United States Army

Edentulous patients not amenable to dental implants due to a severely atrophic ridge may not have suitably retentive dental prostheses. Subperiosteal dental implants, once discarded as a viable treatment option due to postoperative infection and subsequent failure, have become a viable treatment option once again due to newer surgical techniques, technology, and biomaterials. A 54-year-old male presented with a chief complaint of an ill-fitting maxillary complete denture and inability to masticate efficiently. Clinical and radiographic examination revealed severe atrophy of the maxilla with pneumatized sinuses and was not a candidate for traditional dental implants or bone augmentation. A new maxillary complete denture was fabricated and used as a scan appliance and fixed prosthesis template to design a subperiosteal implant. A cone beam computed tomography (CBCT) scan and Digital Imaging and Communications in Medicine (DICOM) file were obtained and the information was sent to KLS-Martin (Tuttlingen, Germany) for virtual planning. Once approved by the surgical and restorative teams, the titanium subperiosteal implant and prosthesis prototype were fabricated and delivered under general anesthesia. After 6 months of wearing the PMMA prototype, a definitive zirconia prosthesis was delivered.

Abstract. Permafrost soils are one of the largest terrestrial pools of mercury (Hg) in the world, storing an estimated 500–1500 Gg of Hg in the top three meters of soil. Ongoing climate-driven thaw threatens to release this legacy Hg into the environment. Efforts to quantify and model this pool have been hindered by a lack of harmonized, spatially resolved observations. To address this, we compiled a database of 117,802 Hg observations collected between 1988 and 2022 from 59 studies across Arctic, sub-Arctic, and alpine permafrost regions of the Northern Hemisphere, including North America, northern Europe, Eurasian and the Tibetan Plateau. The database includes Hg concentration measurements in solid materials—such as soil, leaves, roots, wood, and litter—as well as in water samples from soil porewater, lakes, and rivers across the northern hemisphere permafrost domain. The database enables cross-site synthesis, model calibration and evaluation, and environmental assessments by standardizing and harmonizing data from diverse sources. Data harmonization steps included unit conversion, categorization of observations by type, and quality control measures to ensure consistency across studies. Analytical uncertainty was preserved where reported in source studies, and qualitative uncertainty indicators and flags were applied where uncertainty information was incomplete or heterogeneous. Mercury concentrations vary widely across observations, with lake sediment showing the highest median values (70 ng g⁻¹, IQR: 45–116), followed by soil (50 ng g⁻¹, IQR: 32–90), and vegetation (15 ng g⁻¹, IQR: 9–33). Water observations had a median of 2 ng L⁻¹ (IQR: 2–6). Statistically significant differences in Hg concentrations among observation types were observed at both global and regional scales, consistently following the pattern: lake sediment > soil > vegetation. These patterns, along with spatial and observation-type biases, highlight the need for improved coverage in underrepresented regions such as Eurasia. The database is freely accessible through Zenodo under the concept DOI 10.5281/zenodo.18300989 (all versions), to support ongoing research and model development in Arctic and sub-Arctic Hg cycle studies.

Healthcare professional recruiting within the Army Medical Department (AMEDD) requires specialized knowledge and strategic outreach. This article describes the outcomes of Army Nurse Corps (ANC) officers in medical recruiting roles. Data from Fiscal Year 2024 (FY24) and Quarters 1 and 2 (Q1/2) of FY25 demonstrate that ANC officers may enhance healthcare professional recruiting efficiency, reduce applicant processing timelines, and improve overall mission achievement. ANC officer’s clinical expertise, ability to conduct skills-based outreach events, and familiarity with medical commissioning processes contribute to stronger applicant engagement and throughput. This data although limited, may suggest that expanding the role of ANC officers in recruiting could strengthen the military healthcare workforce pipeline

