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Established measures of lower-limb muscle function repeatedly show weak, inconsistent or absent association and predictive value for injury, re-injury and other musculoskeletal complaints. Progress in prevention, rehabilitation, and return-to-sport decision-making is unlikely to come from recombining or modifying them. The question is whether the quantity they capture is unsuitable-calling for a change in what is measured. Muscle-function assessment should match the demand it sets out to capture: non-contact injuries occur when muscles must stabilise a joint and adapt to a rising external load. This adaptive, stabilising control is largely unaddressed by established measures. Shifting the focus from muscle strength to muscle stability-from producing force against a resistance to holding a position while adapting to a rising external load (Adaptive Force)-may bring assessment closer to what actually determines joint protection and clinical outcome.
Invasive species are a threat to ecological and anthropogenic systems. In the United States, policies to coordinate funding and precipitate management action have been slow to emerge at the federal level, and there is a patchwork of regulation and legislation at the state level. This means that managers and policymakers, already facing limited budgets and evolving goals for action on invasive species, also face detrimental policy inconsistencies across states. Although previous research has explored state-level invasive plant policy, policy relating to invasive invertebrate and vertebrate taxa (and across all three) is understudied. We expand upon previous taxa-limited examinations of public policy related to invasives, looking across all taxonomic groups, including plants, to explore coherency of state regulations. We expanded the taxonomicscope of a database of policies in 21 contiguous eastern US states and used it to examine (in)consistencies in spatial trends for invasive species listed in policies across and within taxonomic groups. We examined the coherency of neighboring states and regional overlap of named species. We also analyzed correlations between distances among states and the species listed in the policy to examine regional trends. We found 1117 policy segments relevant to invasive species with 448 naming at least one taxon at the genus or species level. Of these, 35.3% were plants, 19.9% were invertebrates, and 44.8% were vertebrates. The distribution of taxa contained within policies varied across states, underscoring high variability in the proportion of taxa listed in the policies of neighboring states. Even lower policy coherency existed at the regional scale, particularly for invertebrate and vertebrate taxa. Our results indicate that policy inconsistency exists across all taxonomic groups, and the lack of attention to invasive invertebrates and vertebrates across state policies is particularly concerning. Policy inconsistency means that proactive states are susceptible to invasion from neighboring states where invasives are not similarly regulated. There is an opportunity to improve coordination between states to reduce vulnerability to invasives due to policy inconsistency.
Delaware is experiencing a significant demographic shift as its older adult population continues to grow. Currently, approximately 18 percent of Delaware residents are age 65 years and older, and projections indicate that more than one in five Delawareans will be over age 65 by 2030. Concurrently, chronic disease prevalence, physical inactivity, cognitive decline, and other aging-related health challenges continue to place increasing demands on healthcare systems, community services, and public health infrastructure. Addressing these complex issues requires coordinated, interdisciplinary approaches that integrate research, education, workforce development, and community engagement. This paper highlights the collective contributions of Delaware's public institutions of higher education in advancing healthy aging initiatives across the state. Programs and activities supported by Delaware State University, Delaware Technical Community College, and the University of Delaware are unique in scope and topic but collectively contribute to research, workforce training, evidence-based program implementation, policy development, and community outreach. Beyond individual programs, this paper emphasizes the value of interdisciplinary partnerships among academic institutions, healthcare organizations, government agencies, and community stakeholders. Such collaborations enhance opportunities for experiential learning, translational research, workforce development, and evaluation of programs that support older adults across rural, suburban, and urban communities. Looking forward, Delaware's higher education institutions are uniquely positioned to strengthen statewide collaboration through shared educational opportunities, aging-focused workforce initiatives, coordinated research efforts, and a proposed statewide aging summit. By leveraging collective expertise and resources of the state's rich academic programs, Delaware can develop a coordinated strategy to promote healthy aging, improve quality of life, and prepare for the needs of its rapidly growing older adult population.
