搜索结果：Surveillance

PROBLEM/CONDITION: Asthma, a chronic disease occurring among both children and adults, has been the focus of clinical and public health interventions during recent years. In addition, CDC has outlined a strategy to improve the timeliness and geographic specificity of asthma surveillance as part of a comprehensive public health approach to asthma surveillance. REPORTING PERIOD COVERED: This report presents national data regarding self-reported asthma prevalence, school and work days lost because of asthma, and asthma-associated activity limitations (1980-1996); asthma-associated outpatient visits, asthma-associated hospitalizations, and asthma-associated deaths (1980-1999); asthma-associated emergency department visits (1992-1999); and self-reported asthma episodes or attacks (1997-1999). DESCRIPTION OF SYSTEMS: CDC's National Center for Health Statistics (NCHS) conducts the National Health Interview Survey annually, which includes questions regarding asthma and asthma-related activity limitations. NCHS collects physician office-visit data in the National Ambulatory Medical Care Survey, emergency department and hospital outpatient data in the National Hospital Ambulatory Medical Care Survey, hospitalization data in the National Hospital Discharge Survey, and death data in the Mortality Component of the National Vital Statistics System. RESULTS: During 1980-1996, asthma prevalence increased. Annual rates of persons reporting asthma episodes or attacks, measured during 1997-1999, were lower than the previously reported asthma prevalence rates, whereas the rates of lifetime asthma, also measured during 1997-1999, were higher than the previously reported rates. Since 1980, the proportion of children and adults with asthma who report activity limitation has remained stable. Since 1995, the rate of outpatient visits and emergency department visits for asthma increased, whereas the rates of hospitalization and death decreased. Blacks continue to have higher rates of asthma emergency department visits, hospitalizations, and deaths than do whites. INTERPRETATION: Since the previous report in 1998 (CDC. Surveillance for Asthma--United States, 1960-1995. MMWR 1998;47[No. SS-1]:1-28), changes in asthma-associated morbidity and death have been limited. Asthma remains a critical clinical and public health problem. Although data in this report indicate certain early indications of success in current asthma intervention programs (e.g., limited decreases in asthma hospitalization and death rates), the continued presence of substantial racial disparities in these asthma endpoints highlights the need for continued surveillance and targeted interventions.

In 1986 the World Health Organization (WHO) designated dracunculiasis (guinea worm disease) as the next disease scheduled to be eradicated (by 1995) after smallpox. Dramatic improvement in national and international surveillance has played a key role in the global eradication campaign, which was initiated at CDC in 1980. About 3 million persons are still affected by the disease annually, with adverse effects on their health as well as on agricultural production and education. Over 100 million persons are at risk of having the disease in more than 20,000 villages in India, Pakistan, and 17 African countries. At least one nationwide, village-by-village search to detect all villages with endemic dracunculiasis and count cases is recommended at the outset of each national campaign, followed by monthly reporting by village-based health workers in the targeted villages during the implementation phase. Rapid dissemination of the results of the surveillance is critical. Intensive case detection and containment--with rewards for reporting of cases--are most appropriate near the end of each campaign. Cameroon, Ghana, India, Nigeria, and Pakistan have pioneered the various surveillance methods for this disease in recent years. Methods for conducting surveillance of dracunculiasis and other important diseases must continue to be developed and improved as countries now believed to be free of dracunculiasis prepare to apply to WHO for certification of elimination of dracunculiasis.

PROBLEM/CONDITION: Asthma, a chronic respiratory disease with episodic symptoms, increased in prevalence during 1980-1996 in the United States. Asthma has been the focus of numerous provider interventions (e.g., improving adherence to asthma guidelines) and public health interventions during recent years. Although the etiology of asthma is unknown, adherence to medical treatment regimen and environmental management should reduce the occurrence of exacerbations and lessen the hardship of this disease. CDC has outlined a public health approach to asthma that includes comprehensive analyses of national surveillance data on prevalence, health-care use and mortality, and a strategy to improve the timeliness and geographic specificity of asthma surveillance data. REPORTING PERIOD COVERED: This report presents national data on asthma for self-reported prevalence (1980-1996 and 2001-2004); self-reported attacks (1997-2004); visits to physicians' offices (1980-2004), hospital outpatient departments (1992-2004), and emergency departments (1992-2004); hospitalizations (1980-2004); and deaths (1980-2004). DESCRIPTION OF SYSTEMS: The National Health Interview Survey includes questions about asthma prevalence and asthma attacks. Physicians' office visit data are collected in the National Ambulatory Medical Care Survey, emergency department and hospital outpatient data in the National Hospital Ambulatory Medical Care Survey, hospitalization data in the National Hospital Discharge Survey, and death data in the Mortality component of the National Vital Statistics System. RESULTS: From 1980 to 1996, 12-month asthma prevalence increased both in counts and rates, but no discernable change was identified in asthma attack estimates since 1997 or in current asthma prevalence from 2001 to 2004. During the period of increasing prevalence, patient encounters (office visits, emergency department visits, outpatient visits, and hospitalizations) for asthma increased. However, rates for these encounters, when based on the population with asthma, did not increase. Although the rate of asthma deaths increased during 1980-1995, the rate of deaths has decreased each year since 2000. During 2001-2003, current asthma prevalence was higher in children (8.5%) compared with adults (6.7%), females (8.1%) compared with males (6.2%), blacks (9.2%) compared with whites (6.9%), those of Puerto Rican descent (14.5%) compared with those of Mexican descent (3.9%), those below the federal poverty level (10.3%) compared with those at or above the federal poverty level (6.4% to 7.9%), and those residing in the Northeast (8.1%) compared with those residing in other regions (6.7% to 7.5%). Among persons with current asthma, whites and blacks were equally likely to report an attack during the preceding 12 months. Women with current asthma were more likely to report asthma attacks than men, and children were more likely than adults. The rate for asthma health-care encounters, regardless of place (physician office, emergency department, outpatient department, or hospital), when based on the population with asthma, did not differ by race. However, whites with current asthma had higher rates for physician offices, and blacks had higher rates for hospital-based sites (e.g., outpatient clinics and emergency departments). INTERPRETATION: The findings in this report suggest that from 1980 through the mid-1990s, increases in asthma prevalence played a substantial role in the increases in patient encounter measures used in asthma surveillance. Because no primary strategies for preventing asthma have been identified, efforts to control asthma exacerbations through interventions that promote adhering to proper medical regimens and reducing exposures to causes of asthma exacerbations should continue to be pursued.

