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The discovery of nuclear fission nearly a century ago not only caused the production of significant quantities of radioactive materials, but also purposefully brought naturally occurring radioactive substances from the Earth's crust to the surface through mining. The use of these materials, particularly in nuclear weapons, has profoundly influenced our understanding of the Earth system, driven by the military's need to study the effects of nuclear explosions. This introduced the alarming possibility of irreversible, severe consequences on a global scale within a very short time frame. Despite their critical significance, radioactive materials are scarcely addressed within the Planetary Boundaries framework. This oversight may stem from the challenge of defining control variables or safe operating spaces for the two most consequential release pathways: nuclear power plant accidents and nuclear explosions. Applying the precautionary principle in this context would advocate for a world free of nuclear weapons and a cautious, well-considered approach to the use of nuclear energy.

Burnout remains a persistent challenge for the physician workforce. In this context, the ability to identify and retain physician talent plays a crucial role in optimizing workforce capacity. Other disciplines, such as the military, use comprehensive frameworks to identify, develop, and retain talent. These approaches may offer valuable insights for medical education, particularly with the increasing emphasis on competency-based training. An integrative review examining the military's approach to talent identification, development, facilitation, and management was conducted in 2024, with an updated search performed in October 2025. A total of 477 articles were identified and screened at the title and abstract level using predefined inclusion criteria. Twenty-one articles were ultimately included for data extraction. Four major themes emerged: (1) the military defines talent holistically; (2) organizational structures align individual talent with specific positions to support well-being and maximize job performance; (3) individual talents are viewed as contributing to the success of a broader entity (e.g., a team, unit, or community); and (4) talent retention is a primary organizational focus. Reviewing the military's approach to identifying and retaining talent highlights the potential impact of a talent-focused framework in medical education. Addressing workforce challenges through a collective lens and aligning talent with specific roles may enhance physician well-being while also reducing burnout.

The U.S. Coast Guard and the Department of Defense have implemented numerous health, wellness, and prevention programs aimed at improving readiness and supporting the holistic well-being of service members and their families. These include healthcare services, behavioral health interventions, Armed Forces Wellness Centers, Integrated Primary Prevention efforts, the Holistic Health and Fitness program, and family support initiatives. However, these programs often operate in silos, with limited cross-program coordination, fragmented communication, and inconsistent user experiences. This study explores these challenges within the Coast Guard to inform systems-level recommendations for improved integration, visibility, and user-centered delivery across the military health and wellness landscape. This study employed the elaborated Action Design Research methodology, which supports iterative problem-solving through cycles of diagnosis, engagement, reflection, and learning. Three diagnosis cycles were conducted, involving semistructured interviews with Coast Guard service members, family members, and senior leaders. Qualitative data analysis was guided by thematic analysis, drawing on structured coding techniques commonly used in qualitative research. Systems theory served as the conceptual framework to examine dynamic interdependencies and structural misalignments across the Coast Guard's health and wellness ecosystem. The study was exempt from Institutional Review Board review by Lake Erie College of Osteopathic Medicine. Five core themes emerged across stakeholder groups and diagnosis cycles: (1) fragmentation of services; (2) inconsistent and decentralized communication; (3) limited awareness and access to available resources; (4) disconnect between leadership intent and user experience; and (5) lack of structured feedback mechanisms. Participants described disconnected programs and services, scattered communication channels (outdated apps, isolated PDFs), and duplication of effort. Service members and their families reported difficulty navigating systems, with some paying out of pocket for services they were technically eligible for but unable to access because of gaps in provider or network coverage. Additionally, feedback mechanisms were described as informal and inconsistent, limiting the military's ability to adapt programs in real-time. This study highlights the pressing need to transition from a fragmented, program-centric model to a systems-based approach to health and wellness in the Coast Guard. Key recommendations include embedding cross-functional liaisons, establishing recurring interdisciplinary working groups, consolidating digital infrastructure, improving navigation, integrating family engagement, and institutionalizing real-time feedback loops. Implementing these strategies will require a paradigm shift from isolated, expert-led programs to coordinated, user-centered ecosystems. Without this shift, even innovative efforts risk remaining disconnected, duplicative, and insufficient to meet the evolving needs of the force. Aligning structures, strategies, and communication will be critical not only to improve well-being but also to strengthen performance, readiness, and retention across the military.