Evaluating temporal trends in foodborne outbreak and illness attribution to specific food types is important for understanding which foods may be emerging as sources of illness and whether prevention strategies are working to prevent these illnesses. Evaluating these trends can be difficult because foodborne outbreaks are uncommon, and attribution of these outbreaks to a specific food can be difficult. We present a Bayesian trend model looking at outbreaks and outbreak-associated illnesses linked to four Interagency Food Safety Analytics Collaboration (IFSAC) priority foodborne bacterial pathogens: Campylobacter, Shiga toxin-producing Escherichia coli O157, Listeria monocytogenes, and Salmonella using a categorization scheme IFSAC created to classify foods into 17 categories that closely align with the U.S. food regulatory agencies' classification needs. Outbreaks and outbreak-associated illnesses of listeriosis increased in dairy products during 1998-2018 while those linked to meat and poultry decreased. Outbreaks of campylobacteriosis linked to both dairy and poultry products also increased. STEC O157 outbreaks and outbreak-associated illnesses linked to meat decreased over the period. Outbreaks and outbreak-associated illnesses of salmonellosis linked to eggs also decreased over the period. This new approach to evaluating temporal changes in outbreaks and outbreak-associated illnesses may be a useful tool in understanding the epidemiology and impacts of prevention strategies for foodborne illness.
The digital transformation of rehabilitation training has become a public health imperative driven by a global demand that outstrips professional medical resources and is compounded by a deficit in public rehabilitation literacy. As traditional hospital-centric models reach their scalability limits, there is a critical necessity for accessible home-based care solutions to ensure patients do not miss optimal recovery windows. To evaluate computer vision as a potential solution, this paper conducts a systematic review following the PRISMA 2020 reporting framework. We identify that its clinical migration faces a profound "Paradigm Gap" across three critical domains which this study aims to address: (1) the Perception Domain, where algorithms are constrained by inherent reconstruction ambiguities and pathological data scarcity; (2) the Assessment Domain, where a "semantic gap" persists between low-level features and clinical reasoning; and (3) the Coaching Domain, where feedback mechanisms fail to translate summative "Knowledge of Results (KR)" into actionable "Knowledge of Performance (KP)." We formulate and adopt "Perception, Assessment, and Coaching (PAC)" as a novel taxonomy to serve as a logical grid for systematically analyzing existing literature and elucidating technical pathways required to resolve these clinical challenges. This review synthesizes the technological landscape into three evolutionary trajectories: (1) In Perception, research is shifting toward constructing biomechanically consistent digital twins to eliminate visual hallucinations. (2) In Assessment, frontier methods are establishing interpretable clinical reasoning engines to achieve a leap from engineering parameters to Evidence-Based Medicine (EBM) evidence. (3) In Coaching, focus lies in precise movement correction via semantic translation and multimodal strategies to support motor relearning. Furthermore, we explore the potential of Generative AI and Multimodal Large Language Models (MLLMs) in reshaping interaction paradigms (e.g., Visual Self-Modeling) alongside critical discussions on ethical boundaries. Through a systematic literature review, this paper elucidates the task boundaries of rehabilitation vision and constructs the PAC taxonomy. It provides a robust theoretical roadmap and forward-looking guidance for the design of the next generation of clinically valid intelligent rehabilitation systems.
We report a deceptive presentation of Squamous Cell Carcinoma of the Cervix in a 54-year-old postmenopausal woman who presented with postmenopausal bleeding associated with lower abdominal pain for a 3-month duration, with a normal-looking ectocervix. She was diagnosed with squamous cell carcinoma on a pap smear and cervical biopsy. Magnetic resonance imaging revealed an irregular endometrial cavity contour, and a T2 hyperintense lesion was seen (2.3 × 0.8 cm) involving the posterior lip of the cervix at the junction of stroma and endocervix with a mural spread along the uterine myometrium. Histopathology after Wertheim's hysterectomy revealed a squamous cell carcinoma of the endocervix, Stage pT1b3, that had spread superficially to the endometrium, myometrium, and left salpinx. The detection of immunohistochemical expression of p16, p63, and negative for ER and PR in the lesions of the cervix and the endometrium suggests that these two lesions are etiologically related, favoring the possibility of endometrial SCC secondary to cervical SCC.