PROBLEM: Priority health-risk behaviors, which contribute to the leading causes of morbidity and mortality among youth and adults, often are established during childhood and adolescence, extend into adulthood, are interrelated, and are preventable. REPORTING PERIOD COVERED: October 2004-January 2006. DESCRIPTION OF THE SYSTEM: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults, including behaviors that contribute to unintentional injuries and violence; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infections; unhealthy dietary behaviors; and physical inactivity. In addition, the YRBSS monitors general health status and the prevalence of overweight and asthma. YRBSS includes a national school-based survey conducted by CDC and state and local school-based surveys conducted by state and local education and health agencies. This report summarizes results from the national survey, 40 state surveys, and 21 local surveys conducted among students in grades 9-12 during October 2004-January 2006. RESULTS: In the United States, 71% of all deaths among persons aged 10-24 years result from four causes: motor-vehicle crashes, other unintentional injuries, homicide, and suicide. Results from the 2005 national Youth Risk Behavior Survey (YRBS) indicated that, during the 30 days preceding the survey, many high school students engaged in behaviors that increased their likelihood of death from these four causes: 9.9% had driven a car or other vehicle when they had been drinking alcohol; 18.5% had carried a weapon; 43.3% had drunk alcohol; and 20.2% had used marijuana. In addition, during the 12 months preceding the survey, 35.9% of high school students had been in a physical fight and 8.4% had attempted suicide. Substantial morbidity and social problems among youth also result from unintended pregnancies and STDs, including HIV infection. During 2005, a total of 46.8% of high school students had ever had sexual intercourse; 37.2% of sexually active high school students had not used a condom at last sexual intercourse; and 2.1% had ever injected an illegal drug. Among adults aged >/=25 years, 61% of all deaths result from two causes: cardiovascular disease and cancer. Results from the 2005 national YRBS indicated that risk behaviors associated with these two causes of death were initiated during adolescence. During 2005, a total of 23.0% of high school students had smoked cigarettes during the 30 days preceding the survey; 79.9% had not eaten >/=5 times/day of fruits and vegetables during the 7 days preceding the survey; 67.0% did not attend physical education classes daily; and 13.1% were overweight. INTERPRETATION: Since 1991, the prevalence of many health-risk behaviors among high school students nationwide has decreased. However, many high school students continue to engage in behaviors that place them at risk for the leading causes of mortality and morbidity. The prevalence of many health-risk behaviors varies across cities and states. PUBLIC HEALTH ACTION: YRBS data are used to measure progress toward achieving 15 national health objectives for Healthy People 2010 and three of the 10 leading health indicators, to assess trends in priority health-risk behaviors among high school students, and to evaluate the impact of broad school and community interventions at the national, state, and local levels. More effective school health programs and other policy and programmatic interventions are needed to reduce risk and improve health outcomes among youth.

PROBLEM/CONDITION: Priority health-risk behaviors that contribute to the leading causes of mortality, morbidity, and social problems among youth and adults often are established during youth, extend into adulthood, and are interrelated. REPORTING PERIOD: February through May 1995. DESCRIPTION OF THE SYSTEM: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults: behaviors that contribute to unintentional and intentional injuries, tobacco use, alcohol and other drug use, sexual behaviors, unhealthy dietary behaviors, and physical inactivity. The YRBSS includes both a national school-based survey conducted by CDC and state and local school-based surveys conducted by state and local education agencies. This report summarizes results from the national survey, 35 state surveys, and 16 local surveys conducted among high school students from February through May 1995. RESULTS AND INTERPRETATION: In the United States, 72% of all deaths among school-age youth and young adults result from four causes: motor vehicle crashes, other unintentional injuries, homicide, and suicide. Results from the 1995 YRBSS suggest that many high school students practice behaviors that may increase their likelihood of death from these four causes: 21.7% had rarely or never used a safety belt, 38.8% had ridden with a driver who had been drinking alcohol during the 30 days preceding the survey, 20.0% had carried a weapon during the 30 days preceding the survey, 51.6% had drunk alcohol during the 30 days preceding the survey, 25.3% had used marijuana during the 30 days preceding the survey, and 8.7% had attempted suicide during the 12 months preceding the survey. Substantial morbidity and social problems among school-age youth and young adults also result from unintended pregnancies and sexually transmitted diseases, including human immunodeficiency virus infection. YRBSS results indicate that in 1995, 53.1% of high school students had had sexual intercourse, 45.6% of sexually active students had not used a condom at last sexual intercourse, and 2.0% had ever injected an illegal drug. Among adults, 65% of all deaths result from three causes: heart disease, cancer and stroke. Most of the risk behaviors associated with these causes of death are initiated during adolescence. In 1995, 34.8% of high school students had smoked cigarettes during the 30 days preceding the survey, 39.5% had eaten more than two servings of foods typically high in fat content during the day preceding the survey, and only 25.4% had attended physical education class daily. ACTIONS TAKEN: YRBSS data are being used nationwide by health and education officials to improve national, state, and local policies and programs designed to reduce risks associated with the leading causes of mortality and morbidity. YRBSS data also are being used to measure progress toward achieving 21 national health objectives and one of eight National Education Goals.

