their primary intention. Major powers want to convince rivals that the co-location of forces creates a high bar for targeting and raises the risk of nuclear escalation, but they also want to have the flexibility of this not being true in an actual crisis or conflict.
White Paper: Scalable Digital Twin Capabilities for Aging and Surveillance of Engineered Systems
This white paper presents a multi-year initiative to develop practical, secure, and scalable digital twin capabilities for engineered systems in aging and surveillance contexts—an approach pioneered at the National Nuclear Security Administration (NNSA) Lawrence Livermore National Laboratory (LLNL) that maps directly onto the needs and ambitions of the Navy for ship- and fleet-level digital twins. LLNL’s work in building part- and process-level digital twins for advanced manufacturing, with a vision to scale up to entire factory floors and, ultimately, enterprise-wide digital twins, offers an adaptable pathway for the Navy as it seeks to modernize lifecycle management, readiness, and predictive maintenance across ships and fleets. For our application, we integrate physics-based modeling with automated data ingestion, processing, and AI-driven calibration, creating hybrid models that are both interpretable and data responsive. We modernized legacy workflows, established centralized data infrastructure, automated experimental pipelines, and demonstrated end-to-end coupling of accelerated aging data with finite element simulations via optimization and surrogate modeling. The result is a generalizable framework that supports part-level digital twins today and lays the groundwork for future system-level twins suitable for Navy applications.
Google Health Trends performance reflecting dengue incidence for the Brazilian states
Abstract Background Dengue fever is a mosquito-borne infection transmitted by Aedes aegypti and mainly found in tropical and subtropical regions worldwide. Since its re-introduction in 1986, Brazil has become a hotspot for dengue and has experienced yearly epidemics. As a notifiable infectious disease, Brazil uses a passive epidemiological surveillance system to collect and report cases; however, dengue burden is underestimated. Thus, Internet data streams may complement surveillance activities by providing real-time information in the face of reporting lags. Methods We analyzed 19 terms related to dengue using Google Health Trends (GHT), a free-Internet data-source, and compared it with weekly dengue incidence between 2011 to 2016. We correlated GHT data with dengue incidence at the national and state-level for Brazil while using the adjusted R squared statistic as primary outcome measure (0/1). We used survey data on Internet access and variables from the official census of 2010 to identify where GHT could be useful in tracking dengue dynamics. Finally, we used a standardized volatility index on dengue incidence and developed models with different variables with the same objective. Results From the 19 terms explored with GHT, only seven were able to consistently track dengue. From the 27 states, only 12 reported an adjusted R squared higher than 0.8; these states were distributed mainly in the Northeast, Southeast, and South of Brazil. The usefulness of GHT was explained by the logarithm of the number of Internet users in the last 3 months, the total population per state, and the standardized volatility index. Conclusions The potential contribution of GHT in complementing traditional established surveillance strategies should be analyzed in the context of geographical resolutions smaller than countries. For Brazil, GHT implementation should be analyzed in a case-by-case basis. State variables including total population, Internet usage in the last 3 months, and the standardized volatility index could serve as indicators determining when GHT could complement dengue state level surveillance in other countries.
Autonomous System Subversion Tactics: Prototypes and Recommended Countermeasures
One of the fielding requirements for Advanced and Small Modular Reactors (AR/SMR) is the ability to support remote and autonomous operations. Autonomous Control Systems (ACS) are found on platforms such as Autonomous Space Vehicles, Cruise Missiles, and advanced driver-assistance systems. Each of these ACS implementations depends upon a set of decision support subsystems responsible for supporting Autonomous Mission Managers (names vary based upon field and author preferences). These Autonomous Mission Managers receive inputs from system sensors (e.g., LIDAR collection from an automobile travelling down a street; transients from a nuclear reactor), and perform a set of classifications (e.g., Red Traffic Light; Small Pedestrian at 10m; Load Rejection; Single Coolant Pump Trip), and then use these classifications in combination with recommendation algorithms to achieve platform goals (e.g., Stop the Vehicle at the Traffic Light, Avoid the Small Pedestrian; Trip the Reactor to prevent a Safety Event). The design, implementation, and fielding of an ACS capability will alter the cyber-attack surface such that existing risk management plans will need to be updated to include how to protect and defend against data-science and decision-support-system attack classes. These attack classes would include protection of the design and training environments where algorithm selection and testing and training data would be obvious attack vectors. These attack classes would also require an informed set of detection and response procedures to identify anomalous behaviors and document best practices for anomaly assessment and vulnerability mitigation and remediation. Last year we published a Cyber Threat Assessment Methodology for Autonomous and Remote Operations for AR/SMRs along with a companion publication on Cyber Attack and Defense Use Cases. The focus of the methodology was on describing and enumerating ACS processes, components, and functions such that security engineers could: evaluate subversion options against the target; identify threat actor attributes and capabilities derived from each subversion option; and identify security controls and response countermeasures. The Use Cases document offered detailed methodology examples including an assessment of a Military Base SMR, an Autonomous System Decision Loop, and implementation of AR/SMR Machine Learning algorithms. Our proposal at the end of last year was to focus on implementation of subversion prototypes related to the last Use Case area: AR/SMR Machine Learning (ML) Algorithms. We included six attack scenarios in our Use Cases paper: a Poisoning Attack against ML functions implemented using an FPGA; a Trojaning Attack against ML classifiers exploiting the excitability of Nuclear Engineers; a Backdooring Attack against ML Training environments to ensure persistence of an attack vector; a False Positive Evasion Attack against multi-factor Access Control Systems using clever inputs; an Inference Attack against ML models by an Insider with access to the Operational environment; and an Adversarial Reprogramming Attack against a Material Access Control Video Surveillance System. At the beginning of this year these six attack scenarios were provided to our research teams at Georgia Tech and Idaho State University and each team successfully implemented a subversion attack against a ML implementation to include transient misclassifications. While this is a notable outcome from this type of research, this paper offers the reader insight into not only how to structure and execute these types of attacks, but into the thought process behind how the researcher investigated the problem space, performed initial algorithm implementation, and the trial-and-error behind arriving at the successful subversion prototypes. We include in this paper a set of associated Scenarios on how these subversion prototypes could be implemented and an initial set of guidance for AR/SMR architects, Nuclear Regulators, and Cyber Defenders to implement awareness and defense capabilities into their current operational portfolios.