An optimal spatial orientation is essential for pilots. Therefore, pilot applicants in the Royal Danish Air Force undergo various ear-nose-throat evaluations. It is recommended to avoid alcohol for a minimum of 24 h before evaluation. No recommendation has been made regarding nicotine and, with the increasing availability of nicotine through pouches and other products, it is therefore relevant to examine its impact on vestibular function, particularly on nystagmus, which plays a key role in clinical vestibular assessment. We conducted a structured literature search using PubMed and Cochrane Library as the primary databases in 2025 and 2026. The search strategy used a combination of keywords and MeSH terms and criteria for inclusion and exclusion were made. In total, 22 studies were included looking at nicotine's effect on the vestibular system. Overall, the studies showed an impact on the vestibular system and the induction of nystagmus through different delivery methods of nicotine. The effects of nicotine on nystagmus appear within minutes and can persist for up to 30 min, and nicotine blood concentrations are measurable more than 2 h after exposure. We suggest that pilot applicants be advised to abstain from nicotine products for a specified period of 12-24 h before undergoing ear-nose-throat examinations to minimize test interference. Further studies are needed to uncover the effect nicotine can have on in-flight performance. Kahlhofen N, Lindgaard K. Nicotine effects on vestibular function in pilot selection. Aerosp Med Hum Perform. 2026; 97(8):638-643.
Pyroptosis, a lytic and inflammatory form of programmed cell death, has emerged as a regulator of tumor immunity through its capacity to trigger localized cytokine storms (operationally defined in Section 3). This review examines the dual mechanisms by which macrophage pyroptosis-driven cytokine storms influence tumor progression. Pyroptosis is executed through canonical (caspase-1/nucleotide-binding oligomerization domain-like receptor family pyrin domain-containing 3 (NLRP3)-dependent) and non-canonical (caspase-4/5/11-dependent) pathways, both converging on cleavage of gasdermin D (GSDMD) to form membrane pores that release pro-inflammatory cytokines (interleukin-1 beta, IL-1β; interleukin-18, IL-18) and damage-associated molecular patterns (DAMPs). These primary signals initiate cascade amplification through chemokine and cytokine networks, recruit diverse immune cell populations, and establish distinct inflammatory microenvironments. The effects of pyroptotic cytokine storms show striking temporal and intensity dependence. Acute, moderate inflammatory responses activate anti-tumor immunity through induction of immunogenic cell death (ICD), dendritic cell maturation, and cytotoxic lymphocyte priming. Chronic, low-grade cytokine storms, in contrast, promote tumorigenesis through six interconnected mechanisms: genomic instability and epigenetic reprogramming, cancer stem cell enrichment, pro-angiogenic remodeling, pre-metastatic niche formation, establishment of an immunosuppressive microenvironment, and induction of epithelial-mesenchymal transition. This "double-edged sword" phenomenon depends on inflammation intensity, duration, spatial distribution, and tumor microenvironment (TME) characteristics. Clinical investigations indicate that pyroptosis-related biomarkers, including GSDMD, gasdermin E (GSDME), and inflammatory cytokine profiles, may support patient stratification and treatment-response prediction across multiple cancer types in patients with tumor-associated macrophages (TAMs)-rich tumors. Preclinical evidence from bioorthogonal chemical systems in murine models, together with mathematical modeling, has suggested that pyroptosis affecting approximately 10-15% of tumor cells may serve as a tentative threshold for initiating anti-tumor immunity. However, this value has been derived from a limited number of preclinical systems (primarily 4T1 mammary tumor models) and has not yet been validated in human tumors; it should therefore be interpreted as a working hypothesis rather than an established parameter. Current therapeutic strategies targeting this pathway include NLRP3 inhibitors, IL-1β/IL-18 blockers, and combination approaches with immune checkpoint inhibitors (ICIs). Looking forward, future research should prioritize: (i) quantitative in vivo mapping of macrophage pyroptosis using spatial multi-omics and intravital imaging; (ii) development of tumor-targeted, spatiotemporally controlled pyroptosis inducers (e.g., nano-delivery and bioorthogonal activation systems); (iii) rational combination with immune checkpoint inhibitors and epigenetic modulators; and (iv) establishment of pyroptosis-based biomarker panels to guide patient stratification and toxicity prediction in clinical trials. Achieving "controllable cytokine storms" through precise macrophage pyroptosis modulation represents a therapeutic paradigm that balances anti-tumor efficacy against inflammatory toxicity, with the potential to advance cancer immunotherapy toward precision inflammation regulation.