Military leaders must support health care and research to protect the health and readiness of their forces. Part of this effort entails conducting human subjects research to address current and emerging international health threats. The military is also attentive to the national security interests associated with global health, such as protection from widespread disruption due to disasters and epidemics. While military leaders' global health research objectives relate to the military's strategic goals, including force health protection and national security, it is only through longstanding partnerships with partner nations in several world regions that much of the relevant research is possible. Yet military priorities may differ starkly from those of the collaborating partner nations, raising concerns about the potential for exploitation in global health partnerships. However, in spite of differences in overall strategic priorities, a convergence of stakeholder interests allows for appropriate alignment in the choice of clinical research activities at global health sites supported by the military. These complex collaborative research arrangements depend on negotiating and navigating the selection of research goals and activities to ensure fairness and balancing of priorities among partners, thereby maintaining research infrastructure and capacity. Leaders of military institutions and partner nations must attend to the need for this sustained effort to balance priorities to ensure equity and successful maintenance of these essential relationships.

In August 2025, the US Department of Defense (DoD) revised its grooming standards for military personnel across all branches of service. The changes included new policies for managing pseudofolliculitis barbae (PFB), a chronic inflammatory condition aggravated by shaving that can cause facial irritation and scarring. In this article, we review the revised PFB standards for each branch of the military and examine how recent changes affect policies on shaving waivers, which now will have shorter durations, require more frequent medical evaluations, and add administrative steps that apply to both service members and medical providers. Because PFB affects many individuals in the military, the new DoD-promulgated changes impact clinical management, readiness considerations, and retention policies. Civilian dermatologists, who frequently encounter patients with PFB, should be aware of the military's regulatory updates to ensure appropriate counseling of service members and prospective recruits.

This study provides follow-on analysis of "A Description of the Dental Health and Treatment of Ukraine Military at U.S. Army Clinics in Germany" by Mendoza et al 2024. There is no information on the time and cost to support Allies and Partner Forces. During a combined deployment, the medical rules of eligibility (MEDROE) may require that U.S. dental providers treat military personnel who lack dental support. Yet there are no studies that discuss the impact of U.S. providers treating Allied military personnel. Analyzing the dental treatment performed by U.S. Army dentists will improve understanding of the Ukrainian military's dental readiness and treatment needs. The cost for each dental encounter was determined by using the Defense Health Agency Uniform Budget Office Dental Rate Table for the calendar year (CY) 2023. Current Dental Terminology (CDT) codes were used to organize dental encounters by dental treatment categories. Treatment costs were calculated by totaling the CDT codes. The authors also performed an unpaired t-test to compare the average cost of treating the Ukrainian military to those in a recent study on treating U.S. military patients in Iraq from 2007 to 2009. The total cost to treat the Ukrainian military cohort was $335,100.80 in CY 2023 USD. The estimated cost of treating the Ukrainian military was $1,288,849.24 per 1,000 individuals per year. The oral surgery dental treatment category had the highest cost at $153,287.86. The multiple dental treatment category incurred the next highest cost at $57,336.35. The multiple dental treatment category only involved 27 patients; however, these individuals required 102 procedures. Based on individual costs, the DoD W dental codes category, which included computer-aided design/computer-aided manufacturing (CAD/CAM) crowns, had the highest cost at $2,537.63 per person. Oral surgery accounted for 45.7% of total costs. Treatment involving CAD/CAM crowns had the highest cost per person at $2,537.63. Overall, there was a trend for resin-composite restorations with only 2 Ukrainian personnel receiving amalgam. The total cost to treat the Ukrainian military cohort was $335,100.80 in CY 2023 USD. The estimated cost for treating the Ukrainian military equated to $1,288,849.24 per 1,000 personnel per year. The $1.28M represents an estimate of the value cost of work that would be provided to this population over time. Dentists spent 31.83 hours per month treating dental emergencies among Ukrainian personnel. This study supports the need for medical planners to consider dental capabilities and support when determining MEDROE for allies and partners. U.S. military medical providers, whether in garrison or deployed, should also consider allied dental readiness and capabilities, especially since most allied and partner militaries may have limited dental support. Budgets should also account for the additional expenses associated with treating allies and partners. These findings support the assertion that U.S. dental officers must be proficient in oral surgery, restorative care with CAD/CAM utilization, and endodontics.