Addressing Parental Vaccine Hesitancy and Other Barriers to Childhood/Adolescent Vaccination Uptake During the Coronavirus (COVID-19) Pandemic
Routine childhood immunizations are proven to be one of the most effective public health interventions at controlling numerous deadly diseases. Therefore, the CDC recommends routine immunizations for children and adolescent populations against vaccine-preventable diseases e.g., tetanus, pertussis, diphtheria, etc. This current review sought to examine barriers to pediatric vaccine uptake behaviors during the COVID-19 pandemic. We also explored the implications for parental vaccine hesitancy/delay during an ongoing health crisis and proposed recommendations for increasing vaccine confidence and compliance. Our review determined that the receipt for vaccinations steadily improved in the last decade for both the United States and Tennessee. However, this incremental progress has been forestalled by the COVID-19 pandemic and other barriers i.e. parental vaccine hesitancy, social determinants of health (SDoH) inequalities, etc. which further exacerbate vaccination disparities. Moreover, non-compliance to routine vaccinations could cause an outbreak of diseases, thereby, worsening the ongoing health crisis and already strained health care system. Healthcare providers are uniquely positioned to offer effective recommendations with presumptive languaging to increase vaccination rates, as well as, address parental vaccine hesitancy. Best practices that incorporate healthcare providers’ quality improvement coaching, vaccination reminder recall systems, adherence to standardized safety protocols (physical distancing, hand hygiene practices, etc.), as well as, offer telehealth and outdoor/drive-through/curbside vaccination services, etc. are warranted. Additionally, a concerted effort should be made to utilize public health surveillance systems to collect, analyze, and interpret data, thereby, ensuring the dissemination of timely, accurate health information for effective health policy decision-making e.g., vaccine distribution, etc.
Age-specific case data reveal varying dengue transmission intensity in US states and territories
Dengue viruses (DENV) are endemic in the US territories of Puerto Rico, American Samoa, and the US Virgin Islands, with focal outbreaks also reported in the states of Florida and Hawaii. However, little is known about the intensity of dengue virus transmission over time and how dengue viruses have shaped the level of immunity in these populations, despite the importance of understanding how and why levels of immunity against dengue may change over time. These changes need to be considered when responding to future outbreaks and enacting dengue management strategies, such as guiding vaccine deployment. We used catalytic models fitted to case surveillance data stratified by age from the ArboNET national arboviral surveillance system to reconstruct the history of recent dengue virus transmission in Puerto Rico, American Samoa, US Virgin Islands, Florida, Hawaii, and Guam. We estimated average annual transmission intensity (i.e., force of infection) of DENV between 2010 and 2019 and the level of seroprevalence by age group in each population. We compared models and found that assuming all reported cases are secondary infections generally fit the surveillance data better than assuming all cases are primary infections. Using the secondary case model, we found that force of infection was highly heterogeneous between jurisdictions and over time within jurisdictions, ranging from 0.00008 (95% CrI: 0.00002–0.0004) in Florida to 0.08 (95% CrI: 0.044–0.14) in American Samoa during the 2010–2019 period. For early 2020, we estimated that seropositivity in 10 year-olds ranged from 0.09% (0.02%–0.54%) in Florida to 56.3% (43.7%–69.3%) in American Samoa. In the absence of serological data, age-specific case notification data collected through routine surveillance combined with mathematical modeling are powerful tools to monitor arbovirus circulation, estimate the level of population immunity, and design dengue management strategies.
Comparative analysis of SARS-CoV-2 neutralization titers reveals consistency between human and animal model serum and across assays
The evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requires ongoing monitoring to judge the ability of newly arising variants to escape the immune response. A surveillance system necessitates an understanding of differences in neutralization titers measured in different assays and using human and animal serum samples. We compared 18 datasets generated using human, hamster, and mouse serum and six different neutralization assays. Datasets using animal model serum samples showed higher titer magnitudes than datasets using human serum samples in this comparison. Fold change in neutralization of variants compared to ancestral SARS-CoV-2, immunodominance patterns, and antigenic maps were similar among serum samples and assays. Most assays yielded consistent results, except for differences in fold change in cytopathic effect assays. Hamster serum samples were a consistent surrogate for human first-infection serum samples. These results inform the transition of surveillance of SARS-CoV-2 antigenic variation from dependence on human first-infection serum samples to the utilization of serum samples from animal models.