PREAMBLE The guidelines for the diagnosis, surveillance and therapy of Barrett's esophagus were originally published by the American College of Gastroenterology in 1998 and updated in 2002. These and other guidelines undergo periodic review. Significant advances have occurred in the area of Barrett's esophagus over the past four years leading to another revision of the prior guidelines. These advances include the potential use of esophageal capsule endoscopy for the diagnosis and screening of Barrett's esophagus, data regarding the outcome of low-grade dysplasia, the treatment of high-grade dysplasia using photodynamic therapy, and the development of new ablation techniques such as radiofrequency ablation. These guidelines are intended to be applied by physicians who see Barrett's esophagus patients and are intended to indicate a preferred, but certainly not the only, acceptable approach. Physicians need to choose the course best suited to the individual patient and to the variables that exist at the time of decision making. The guidelines are for adult patients with the diagnosis of Barrett's esophagus, as defined herein. Both these and the original guidelines were developed under auspices of the American College of Gastroenterology and the Practice Parameters Committee and approved by the Board of Trustees. The world literature was reviewed extensively for the original guidelines and once again reviewed using the National Library of Medicine database. Search terms used included Barrett's esophagus, esophageal neoplasm, esophagus, intestinal metaplasia, esophageal diseases, and adenocarcinoma, all appropriate studies and any additional ones found in reference to these papers were obtained and reviewed. Evidence was available from a hierarchy of trials and randomized controlled trials were given the greatest weight. Abstracts presented at national and international meetings were only used when unique data from ongoing trials were presented. When scientific data were lacking, recommendations are based on expert opinion. The recommendations made are based on the level of evidence found. Grade A recommendations imply that there is consistent level 1 evidence (randomized controlled trials), Grade B indicates that the evidence would be level 2 or 3 which are cohort studies or case control studies. Grade C recommendations are based on level 4 studies meaning case series or poor quality cohort studies, and Grade D recommendations are based on level 5 evidence meaning expert opinion. SIGNIFICANCE OF BARRETT'S ESOPHAGUS Barrett's esophagus continues to be increasingly recognized in the United States and is believed to be the major risk factor for the development of esophageal adenocarcinoma. The incidence of adenocarcinoma of the esophagus continues to rise rapidly. The rate of rise is alarming and is widespread in Western countries. In a review by the epidemiologists of the National Cancer Institute of cancer incidences normalized to the year 1975, esophageal adenocarcinoma incidence rates were found to outpace even those of melanoma, breast cancer and prostate cancer in terms of the rapidity of rise (1). These epidemiologists also found there was no concomitant decrease in diagnoses of gastric cancers or more proximal cancers, making a classification change unlikely to be responsible for this increase in adenocarcinoma. In the Danish Cancer Registry, adenocarcinoma incidence rates actually decrease in patients older than 85 (14.14/100,00 (80–84 yr) decreasing to 7.2/100,000 (85+ yr) unlike squamous cancer rates suggesting that this rise in adenocarcinoma incidence may be truly a recent phenomenon as evidenced by this age cohort effect (2). DEFINITION OF BARRETT'S ESOPHAGUS Barrett's esophagus is a change in the distal esophageal epithelium of any length that can be recognized as columnar type mucosa at endoscopy and is confirmed to have intestinal metaplasia by biopsy of the tubular esophagus. (Grade B recommendation). This working definition of Barrett's esophagus has changed little over the last 10 years. A recent "critical review of the diagnosis" of Barrett's esophagus concluded that "the working definition of BE is displacement of the squamocolumnar junction proximal to the gastroesophageal junction" and "endoscopy with multiple systematic biopsies is needed to establish the diagnosis of Barrett's esophagus" (3). This definition does not distinguish between short and long segment Barrett's esophagus and implies that only columnar lined esophagus should be biopsied. Although intestinal metaplasia is not specifically mentioned in this definition, clearly the reason to do multiple biopsies in the columnar appearing esophagus is to identify the presence of intestinal metaplasia, the premalignant lesion for esophageal adenocarcinoma (EAC). The vast majority of adenocarcinomas of the esophagus are accompanied by intestinal metaplasia in multiple cohort studies (4–8) and many adenocarcinomas of the esophagogastric junction are also associated with esophageal intestinal metaplasia (9–11). The incidence of adenocarcinoma of the esophagus has continued to rise in the United States, at least until the year 2002 (12). Supporting the primary role of BE as the premalignant lesion for EAC is the unmasking of underlying BE by chemotherapy of adenocarcinoma of the distal esophagus. A retrospective study reviewed 79 patients with locally advanced EAC who had preoperative chemotherapy and had restaging endoscopy and biopsy prior to resection. Pre-therapy endoscopy showed BE in 75%, whereas 97% had documented BE on post-chemotherapy biopsy or in the resected specimen (13). This suggests that the cancer overgrows the fertile field of BE so that at presentation of the patient with EAC, BE may no longer be detectable. Esophagitis might also mask Barrett's esophagus. In a recent study of 172 patients with erosive esophagitis, a full 12% were found to have Barrett's metaplasia after healing of the esophagitis (14). There is not universal agreement on the inclusion of intestinal metaplasia as a criterion for BE. The British Society of Gastroenterology has excluded the need for IM from the diagnosis of BE (15). It is well recognized that the yield of IM decreases as the segment of columnar lining shortens and fewer biopsies are taken. Repeat endoscopy and biopsy are often necessary to establish the presence of IM (16, 17). In patients with >1cm of columnar lined esophagus at endoscopy, multiple biopsies may be necessary to confidently detect intestinal metaplasia. Based on a recent retrospective study, eight biopsies may provide an adequate assessment of the presence of intestinal metaplasia (18). The issue becomes when to label a patient as having BE and having an increased risk for EAC compared to someone lacking BE. Because of the implication of the label of BE in the United States for obtaining health insurance and the increased cost of life insurance in the United States (19), it seems appropriate to establish the presence of IM before committing the patient to the diagnosis of BE and to surveillance endoscopy. There are no data on the risk of EAC in columnar lined esophagus lacking IM. Another new development in the endoscopic standardization of Barrett's esophagus is the Prague classification system of circumferential (CM) and maximal length (M). This system identifies the landmarks of the squamocolumnar junction, the gastroesophageal junction, the extent of circumferential columnar lining and the most proximal extension of the columnar mucosa excluding islands to determine the length of Barrett's esophagus. Twenty-nine endoscopists scored 29 videos with centimeter intervals marked on the image (20). The reliability coefficients (RC) for C 0.95, M 0.94, the gastroesophageal junction 0.88 and the location of the hiatus 0.85 were excellent. The overall RC for the endoscopic recognition of BE ≥1cm was 0.72. However, for less than 1cm of columnar lining the coefficient was only 0.22. In an era of growing endoscopic therapy for neoplastic BE, this standardization is important. Unfortunately, proximal islands of columnar lining and ultra-short BE <1cm are not included in this schema. In summary, a strategy to decrease the recent rise in esophageal cancer would be earlier diagnosis of Barrett's esophagus. The diagnosis should be made with endoscopy and biopsy of columnar lined esophagus only (Grade B Recommendation). Histological changes of intestinal metaplasia (goblet cells) are needed for the diagnosis prior to recommendations of surveillance. Ideally, erosive esophagitis should be healed prior to biopsy to increase the yield and avoid missing short segments of columnar lining (Grade B Recommendation). Endoscopic descriptions of a Barrett's esophagus should be precise and ideally follow established classification systems (Grade D Recommendation). SCREENING Screening for Barrett's esophagus remains controversial because of the lack of documented impact on mortality from EAC. The large number of patients that lack reflux symptoms but have Barrett's esophagus provides a diagnosis challenge. The highest yield for Barrett's is in older (age 50 or more) Caucasian males with longstanding heartburn. Patients with the highest likelihood of BE are older Caucasian males with chronic reflux symptoms. The challenges to screening