In this paper I explore the moral responsibility that is owed to post-enhanced military veterans who were enhanced with biotechnological interventions as part of their military service, but then suffer from these biotechnological interventions when returning to civilian life. By exploring two ways that these interventions can become detrimental to a veteran's quality of life, I suggest that the institutional duty of care to post-enhanced veterans arises even though the problems arise after service ends. When we see that soldiers can become disenhanced or de-enhanced, in both cases, the military as an institution owes those post-enhanced veterans a special duty of care because of the military's role in the initial enhancement. Finally, I argue why the conceptual clarity regarding enhancement, disenhancement, and de-enhancement is useful for assigning institutional responsibility with regard to post-enhanced veterans.

Following the military's advancement of prehospital blood into the field, civilian prehospital blood programs are becoming more prevalent. However, there are significant differences between civilian and military prehospital operations that should be considered. Civilian prehospital systems also vary widely in terms of resources, transport times, and patient types. Given these variations and the logistical challenges associated with establishing a prehospital blood program, careful consideration of the state of the science is warranted. Although blood is the preferred fluid for patients in hemorrhagic shock, there have only been a few high-quality studies that have examined the efficacy of administering blood in the prehospital setting. Given the conflicting results of these studies, individual medical directors must determine whether the risk-benefit analysis for their system warrants establishing such a resource-intensive operation. Efforts to establish a prehospital blood program should not supersede attempts to optimize the fundamental components of trauma operations and management.

The practice of public health within military settings presents distinct ethical challenges that differ from those encountered in civilian public health practice. This article explores the unique ethical considerations faced by military public health professionals, focusing on the tensions between individual rights and the health needs of the collective, which is amplified by the military's relative control over the lives of service personnel. The paper applies Upshur's (2002) 'Principles for the Justification of Public Health Intervention'-harm, least restrictive means, reciprocity, and transparency-to the military context, including in combat operations. It examines the 'dual loyalty' dilemma faced by military public health professionals, who hold professional commitments to both their patient population and, as military officers, to the chain of command. Further ethical considerations around defining the 'public' in military settings, access to healthcare, and the risk of moral injury are explored, including examples from previous military operations. The article provides a novel contribution to public health ethics practice by offering an overview from the perspective of public health professionals working within the armed forces which could guide training, policy development, and practice.

The lack of adequate diverse representation (racially, socioeconomically, gender, second career applicants, student parents, etc.) within secondary education in the United States has proven to be a challenging and complex, multifaceted problem, and despite ongoing efforts, one that continues to remain unsolved. These disparities are well known and documented at all levels of education. The Uniformed Services University of Health Sciences is the nation's only fully federally funded medical school and capitalizes on the preexisting diversity and exceptional training already existing within the U.S. military's enlisted force through the Enlisted to Medical Degree Preparatory Program (EMDP2). This study aims to investigate how a novel program at a unique military medical school influences medical school class cohorts. This study used a traditional thematic qualitative analysis format. Thematic qualitative analysis is a method for identifying, analyzing, organizing, describing, and reporting themes found within survey responses. One hundred nine surveys via SurveyMonkey© were sent to EMDP2 students. Thirty-six surveys were returned for a response rate of 33%. Two co-investigators carefully read each participant response and coded independently line-by-line with constant comparison of each quote. NVivo© software was used to store the data as the counts progressed. After completion of data collection, results identified the following themes among survey responses being accepted, bridging the gap, feeling valued, gratitude, prior experiences, and professionalism. Students with prior military experience have a significant impact on our institutions medical school classes. These students provide mentorship and professionalism to their fellow classmates. This study helps educators understand the perspectives and challenges faced by prior-service medical students and appreciate how to use the prior experience of these unique prior-service members to benefit the entire class.