MXenes, a burgeoning family of two-dimensional transition metal carbides, nitrides, and carbonitrides, have garnered significant attention due to their metallic conductivity, hydrophilicity, and surface-rich chemistry, offering immense potential across electrochemical energy storage, catalysis, and advanced sensing. Achieving precise control over their surface chemistry is pivotal for tailoring physicochemical properties and unlocking application-specific functionalities. This review comprehensively summarizes recent progress in MXene chemistry modulation via advanced synthesis protocols and post-synthetic modifications, with an emphasis on surface terminations and interlayer engineering. We discuss the influence of etching conditions, delamination strategies, and intercalation chemistries on the structural and electronic characteristics of MXenes. Moreover, mechanistic insights into ion intercalation and surface functional group evolution are critically analyzed to guide rational design strategies. Key challenges-including batch-to-batch variability, limited scalability, and insufficient mechanistic understanding of surface transformations-are also addressed. This review provides a forward-looking perspective on engineering MXenes with tunable interfaces for next-generation applications in energy, catalysis, and flexible electronic skin systems.
Colloidal models with short-range attraction and long range repulsion (SALR) have been extensively studied using theoretical and simulations methods due to their rich and universal equilibrium phase behavior. Using Brownian dynamics simulations, we study the dynamical phase behavior of active suspensions in which colloidal particles interact with each other via a SALR potential. Upon increasing the self-propulsion force of the particles, we observed that the structural transitions the active suspension undergoes resemble those observed in its passive counterpart by increasing the temperature of the thermal bath. However, when looking at the transport properties of active and passive suspensions with similar structure, we observed a clear mismatch. We demonstrated that increasing the activity enhances the particles mobility within the SALR fluid while simultaneously preserving the structure. This leads to a structure-dynamics decoupling induced by the activity while highlighting the structural memory of SALR potentials under non-equilibrium conditions.
The Wnt family ligands carry a lipid moiety that must be shielded from the aqueous environment. During secretion, this is achieved by the cargo receptor Wntless. The effect of acute endocytosis inhibition suggests that Wingless dissociates from Wntless at the apical plasma membrane but is prevented from being released extracellularly by rapid endocytosis. Super-resolution microscopy shows that Wingless then traffics, without Wntless, through specialized Rab7/Rab4-positive endosomes before basolateral release. In the absence of endocytosis, apical release is allowed, albeit in punctae. Similar punctae are formed upon abrogation of the ceramide synthase Schlank. We suggest that they represent insoluble aggregates since they are 'solubilized' by the lipid-binding protein Dally-like protein. Moreover, purified Wingless forms similar-looking structures that are solubilised by liposomes in vitro. These findings suggest that membrane lipid composition could modulate the stability of the Wingless-Wntless complex and/or the lipid bilayer's ability to accommodate the Wingless lipid. Together with rapid endocytosis, this ensures orderly transfer of Wingless from Wntless to the membrane, preventing aggregation, and promoting basolateral secretion.