for BE include the inability to predict who has BE prior to endoscopy, the lack of evidence based criteria, the invasiveness and expense of endoscopy, and the increasing documentation of a subgroup of patients with BE who lack reflux symptoms. Investigators have attempted to predict BE with clinical and demographic features comparing documented BE patients to patients with GERD lacking BE. Predictors included age >40 (21), heartburn (21–23), long duration GERD symptoms (more than 13 years) (23), and male gender (22). Yet the only consistent correlation in most studies was heartburn and the sensitivity was poor. With the nation's increasing obesity problems, it is not surprising that increased body mass index is correlated with Barrett's esophagus, particularly visceral adiposity characterized by CT scan of the abdomen (24). The emerging data on the potential mechanistic role of cytokines from increasing visceral fat will bear watching. The epidemiology of EAC in the United States identifies risk factors of male gender and Caucasian ethnicity: the annual incidence of EAC in Caucasian men is 3.6/100,000 compared to 0.8 in African American men and 0.3 in Caucasian women (12). The precise magnitude of risk for gender, ethnicity and age are not defined. Esophageal capsule endoscopy is a new technique that has the potential to provide a noninvasive diagnosis of suspected BE, i.e. a columnar lined esophagus. Early studies of small numbers of patients showing high sensitivity have been followed by data sets in abstract form documenting substantially lower sensitivity (25, 26). Although intriguing, this technique cannot be recommended in the screening setting at this time (Grade B Recommendation). It is anticipated that the cost of the capsule and its accuracy will be barriers to lowering the threshold for screening for BE. A more definitive estimate of the population prevalence of BE −1.6% - provides evidence of asymptomatic BE. Forty-four percent of the BE patients from a random sample of adults in 2 communities in Sweden lacked "troublesome heartburn and/or regurgitation over the past 3 months" (27). The inability to distinguish these patients' poses a major problem in developing an effective screening strategy for BE based upon symptoms. There are no current risk factors recognized to identify asymptomatic patients with BE. Such identification will be necessary before screening can be expected to effectively detect the majority of patients with BE. The natural history of asymptomatic BE is undefined. In summary, screening for Barrett's esophagus in the general population cannot be recommended at this time. (Grade B recommendation) The use of screening in selective populations at higher risk remains to be established (Grade D recommendation) and therefore should be individualized. SURVEILLANCE OF BARRETT'S ESOPHAGUS The grade of dysplasia determines the appropriate surveillance interval. Any grade of dysplasia by histology should be confirmed by an expert pathologist. Surveillance endoscopy remains controversial because of the lack of randomized trials supporting its value. Critical analysis of the literature does suggest a survival advantage of endoscopic surveillance. Multiple retrospective studies have been published, all of which indicate that survival is statistically enhanced if the cancers are detected by endoscopic surveillance rather than presenting with symptoms (Table 1). In a California community-based population, surveillance detected cancer had lower staging with better survival (28). A larger SEER/Medicare database documented that an EGD 1 year prior to the diagnosis of EAC was associated with earlier stage and improved survival (29).Table 1: Retrospective Surgical Series of Survival for EAC Based on Surveillance StatusSurveillance is practiced by the vast majority of endoscopists in the US (30, 31). The strongest rationale for early case detection of EAC is the poor 5 year survival of EAC of 13% even with contemporary therapy (32). A patient with documented BE needs to be assessed as a candidate for surveillance. It is recommended that patients be advised of the benefits and risks of surveillance endoscopy. Consideration for beginning a surveillance program should include age, likelihood of survival over the next five years, patient's understanding of the process and its limitations for detection of cancer, and the willingness of the patient to adhere to the recommendations (Grade B Recommendation). Surveillance endoscopy should be performed in patients whose reflux symptoms are controlled with proton pump inhibitor therapy. The goal is healing the esophagitis to reduce the likelihood of the inflammatory process interfering with the visual recognition of BE (14) and contributing to cellular changes confusing the reading of dysplasia. Four quadrant biopsies every 2cm of the Barrett's mucosa sample only a small fraction of the lining but offer the possibility of recognizing dysplasia. Ideally the biopsies from a given segment of Barrett's esophagus should be submitted to pathology in a separate container to enable the focusing of subsequent biopsies on the area if dysplasia is identified. Cost effectiveness studies are needed to evaluate this approach. Even if the initial two endoscopies within one year lack dysplasia, there is no guarantee of the subsequent lack of neoplasia, but may allow an interval of three years for surveillance (Table 2). A combined cohort of BE patients documented that half of patients who developed HGD/EAC had no dysplasia on their first two endoscopies (33).Table 2: Dysplasia Grade and Surveillance IntervalThe finding of low grade dysplasia (LGD) warrants a follow-up endoscopy within six months to ensure that no higher grade of dysplasia is present in the esophagus. If none is found, then yearly endoscopy is warranted until no dysplasia is present on two consecutive annual endoscopies. LGD should be confirmed by an expert GI pathologist because of the problem of reading variability (34). When two pathologists agree on the diagnosis of LGD, the patient has a greater likelihood of neoplastic progression percent of biopsies the recognition of LGD will be (20). of patients with LGD had no dysplasia after a follow-up of 4 years. The finding of high grade dysplasia in mucosa should to by an expert GI pathologist and a subsequent endoscopy within three with should undergo endoscopic resection. Although the natural history of is there is a five year risk of EAC excluding in the first It is because of the high risk of cancers that these patients are often as if cancer is with endoscopic CT and even have been performed there is not evidence to their Patients with confirmed high grade dysplasia, even if should be regarding their or would use as a threshold for or surveillance. who to have their dysplasia on surveillance should be to the highest of dysplasia found. This is based upon the problem of on subsequent of intestinal metaplasia mucosa can also with short segments of columnar so the patient should undergo periodic surveillance. If therapy has been patients should be followed and in the area of prior Barrett's mucosa at intervals appropriate for their prior grade of dysplasia until there is of ablation is documented on at least three consecutive endoscopies. (Grade D recommendation) surveillance is recommended Barrett's mucosa has been to recommendations regarding these intervals are not made given the of data of intestinal metaplasia but case series have established that the phenomenon does In summary, the surveillance of Barrett's esophagus does have evidence suggesting The more advanced the in terms of dysplasia, the more surveillance is However, using evidence of dysplasia as the primary to establish surveillance is There are with and need for endoscopies which this an that will need Surveillance is recommended but is a Grade C as long controlled studies are not OF grade dysplasia expert pathologist and more endoscopy and grade dysplasia also by an expert pathologist and a threshold for A more biopsy is necessary to the presence of concomitant adenocarcinoma. Any such as or is best assessed with endoscopic for a more and of of patients with high grade dysplasia is on endoscopic and and the patient's age, and is no longer the necessary treatment to have that for high-grade dysplasia the of four quadrant biopsies should be every 1 because larger intervals to a greater rates of cancer In any within the Barrett's if high-grade dysplasia has been found, should undergo endoscopic to adequate for more has been to be associated with a higher of and with to endoscopic may be these are The use of large has been in the setting of high-grade dysplasia, to biopsy have not been in terms of changes in patient The endoscopic technique to be used to yield is a which should the mucosa in to the biopsy Endoscopic has also been used surveillance of Barrett's esophagus in the that increased to sample the might to better diagnoses are as to additional can be obtained from However, the use of new such as in may be in increasing the clinical of ablation therapy has also been to decrease the risk of development of cancer within Barrett's esophagus. This is in with which to be a The of has not been established However, all studies on ablation therapy have been in with at least