The military's high-pressure environment can lead to burnout syndrome, characterized by emotional fatigue, depersonalization, and decreased personal accomplishment. Validating a culturally appropriate tool for assessing burnout among military personnel is crucial for early detection and intervention. This study assessed the psychometric properties of the Arabic version of the Maslach Burnout Inventory (MBI) and its validity among Tunisian military personnel. A validation study was conducted among 520 Tunisian military personnel (mean age = 36 ± 9.3 years; male (n = 486) and female (n = 34)), including commandos, pilots, and divers. The Arabic version of the Maslach Burnout Inventory MBI-HSS was administered, including participants' sociodemographic characteristics. The exploratory (EFA) and confirmatory (CFA) factor analyses were performed to identify the factor structure, with assessments of the internal consistency of the model. The factor analysis confirmed the three-factor model of burnout: emotional exhaustion, depersonalization, and personal accomplishment consistent with the original MBI. The A-MBI-MP demonstrated strong internal consistency, with Cronbach's alpha values exceeding 0.8 for all subscales. The test-retest reliability was also excellent, confirming the stability of the instrument. The CFA validated the three-factor structure of the A-MBI-MP. The fit indices demonstrated an acceptable model fit: Comparative Fit Index (CFI) = 0.949, Tucker-Lewis Index (TLI) = 0.943, and Root Mean Square Error of Approximation (RMSEA) = 0.0742 (95% CI: 0.068-0.0797). These results validate the reliability of the A-MBI-MP in assessing burnout in the military context. The Arabic version of the Maslach Burnout Inventory (A-MBI-MP) is a valid and reliable tool for assessing burnout among Tunisian military personnel. The validated instrument can be used to offer early treatments and to promote the mental health of military personnel in high-stress situations.

In the 1820s, Stockholm Observatory undertook a significant upgrade of its instruments. The new acquisitions included a meridian circle, crafted by Traugott Ertel in Munich, which - after extensive delays - was finally installed at the observatory in 1834. Despite its advanced capabilities, the instrument saw limited use during its first forty years, as observatory directors were largely occupied with geodetic projects for the Crown. The meridian circle only reached its full scientific potential when Hugo Gyldén became the Academy Astronomer in 1871, marking the end of the Observatory's geodetic era. In addition to observations for a major zone project, from 1879 the instrument became the engine of the Swedish standard time system. Throughout the nineteenth century it also had an important role as the zero meridian for the military's geodetic pursuits. The instrument remained in use until the Observatory relocated to Saltsjöbaden in 1931. This paper explores the various roles played by the Ertel meridian circle during its century-long history, with a focus on the strategies employed by astronomers to preserve the ageing instrument's relevance.

The military's approach to medication use often evolves in response to operational issues that have the potential to impact the medical readiness and combat effectiveness of active duty service members (ADSMs). Historically, medications have been considered problematic because they serve as surrogate markers for deployment limiting health conditions or due to factors that make sustainment challenging in military/austere environments. This study aims to identify key concepts that capture the aspects of a medication that make it problematic in ADSMs. The goal of this effort would be to inform a future policy and establish criteria for Problematic Medications in Active Duty Servicemembers (ProMADS) to enhance the readiness and deployability of ADSMs. Concepts of ProMADS were elicited from 8 key informants (KIs). Key informants included care providers and care recipients from the Army, Navy, Air Force, and Defense Health Agency. Semi-structured interviews were conducted, and a phenomenological approach was used to summarize KI perspectives, and thematic analysis identified core elements and sub-elements. Five core elements were identified: (1) Adverse cognitive or behavioral effects, (2) sustainment issues, (3) controlled substance compliance and risk mitigation, (4) medication-related hemostasis interference, and (5) combat-readiness inhibitors. Key sub-concepts were related to whether a medication might impact cognition, cause sedation, have complex monitoring requirements (e.g., laboratory, adverse drug reactions, etc.), is temperature sensitive, or impacts the functioning of the immune system. This study generated core medication-related concepts and sub-concepts that KIs believe make a medication innately problematic among ADSMs. These findings can guide consensus-driven efforts to identify ProMADS which would enable Military Departments and Combat Support Agencies to create programs that improve lethality, warfighting, and readiness by optimizing medication use.

Battlefield medicine has advanced trauma care knowledge throughout history and continues to do so now. However, as war has become less common and civilian trauma continues to occur, civilian trauma centers have become essential in maintaining competency in casualty care. Military-civilian partnerships, such as the US Army Military Civilian Trauma Team Training program and the Strategic Medical Asset Readiness Training program, allow military medical personnel to practice complex trauma care in high-volume trauma centers. Civilian centers benefit from both the deployed experience of the military personnel and extra skilled personnel contributing to their practice without the salary costs. Although both sides have potential drawbacks, these partnerships represent one strategy to meet the military's goal of decreasing battlefield mortality.

This Viewpoint draws comparisons between the recent Los Angelese wildfires and the military’s experience with burn pit exposures to offer insights into understanding and mitigating the health challenges that result from these fires.