What Should Health Departments Do with HIV Sequence Data?
Many countries and US states have mandatory statues that require reporting of HIV clinical data including genetic sequencing results to the public health departments. Because genetic sequencing is a part of routine care for HIV infected persons, health departments have extensive sequence collections spanning years and even decades of the HIV epidemic. How should these data be used (or not) in public health practice? This is a complex, multi-faceted question that weighs personal risks against public health benefit. The answer is neither straightforward nor universal. However, to make that judgement—of how genetic sequence data should be used in describing and combating the HIV epidemic—we need a clear image of what a phylogenetically enhanced HIV surveillance system can do and what benefit it might provide. In this paper, we present a positive case for how up-to-date analysis of HIV sequence databases managed by health departments can provide unique and actionable information of how HIV is spreading in local communities. We discuss this question broadly, with examples from the US, as it is globally relevant for all health authorities that collect HIV genetic data.
Automatic Calibration and Health Monitoring of Infrastructure Sensors
Smart transportation infrastructure relies on networks of heterogeneous sensors - cameras, radars, and lidars - continuously monitoring traffic conditions. However, executing the initial spatial calibration of multiple sensors and the subsequent health monitoring presents significant operational challenges. Environmental factors, mechanical vibrations, and gradual drift cause spatial misalignment, degrading fusion performance and tracking accuracy. Traditional calibration approaches require manual intervention with specialized targets or survey equipment, resulting in service interruptions and high maintenance costs. This work presents an automated framework for initial calibration and continuous health monitoring without human intervention or service disruption. Our approach addresses two critical problems: (1) detecting when sensors become miscalibrated during operation, and (2) automatically re-establishing spatial alignment using only operational traffic data. The health monitoring component analyzes measurement innovations - differences between sensor observations and predicted object states - to detect systematic biases indicative of calibration drift. By computing bias magnitude, directional consistency, and rejection rates, the system identifies miscalibrations as small as 0.5 meters. Unlike traditional methods requiring known calibration targets, our diagnostic operates continuously on live traffic observations, enabling early detection before fusion quality degrades. The automatic recalibration algorithm leverages overlapping sensor fields-of-view and temporal correlation of vehicle observations. Using graph-based optimization, the system automatically discovers which sensor pairs observe common regions, estimates pairwise spatial transformations using RANSAC-based robust estimation, and jointly optimizes all sensor poses through bundle adjustment. The framework handles practical deployment challenges, including different sensor sampling rates (1-10 Hz), varying installation positions, unknown orientations, and limited overlap regions (>10%). When approximate sensor positions are available from installation surveys (+/-1m accuracy), the algorithm additionally estimates sensor orientations, refining both position and rotation to sub-meter and sub-degree accuracy. We validate the framework on multi-hour traffic datasets from six heterogeneous sensors with sampling rates ranging from 1 Hz to 10 Hz. Results demonstrate successful calibration even with sparse overlap (<20%) and automatic detection of miscalibrations exceeding 0.8 meters. This work enables a "deploy-and-forget" sensor infrastructure that maintains calibration autonomously, reducing maintenance costs while improving tracking accuracy. The techniques generalize beyond transportation to any multi-sensor monitoring application requiring robust spatial alignment, including smart cities, industrial monitoring, and surveillance systems.
Evaluating disease surveillance strategies for early outbreak detection in contact networks with varying community structure
Disease surveillance systems allow public health agencies to respond to emerging diseases before they become widespread. Developing such systems requires identifying optimal ways to monitor in the context of an epidemic outbreak; this problem is known as sensor selection. Contact networks represent the dynamics of interaction in a population and are used to model how a disease spreads in a population and to explore strategies of sensor selection. We evaluated five sensor selection strategies on their ability to provide an early warning of a COVID-like outbreak in synthetic contact networks encapsulated in four network scenarios. Three of these scenarios assessed different aspects of community structure. The fourth scenario employed a contact network representing the population and interactions of 6.8 million people in New York City, constructed from an agent-based simulation using census and transportation data. This scenario exemplifies how sensor selection strategies may perform in a real-world, urban context. Our findings suggest that the choice of the optimal strategy depends heavily on the community structure of the network. Strategies that select highly connected nodes or maximize network coverage are the optimal surveillance strategy for outbreak detection in many network community structures. However, a naive implementation of these strategies may fail to provide an early warning at all—including in the New York City scenario. Moreover, these methods are impractical for real-world use as they require knowledge of the underlying contact network. Instead, a selection strategy that starts with a set of random nodes and then performs a random walk through a chain of neighbors reliably provides early warnings without requiring prior knowledge of the network. We find this method, called “random chain”, to be the most pragmatic for implementation in a real-world disease surveillance context.