and most often proton pump inhibitor therapy. therapy has been the only therapy in a randomized control to decrease cancer risk in Barrett's esophagus In this study, patients were randomized to photodynamic therapy or with the primary of therapy using and was to decrease the risk of by but not the development of cancer after at least months of follow The therapy was also to high-grade dysplasia in of patients of patients in the control also high-grade dysplasia These were if high-grade dysplasia at any subsequent endoscopy. ablation techniques were originally for the treatment of Barrett's esophagus lacking dysplasia. The initial were that The of ablation was first with these ablation has been with or which to have based upon recent small randomized trials at high has been in case series to be to high-grade dysplasia and even small cancers, follow-up is not available has been used to low-grade dysplasia and rates of the Barrett's mucosa are in the with multiple of the of the have been in small of patients followed over short of time. therapy with an with has been in It is in high-grade dysplasia and early EAC in case series It does have of and even patient ablation using a based system has been to be of in of Barrett's esophagus in months after of treatment a radiofrequency on the has treatment of with this This was to the of the esophagus with high radiofrequency and esophageal have been Endoscopic of has also been to Barrett's esophagus, there is data its Surgical has been a of therapy for Barrett's esophagus with high grade dysplasia based upon that endoscopic surveillance may not detect early cancers in to of patients and the for prior to development of cancer may be the of EAC at in patients with at biopsy has been as low as recent studies have that the risk of cancer in the setting of is low at if there is no evidence of cancers detected in the presence of prior high grade dysplasia are early stage This has to changes in the is performed in these can be performed with techniques that the use of and However, the invasiveness of the one large series of patients the major rates time in and time of to be to that from which the of the esophagus the mucosa and with has also been in to decrease the after This has been to but has not been by the because of the need for the Patients need to be to a higher for the best A recent analysis of the literature has there needs to be at least a year at an to decrease mortality to or less A recent retrospective study comparing the mortality of patients with high-grade dysplasia with photodynamic therapy and endoscopic compared with found between the two at months of patients in had an esophageal cancer In summary, high-grade dysplasia is associated with a risk of cancer needs to be with of endoscopic ablation therapy, and presented to the patient based on their for these and the available to provide the current it as if surveillance with endoscopic techniques a of or may in retrospective cohort studies from expert The of which of these be and will on the available in the patient's the patient's and the (Grade B recommendation). BARRETT'S ESOPHAGUS Barrett's esophagus has been the of new It is not surprising the esophagus is using and the of mucosa to be is There have been to image Barrett's esophagus. The most available technique is a of the to two major and which are actually more by in the mucosa and These the to the mucosa better in with a high This has been the has been or A can be performed after image and has been by another The is based on with of by the Both of these can be applied to Barrett's esophagus In one study of patients with Barrett's esophagus with of had high grade dysplasia, the sensitivity of detection for a was with a of However, studies regarding the in of these has not been has also been used in to of dysplasia in Barrett's esophagus. This to detect from cellular in the esophagus. of dysplasia do not have as as and This may be more for screening larger of In Barrett's esophagus, one study has found that was for of high grade dysplasia in patients but had a rate have been used to image the esophagus with to the mucosa of of intestinal metaplasia but will not if there is high grade dysplasia or cancer The by which is applied and the of performed prior to of the this technique have had and studies have not found a advantage to in to random four quadrant biopsies in detection of dysplasia such as and have also been to the detection of in Barrett's esophagus in with high endoscopy There is in these it is the identification of will be in clinical The can the other techniques have been developed that small mucosa that might be on these These include and which can the mucosa and actually image cellular studies are in in Barrett's esophagus. in patients had an accuracy of for detection of which in a more to but using to also has for the detection of intestinal metaplasia at the gastric junction prior studies have not been in dysplasia can the from the mucosa and its to determine the of dysplasia that is that can such as and have been combined to allow improved of the mucosa the present of these is to in an and Although there is not evidence at this time to the use of these systems on a clinical BARRETT'S ESOPHAGUS Multiple have been but have actually been There is in the use of such as and in biopsy in cancer as well as of of such as and In recent studies that of and as well as demographic of the patients and BE length are of cancer or is for clinical There is a large cohort of patients that has been followed with the in the This has been using of that have been by to a of Based on these studies, there is no risk of cancer development for five years if there is no evidence of increased than or However, if was there was an increased risk of cancer whereas evidence of increased risk However, these have been to clinical because of the number of biopsies in the needed to In the in has at of as a using to detect of of and these are of cancer with a increased risk of cancer if of is detected However, these techniques have only been applied to that have been of these in a study is needed before it can be recommended for In a recent an of from patients who had developed cancer compared to case who had not found that of three and in their once again to predict cancer These be on which is an advantage over the mentioned However, these studies have only been on patient and have not been applied in a large that have been over time include of of and Although multiple have been to be in small of none of these has been in studies. The for the detection of GERD patients who will to BE would be noninvasive i.e. and or The to risk patients with BE would be noninvasive and the focusing of surveillance endoscopy on this high risk for EAC. This would identify patients with BE who will to EAC early for even the appropriate therapy. A low risk also be which might not cost effective surveillance would be this that can be performed on a clinical for widespread use are not BARRETT'S ESOPHAGUS a in the stage of esophageal adenocarcinoma by Barrett's esophagus seems Unfortunately, evidence that any treatment cancer and more cancer in this setting is The best evidence for any with that have been in multiple studies to be associated with a risk of cancer with an of interval This risk has also been with the that such as and were also with Unfortunately, in a randomized not its patient was not more effective than in patients with BE and dysplasia in the of the change of the of biopsies with dysplasia studies have risk of cancer in given trials are the use of and low and high proton pump inhibitor therapy in Barrett's esophagus but these will years to from two retrospective cohort studies suggest that therapy the likelihood of developing dysplasia This provides a rationale to even asymptomatic BE patients with The of therapy as a of cancer has not been documented can be made to use these as BARRETT'S ESOPHAGUS patients with Barrett's esophagus, the goal of with such as the proton pump is to control reflux symptoms. symptoms can be controlled in most patients with proton pump inhibitor therapy. a may be necessary in a subgroup of Retrospective studies have a decrease in development of dysplasia in patients with or proton pump have that of esophageal may decrease of there are no data that the use of high therapy to or the development of EAC. Patients who are for may These include patients lacking major and whose reflux symptoms are controlled with therapy. are with a rate at 5 years The vast majority of data do not provide that EAC detection of It is anticipated that in the short may available that identify Barrett's mucosa based on high or A randomized impact of surveillance endoscopy. A randomized controlled of surveillance is needed to determine the of this recognition of techniques are available that can distinguish of dysplasia. These from and to such as and or more of these will definition of risk of dysplasia. in the of endoscopic ablation of the most recent radiofrequency ablation is is beginning clinical trials and older are more photodynamic therapy with the development of new of the and duration of the surveillance after endoscopic ablation therapy of a to risk BE There are many potential but clinical trials that their This will change given the many for