Objectives. To assess the effect of the vaccination mandate on COVID-19 vaccination rates and identify independent factors associated with lack of postmandate vaccination among service members. Methods. We assessed all active component service members for COVID-19 vaccination status from December 11, 2020, to January 1, 2022. We used comparative interrupted time series analysis and logistic regression to compare pre- and postmandate completion of the vaccine series between the US military and the US general population. Results. Previous documented infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), lower rank, and non-Hispanic Black race were associated with lower premandate vaccination. Postmandate vaccination rates were significantly higher in the active component population (P&#x2009;<&#x2009;.001) compared with the premandate period and the US population. Also notable was the higher incidence of postmandate vaccination among those who were non-Hispanic Black or of lower rank. Conclusions. The US military's COVID-19 vaccination mandate was effective at both increasing overall vaccination rates and reducing disparities in vaccination, including race and ethnicity and rank. Vaccine mandates increase the receipt of vaccines and promote health, readiness, and equity within the US military. (Am J Public Health. 2025;115(7):1146-1156. https://doi.org/10.2105/AJPH.2025.308120).

Service members can harm others through sexual assault, harassment (e.g., sexual harassment, bullying, hazing, reprisal, retaliation), domestic abuse, child abuse and neglect, and intimate partner abuse and can harm themselves through attempting or dying by suicide. This range of harmful behaviors can affect service members' overall physical and mental health and be detrimental to force readiness. A robust prevention system is needed to address these harms. A dedicated, qualified, and competent prevention workforce across strategic, operational, and tactical levels is one of the cornerstones of a robust prevention system. In response to a recommendation from the Independent Review Committee on Sexual Assault in the Military, the U.S. Department of Defense is hiring roughly 2,000 Integrated Primary Prevention (IPP) personnel-individuals with particular knowledge and skills in the conduct of prevention activities. These individuals' sole function will be to conduct data-informed activities to prevent various harmful behaviors experienced by service members. In this study, the authors describe the methods for evaluating progress toward fully implementing an IPP workforce. Once this five-year evaluation is completed, the findings will document how much progress has been made toward full implementation, including an understanding of the structure and functioning of the prevention infrastructure and prevention teams, leader support of IPP, and the quality and comprehensiveness of prevention plans. These findings will be useful for professionals responsible for addressing a variety of harmful behaviors (e.g., sexual assault, suicide) and for commanders and other senior-level military leaders and policymakers interested in improving the quality of efforts to prevent harmful behavior in the military.

Between October 2023 and January 2025, the Israeli military's sustained attacks on Gaza resulted in an estimated 186,000 deaths and the systematic destruction of healthcare infrastructure. Despite the professed commitment to human dignity, justice, and the minimization of suffering within bioethics, major institutions and scholars in the field have largely remained silent or selectively engaged with the crisis. This paper argues that the Gaza genocide exposes a deeper crisis within bioethics: its growing detachment from urgent, real-world ethical challenges. Such detachment erodes public trust and raises fundamental questions about the discipline's relevance and credibility. The article interrogates the possible reasons and motivations for the silence and disengagement in the face of genocide in Gaza, and examines the institutional and disciplinary responsibilities that bioethics bears in response to health-destroying state violence. Framing the inaction as a moral failure with far-reaching implications, the article proposes alternative routes of ethical engagement and outlines steps toward a more inclusive and responsive bioethics. It calls for the urgent reorientation of the field toward a justice-driven, politically conscious practice capable of confronting today's most pressing ethical issues.

As military institutions explore the use of enhancement technologies to improve combat readiness and operational effectiveness, critical ethical and policy questions emerge about the long-term consequences of these interventions. This paper examines the reintegration challenges facing enhanced veterans-those who undergo cognitive, neurological, genetic, or physiological modifications during service-and explores the military's obligations to support their post-service lives. We analyze how enhancements, though often framed as temporary or mission-specific, may result in lasting changes to cognition, emotion, and identity that complicate veterans' ability to rejoin civilian life. Drawing from military ethics, bioethics, and neuroethics literature, we examine issues of autonomy, informed consent, and structural coercion within the hierarchical nature of military service. We argue that enhancement may not only exacerbate existing barriers to healthcare, employment, and social belonging but also generate novel forms of stigma and challenge existing systems of support. To address these challenges, we recommend policy interventions including the establishment of an enhanced veteran registry, expanded research funding, and the development of tailored long-term care strategies. We conclude that protecting the rights and dignity of enhanced service members requires proactive ethical and institutional planning-before, during, and long after their time in uniform.