Subsurface oil exploration is becoming increasingly challenging due to the complexity of geological formations, growing exploration depths, and the limitations of conventional interpretation methods. A thorough analysis of current developments in artificial intelligence and sophisticated sensing technologies for subsurface oil prospecting is presented. With special emphasis on their uses, advantages, and implementation difficulties, this paper assesses advancements in seismic imaging, electromagnetic surveys, remote sensing, machine learning, and integrated data interpretation frameworks. The results show that while advanced sensing technologies offer higher-resolution subsurface information and lower exploration uncertainty, artificial intelligence greatly increases exploration efficiency by enhancing data processing, pattern recognition, reservoir characterization, and decision-making. Nonetheless, there are lots of issues with data quality, model dependability, scalability, and field deployment. The review offers a thorough reference for researchers and industry practitioners looking to increase exploration accuracy, efficiency, and sustainability. It also emphasizes future research possibilities for intelligent, integrated exploration systems.
Ultrasound-guided nerve blocks (UGNB) are an effective and safe method of pain control that are increasingly used for pain management in the emergency department (ED). However, performing these procedures is often time-intensive due to the need to locate and gather necessary supplies. Our ED recently implemented use of a nerve block cart, which contains all the supplies needed for performing a nerve block. Our objective in this quality improvement study was to assess whether the presence of an ED nerve block supply cart was associated with an increase in the number of UGNBs performed. We conducted a retrospective review of point-of-care ultrasound examinations performed in a single academic quaternary-care community ED over 22 months, looking at 11-month time periods before and after implementation of an ED nerve block supply cart in March 2023. Our primary outcome measure was documentation of a UGNB, and our secondary outcome measure was the type of UGNB performed. We reviewed 14,321 ultrasound exams over 22 months-11 months pre-cart (6,853) and 11 months post-cart (7,468) implementation. We noted a statistically significant increase in the number of UGNBs, from 21 performed in the pre-cart period (0.31% of all ultrasound exams [95% CI, 0.17-0.43%], to 50 UGNBs in the post-cart period (0.67% of all ultrasound exams [95% CI, 0.46-0.86%], P < .01). The fascia iliaca block was the most common UGNB performed in both the pre- (52.4%) and post-cart (62.0%) periods. We found that the deployment of an ED nerve block supply cart was associated with an increased number of ultrasound-guided nerve blocks performed by emergency clinicians in our hospital.
The integration of environmental and developmental cues into coherent physiological responses is fundamental to plant survival. Reactive oxygen, nitrogen, and sulfur species (ROS/RNS/RSS) are now recognized as essential signaling molecules, not merely cytotoxic byproducts. Their specificity is largely achieved through reversible, site-specific cysteine oxidative post-translational modifications (Cys-OxiPTMs), which constitute a dynamic and sophisticated "redox code". This review provides a systematic synthesis of the current landscape of Cys-OxiPTMs in plants, bridging chemistry, hormone biology, agronomy, detection, and engineering. The chemical and enzymatic basis of major Cys-OxiPTMs is detailed, along with a discussion of how their spatiotemporal interplay orchestrates signaling specificity. A critical examination is then presented on how these modifications decode and integrate plant hormone signaling networks to regulate key agronomic traits. Cutting-edge proteomic technologies that have revolutionized the identification of redox-sensitive cysteines are also evaluated. Finally, forward-looking strategies to "write" the redox code are explored. By moving the field from descriptive cataloging to predictive "redox breeding," this review establishes a foundational framework for manipulating Cys-OxiPTMs to develop climate-resilient, high-yielding crops for sustainable agriculture.