Geofencing surveillance poses a dynamic spatial sampling problem. Law enforcement must establish geofence perimeters to identify a relevant suspect. This requires identifying a sampling region around a surveillance site and counting the number of intersecting individuals as proxied by geolocation tags. Law enforcement commonly constructs sampling regions with fixed distance intervals or fixed polygon boundaries. This generates privacy concerns as considerations for constructing these perimeters do not factor in the local density of human activity, such as pedestrian flows or traffic patterns. This increases the risk of selective expansion where agencies attempt to extend their data collection beyond what a warrant previously approved. This paper attempts to balance law enforcement's needs for surveillance with individual level privacy by proposing a set of optimal radius estimators. These plug-in estimators use the empirical distribution of human activity patterns to estimate an optimal radius. Given a surveillance site and set of point densities, the optimal radius generates surveillance perimeters that adapt to local conditions. We discuss the implications of applying this estima

High-Frequency (HF) radar is well suited to the surveillance of low-Earth-orbit space. For large targets, a small deployable HF radar is able to match the detection performance of much larger space surveillance radar systems operating at higher frequencies. However, there are some unique challenges associated with the use of HF, including the range--Doppler coupling bias, coarse detection-level localisation, and the presence of meteor returns and other unwanted signals. This paper details the use of HF radar for space surveillance, including signal processing and radar product formation, tracking, ionospheric correction, and orbit determination. It is shown that by fusing measurements from multiple passes, accurate orbital estimates can be obtained. Included are results from recent SpaceFest trials of the Defence Science and Technology Group's HF space surveillance radar, achieving real-time wide-area surveillance in tracking, orbit determination, and cueing of other space surveillance sensors.