Abstract Background: Extrahepatic biliary obstruction (EHBO) predisposes to bactibilia due to impaired bile flow and increased intraductal pressure. While benign etiologies are traditionally associated with higher rates of bile infection, malignant biliary obstruction is often presumed to be sterile. Available evidence is conflicting and largely retrospective, with limited prospective data from the Indian subcontinent. Methods: This prospective observational study included consecutive patients aged 18–65 years undergoing first-time ERCP for EHBO at two tertiary care centers in India between March 2018 and February 2021. Bile was aspirated aseptically prior to contrast injection and cultured using automated blood culture systems. Patients were categorized into benign and malignant obstruction groups. Culture positivity, growth patterns, and organism distribution were compared between groups. Results: A total of 204 patients were included (benign: n=144; malignant: n=60). Overall, bile cultures were positive in 63.7% of patients. Culture positivity was significantly higher in benign obstruction compared to malignant obstruction (69.4% vs 50.0%, p=0.01). Polymicrobial growth was observed exclusively in benign obstruction (20.1%), whereas all malignant cases demonstrated monomicrobial growth. Among 153 bacterial isolates identified, Escherichia coli was the most common organism, followed by Klebsiella spp., Enterococcus spp., and Pseudomonas spp. The distribution of bacterial isolates did not differ significantly between benign and malignant obstruction (p>0.05). Conclusion: Bactibilia is common in EHBO and occurs more frequently in benign disease; however, malignant biliary obstruction is not invariably sterile. While growth patterns differ by etiology, the bacterial spectrum remains similar. These findings highlight the need for vigilance regarding biliary infection in both benign and malignant EHBO, particularly during endoscopic intervention.

Reluctance to disclose new mental or physical health symptoms and seek healthcare can be exacerbated among pilots due to fear of jeopardizing one's aviation career. The current qualitative study focused on undergraduate pilot trainees' beliefs about healthcare and help seeking behaviors. Individual semi-structured virtual interviews were completed with 28 undergraduate pilot trainees to identify barriers to symptom disclosure and health care service utilization. Six thematic barriers to help seeking were identified, including (lack of) health system literacy, fear, delay in seeking care, lack of understanding the FAA aeromedical process, trust, and financial constraints. These findings contribute to understanding healthcare avoidant behavior among aviators early in their training and have implications for industry leaders in considering revisions to health-related communications, education, and services available to pilot trainees and across the aviation industry more broadly.

The following chapter explores the potential of digital twin technology (DTT) implementation in human resources (HR) functions, such as improving employee management, fetching real-time data, and using artificial intelligence (AI). Through DTT, companies can virtually create all HR operations by simulating work processes, forecasting results, and designing proactive strategies, thereby improving decision-making, increasing productivity, and managing processes. This chapter discusses the practical implementation of digital twins (DTs) in HR planning, employee engagement, performance evaluation, and career development. Additionally, it proposes a step-by-step methodology for developing and integrating DTs in HR functions for increasing efficiency while ensuring accuracy and relevance. Although this technology is hugely beneficial, it has certain limitations and concerns like data privacy, hefty implementation cost, technological barriers, skill gap, and resistance to change. There is a strong need to mitigate these challenges by adopting proactive strategies like upskilling HR professionals, incorporating cybersecurity software, and creating organizational trust. This chapter discusses DTT as an important innovation for enhancing HR function. It will enable organizations to navigate workforce difficulties and develop employee-centric and data-driven strategies in the rapidly changing work landscape.

This paper presents the mechanism, technical development, and practical applications of the vacuum preloading method in treating weak soil foundations. This method allows accelerating the consolidation process, significantly shortening construction time compared to traditional preloading. Studies and applications in many countries, including Vietnam, demonstrate the superior effectiveness of this technology. The paper also introduces recent improvements, including membrane-less techniques, combination of vacuum preloading with static loads, and numerical analysis applications.

Purpose:This study evaluated the performance of multivariate linear regression relative to multiple linear regression when applied to non-normal data, with the objective of identifying the model that offers greater accuracy and reliability under conditions of equal mean vectors and known variance–covariance matrices. Methodology:Simulated datasets were generated using R software. Prior to estimation, all relevant assumptions for both multivariate and multiple linear regression were tested. Model evaluation involved examining residual symmetry, assessing the influence of independent variables on dependent variables, and testing overall model significance. Multivariate regression performance was assessed using Pillai’s Trace, Wilks’ Lambda, Hotelling–Lawley Trace, and Roy’s Largest Root, while the multiple linear regression model was evaluated using analysis of variance. Results:The findings revealed that the multivariate linear regression model outperformed the multiple linear regression model under non-normal conditions. The multivariate approach demonstrated more stable residual behavior and stronger statistical evidence of relationships among variables, indicating superior model fit and robustness. Novelty and contribution:This study provides new empirical evidence on the comparative suitability of regression models under non-normal data conditions, highlighting the superior performance of multivariate linear regression in handling multiple dependent and independent variables simultaneously. Practical and social implications:The results offer practical guidance for researchers, data analysts, and policymakers in selecting appropriate analytical techniques for non-normal multivariate datasets. Improved model selection enhances the accuracy of empirical findings and supports more reliable decision-making in education, health, and the social sciences.