High-fat dairy emulsions are widely applied in the bakery and beverage industries for their distinctive texture and functional properties, yet confront the core challenge of long-term storage stability and desirable aeration performance. This review focuses on the interfacial properties of such systems, systematically elaborating on the formation, structural features and characterization methods of oil-water (OW) interfacial layers in emulsions and oil-water-air (O-W-A) interfacial layers in foams. It highlights the pivotal role of interfacial layers in regulating kinetic stability, while noting the intrinsic thermodynamic instability of these systems that induces emulsion destabilization (flocculation, coalescence, creaming) and foam deterioration (drainage, coalescence, disproportionation). The review further summarizes key factors modulating interfacial properties and, in turn, emulsion stability and aeration performance, including compositional (milk proteins, emulsifiers, polysaccharides, milk fat crystals), processing (thermal treatment, homogenization) and environmental (pH, ionic strength) factors. Looking ahead, future efforts should focus on elucidating the dynamic interfacial evolution during processing and long-term storage, and developing data-driven predictive models by integrating existing knowledge. Overall, this review constructs a comprehensive framework for understanding the interfacial properties of high-fat dairy emulsions, providing actionable insights to advance product innovation and meet market demands for tailored dairy emulsion performance.
Patient portal use has been linked to increased patient engagement, improved relationships with healthcare providers, and higher patient satisfaction. The current study aimed to contribute to patient portal research by proposing the breadth of functions utilized and the breadth of healthcare entities connected as two novel ways to conceptualize and operationalize patient portal use, updating the research on the disparities in patient portal access, and examining differentiated use of patient portals beyond the dichotomy of access vs no access. We analyzed Health Information National Trends Survey (HINTS) 7 data with the full-sample person weights and replicate weights. More than two-thirds of the U.S. adult population had patient portal access, but the vast majority of them accessed patient portals less than once every two months on average. Making appointments, messaging providers, looking up test results, and viewing clinical notes were used by more than half of the U.S. adult population. Primary care providers were the most widely connected entities, with other providers, insurers, clinical labs, pharmacies, and hospitals showing a low level of connection to patients via portals. In the United States, both unequal access and differentiated use exist between sociodemographic groups, highlighting the need for continued monitoring and concerted efforts to address them. At the same time, a close examination of the factors that led to the higher access rates and beneficial uses by traditionally disadvantaged groups-women and people with poorer health-could offer effective strategies to close the gaps.
The UK Biobank Imaging Study, with its dedicated cardiovascular magnetic resonance substudy, has redefined the scale and scope of cardiovascular research, generating high-quality imaging in 100 000 participants with linkage to rich genetic, demographic, lifestyle, and clinical data. The resource has enabled transformative discoveries across genomics, epidemiology, and biomedical engineering and has served as a global blueprint for population imaging studies. Its success has been accelerated by an equitable data access model that fosters international collaboration. The UK Biobank cardiovascular magnetic resonance experience illustrates the power of large-scale imaging cohorts and sets a benchmark for future initiatives aimed at improving cardiovascular health through integrated, collaborative science. Looking ahead, efforts should focus on harmonization across cohorts, adherence to rigorous methodological standards, and multidisciplinary collaboration to drive meaningful clinical translation. This article provides an overview of the UK Biobank and its cardiovascular magnetic resonance substudy, systematically reviews publications to date, discusses limitations and methodological considerations, and highlights future directions.