As panoptical, AI-driven surveillance becomes a norm, everyone is impacted. In a reality where all people fall victim to these technologies, establishing links and solidarity is essential to fighting back. Two groups facing rising and targeted surveillance are workers and individuals impacted by the carceral system. Through preliminary data collection from a worker-surveillance lens, our findings reveal several cases of these surveillance infrastructures intersecting. Continuation of our work will involve collecting cases from a carceral-centered lens. Driven by a community-facing analysis of the overlap in the AI-driven surveillance experienced by workers and individuals impacted by the carceral system, we will facilitate discussions with restorative justice activists around cultivating solidarity and empowerment focused on the interconnected nature of workplace and carceral surveillance technologies.

Automatic identification of events and recurrent behavior analysis are critical for video surveillance. However, most existing content-based video retrieval benchmarks focus on scene-level similarity and do not evaluate the action discrimination required in surveillance. To address this gap, we introduce SOVABench (Surveillance Opposite Vehicle Actions Benchmark), a real-world retrieval benchmark built from surveillance footage and centered on vehicle-related actions. SOVABench defines two evaluation protocols (inter-pair and intra-pair) to assess cross-action discrimination and temporal direction understanding. Although action distinctions are generally intuitive for human observers, our experiments show that they remain challenging for state-of-the-art vision and multimodal models. Leveraging the visual reasoning and instruction-following capabilities of Multimodal Large Language Models (MLLMs), we present a training-free framework for producing interpretable embeddings from MLLM-generated descriptions for both images and videos. The framework achieves strong performance on SOVABench as well as on several spatial and counting benchmarks where contrastive Vision-Language Models of

The modern web is increasingly characterized by the pervasiveness of Surveillance Capitalism. This investigation employs an empirical approach to examine this phenomenon through the web tracking practices of major tech companies -- specifically Google, Apple, Facebook, Amazon, and Microsoft (GAFAM) -- and their relation to financial performance indicators. Using longitudinal data from WhoTracks.Me spanning from 2017 to 2025 and publicly accessible SEC filings, this paper analyzes patterns and trends in web tracking data to establish empirical evidence of Surveillance Capitalism's extraction mechanisms. Our findings reveal Google's omnipresent position on the web, a three-tier stratification among GAFAM companies in the surveillance space, and evidence suggesting an evolution of tracking techniques to evade detection. The investigation further discusses the social and environmental costs of web tracking and how alternative technologies, such as the Gemini protocol, offer pathways to challenge the extractive logic of this new economic order. By closely examining surveillance activities, this research contributes to an ongoing effort to better understand the current state and future t

Introduction: The value of integrating federal HIV services data with HIV surveillance is currently unknown. Upstream and complete case capture is essential in preventing future HIV transmission. Methods: This study integrated Ryan White, Social Security Disability Insurance, Medicare, Children Health Insurance Programs and Medicaid demographic aggregates from 2005 to 2018 for people living with HIV and compared them with Centers for Disease Control and Prevention HIV surveillance by demographic aggregate. Surveillance Unknown, Service Known (SUSK) candidate aggregates were identified from aggregates where services aggregate volumes exceeded surveillance aggregate volumes. A distribution approach and a deep learning model series were used to identify SUSK candidate aggregates where surveillance cases exceeded services cases in aggregate. Results: Medicare had the most candidate SUSK aggregates. Medicaid may have candidate SUSK aggregates where cases approach parity with surveillance. Deep learning was able to detect candidate SUSK aggregates even where surveillance cases exceed service cases. Conclusions: Integration of CMS case level records with HIV surveillance records can incre

The growing demand for surveillance in public spaces presents significant challenges due to the shortage of human resources. Current AI-based video surveillance systems heavily rely on core computer vision models that require extensive finetuning, which is particularly difficult in surveillance settings due to limited datasets and difficult setting (viewpoint, low quality, etc.). In this work, we propose leveraging Large Vision-Language Models (LVLMs), known for their strong zero and few-shot generalization, to tackle video understanding tasks in surveillance. Specifically, we explore VideoLLaMA2, a state-of-the-art LVLM, and an improved token-level sampling method, Self-Reflective Sampling (Self-ReS). Our experiments on the UCF-Crime dataset show that VideoLLaMA2 represents a significant leap in zero-shot performance, with 20% boost over the baseline. Self-ReS additionally increases zero-shot action recognition performance to 44.6%. These results highlight the potential of LVLMs, paired with improved sampling techniques, for advancing surveillance video analysis in diverse scenarios.

Communication, Navigation, and Surveillance (CNS) is the backbone of the Air Traffic Management (ATM) and Unmanned Aircraft System (UAS) Traffic Management (UTM) systems, ensuring safe and efficient operations of modern and future aviation. Traditionally, the CNS is considered three independent systems: communications, navigation, and surveillance. The current CNS system is fragmented, with limited integration across its three domains. Integrated CNS (ICNS) is a contemporary concept implying that those systems are provisioned through the same technology stack. ICNS is envisioned to improve service quality, spectrum efficiency, communication capacity, navigation predictability, and surveillance capabilities. The 5G technology stack offers higher throughput, lower latency, and massive connectivity compared to many existing communication technologies. This paper presents our 5G ICNS vision and network architecture and discusses how 5G technology can support integrated CNS services using terrestrial and non-terrestrial networks. We also discuss key 5G radio access technologies for delivering integrated CNS services at low altitudes for Innovative Air Mobility (IAM) and Advanced Air Mob

Wide exploration on robocall surveillance research is hindered due to limited access to public datasets, due to privacy concerns. In this work, we first curate Robo-SAr, a synthetic robocall dataset designed for robocall surveillance research. Robo-SAr comprises of ~200 unwanted and ~1200 legitimate synthetic robocall samples across three realistic adversarial axes: psycholinguistics-manipulated transcripts, emotion-eliciting speech, and cloned voices. We further propose RoboKA, a Kolmogorov-Arnold Network (KAN)-based multimodal fusion framework designed to model structured nonlinear interactions between acoustic and linguistic cues that characterize diverse adversarial robocall strategies. RoboKA first leverages cross-modal contrastive learning to align latent modality representations and feeds the resulting embeddings to a KAN-projection head for final classification. We benchmark RoboKA against strong unimodal and multimodal baselines in both in-domain and out-of-domain setups, finding RoboKA to surpass all baselines in terms of recall and F1-score.

Sixth-generation (6G) communication systems are expected to support direct-to-device (D2D) connectivity, enabling standard user equipment (UE) to seamlessly transition to non-terrestrial network (NTN), particularly satellite communication mode, when operating beyond terrestrial network (TN) coverage. This D2D concept does not require hardware modifications to conventional UEs and eliminates the need for dedicated satellite ground terminals. D2D-capable UEs can be mounted on both manned and unmanned aircraft, however, they are especially well-suited for low-altitude unmanned aircraft due to their compact form factor, lightweight design, energy efficiency, and TN-NTN roaming capabilities. D2D can also enable beyond-visual-line-of-sight operation by providing NTN support for Communications, Navigation, and Surveillance (CNS) services during TN outages or congestion. This paper investigates the capabilities and limitations of D2D connectivity for low-altitude unmanned aircraft operating in urban environments. We analyze the variation in line-of-sight probability for both TN and NTN links as a function of aircraft altitude. We further compute path loss and received signal strength while

To ensure safe, secure, and efficient advanced air mobility (AAM) operations, an AAM surveillance network is needed to detect and track AAM traffic. Additionally, a cloud-based surveillance data collection, monitoring, and distribution center is needed, where AAM operators and service suppliers, law enforcement agencies, correctional facilities and municipalities can subscribe to for receiving relevant AAM traffic data to plan and monitor AAM operations. In this work, we develop an optimization model to design a surveillance sensor network for AAM that minimizes total sensor cost while providing full coverage in the desired region of operation, considering terrain types of that region, terrain-based sensor detection probabilities, and meeting the minimum detection probability requirement. Moreover, we present a framework for low altitude surveillance information clearinghouse (LASIC), connected to the optimized AAM surveillance network for receiving live surveillance feed. Additionally, we conduct a cost-benefit analysis of the AAM surveillance network and LASIC to justify investment in it. We examine six potential types of AAM sensors and homogeneous and heterogeneous network type

Surveillance videos are an essential component of daily life with various critical applications, particularly in public security. However, current surveillance video tasks mainly focus on classifying and localizing anomalous events. Existing methods are limited to detecting and classifying the predefined events with unsatisfactory semantic understanding, although they have obtained considerable performance. To address this issue, we propose a new research direction of surveillance video-and-language understanding, and construct the first multimodal surveillance video dataset. We manually annotate the real-world surveillance dataset UCF-Crime with fine-grained event content and timing. Our newly annotated dataset, UCA (UCF-Crime Annotation), contains 23,542 sentences, with an average length of 20 words, and its annotated videos are as long as 110.7 hours. Furthermore, we benchmark SOTA models for four multimodal tasks on this newly created dataset, which serve as new baselines for surveillance video-and-language understanding. Through our experiments, we find that mainstream models used in previously publicly available datasets perform poorly on surveillance video, which demonstrate

The deployment of traditional deep learning models in high-risk security tasks in an unlabeled, data-non-exploitable video intelligence environment faces significant challenges. In this paper, we propose a lightweight anomaly detection framework based on color features for surveillance video clips in a high sensitivity tactical mission, aiming to quickly identify and interpret potential threat events under resource-constrained and data-sensitive conditions. The method fuses unsupervised KMeans clustering with RGB channel histogram modeling to achieve composite detection of structural anomalies and color mutation signals in key frames. The experiment takes an operation surveillance video occurring in an African country as a research sample, and successfully identifies multiple highly anomalous frames related to high-energy light sources, target presence, and reflective interference under the condition of no access to the original data. The results show that this method can be effectively used for tactical assassination warning, suspicious object screening and environmental drastic change monitoring with strong deployability and tactical interpretation value. The study emphasizes the