Xenotransplantation has entered a phase of accelerated clinical translation, necessitating renewed international consensus on governance, ethics, safety, and regulatory oversight. In September 2025, the International Xenotransplantation Association (IXA), in partnership with The Transplantation Society (TTS) and with engagement from the World Health Organization (WHO), convened a Global Consultation in Geneva to review, update, and harmonise international guidance for clinical xenotransplantation. This IXA consultation marked the twentieth anniversary of the first WHO Xenotransplantation Advisory Consultation in 2005 and built upon the foundational principles established through the Changsha Communiqué (2008, 2011 and 2018) and subsequent IXA and WHO-led initiatives. Responding to rapid scientific advances, including some defined donor genetic standards, improved immunosuppression, enhanced biosecurity, and strengthened infectious disease surveillance, the IXA undertook an 18‑month, structured, evidence‑based revision process. Seven expert working groups, comprising approximately forty internationally recognised specialists from fourteen countries, reviewed developments across source animal standards and biosecurity, clinical trial design and oversight, immunosuppression and patient management, infectious disease risk and surveillance, ethical and legal frameworks, international governance, and emerging technologies. Draft recommendations were further refined through iterative consultation and plenary deliberation at the in‑person meeting held in Geneva, September 2025. The consultation proposed updated Principles and Recommendations directed to WHO, national regulators, investigators and sponsors, and the IXA/TTS communities. Key elements include proportionate risk benefit assessments, robust donor and recipient surveillance, long‑term biobanking and monitoring, transparency and public engagement, harmonised regulatory oversight consistent with existing allotransplantation frameworks, and equitable access to future clinical applications. The revised guidance aligns with contemporary regulatory expectations of major international jurisdictions regulatory authorities including (AEMPS, ANMAT, CONABIA, CONFEPRIS, EMA, FDA, GTAC, HC, IEC, INCUCAI, Medsafe, MFDS, MHRA, MHLW, NMPA, NZGTAC, MFDS, MHRA, TGA); and consolidates international consensus at a critical juncture for the field. This IXA Global Consultation provides an authoritative, forward‑looking framework to support safe, ethical, and globally coordinated clinical xenotransplantation as it transitions from experimental innovation to regulated clinical practice.
The Army Nurse Corps (ANC) relies on both Areas of Concentration (AOC) and Additional Skill Identifiers (ASI) to define the roles and advanced competencies of its officers. Among these, the M9 ASI, Nurse Case Manager (NCM) has emerged as a critical capability within military healthcare. This article provides a comprehensive overview of the history, strategic relevance, and evolving role of the M9 specialty. The M9 ASI was formally codified in Army regulations to align case management with national professional standards and institutionalize it as a readiness enabler. Nurse Case Managers provide comprehensive care coordination, streamline referrals, and facilitate rehabilitation through the Integrated Disability Evaluation System (IDES) and Soldier Recovery Units (SRUs), directly reducing lost duty days and medical non-deployability. Their contributions extend beyond individual Soldier outcomes, influencing systemic improvements across Army Medicine and the Defense Health Agency (DHA). Case managers operating outside traditional Army medical treatment facilities, particularly in overseas environments, also act as liaisons with host nation healthcare systems, highlighting the adaptability and complexity of the role. Looking forward, the M9 ASI will expand into telehealth, predictive analytics, and enhanced credentialing, ensuring continued alignment with the Army's readiness mission. As a cornerstone of the ANC, the M9 Nurse Case Manager exemplifies how nursing specialization sustains Soldier health, supports leadership decision-making, and advances military healthcare delivery.
The U.S. Army perioperative nurse (66E) plays a pivotal role in delivering surgical care that directly influences battlefield survivability, operational readiness, and overall force health. Rooted in a legacy dating back to the American Revolutionary War, Army perioperative nurses embody a unique blend of clinical precision, operational agility, and leadership excellence. These nurses serve as circulating or scrub personnel in operating rooms, managing sterile technique, surgical equipment, implants, and intraoperative imaging, while coordinating preoperative and postoperative care in both domestic and deployed settings. Their responsibilities extend beyond the surgical suite, encompassing trauma response, setting up field hospitals, managing mass casualties, and providing surgical logistics in austere environments. Specialization in perioperative nursing offers distinct career advancement opportunities and aligns with the Military Health System's goals of maintaining a medically ready force. Through training, mentorship, research dissemination, and advanced academic programs such as the Doctor of Nursing Practice Adult-Gerontology Clinical Nurse Specialist with a perioperative focus at USUHS, 66Es contribute to surgical innovation and quality improvement across the continuum of care. In 2024, 66Es demonstrated significant impact through leadership roles, global deployments, scholarly achievements, and clinical education initiatives. Looking forward, strategic efforts to reintegrate 66Es into forward surgical units and expand CNS authorizations will further strengthen the specialty's influence. Army perioperative nurses remain essential to military surgical capability, shaping the future of combat care and enhancing patient outcomes across operational and humanitarian missions.