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Research on transgender people's health, particularly in reproductive health, has expanded exponentially over the past decades. However, previous studies frequently highlight perceived inaccessibility and gender-exclusivity of reproductive and perinatal care for transgender people. This observational study used a cross-sectional content analysis to examine online obstetrics, labor and delivery, and pregnancy-related materials from a purposive sample of 178 online hospital resources across the United States to understand the extent to which they use gender-inclusive and gender-exclusive language, imagery, and other inclusive symbolism. Two hundred US hospitals were purposively selected from the most populous cities in each state; 22 (11%) lacking obstetrics pages were excluded, yielding 178 (89%) hospitals across all 50 states. Four coders assessed obstetrics websites (from October 2025 to December 2025) for transgender-specific resources, inclusive language, second-person language, exclusive language, inclusive imagery, and inclusive symbols or statements. Hospitals were categorized by US Census region, transgender-specific legal protections, and university or religious affiliation. Across the United States, the presence of gender-inclusive elements was relatively rare, while most hospitals consistently used second-person or gender-exclusive elements. These patterns persisted across geographic regions, university affiliations, religious affiliations, and variation in state-level, transgender-specific legal protections, although hospitals in states with stronger protections and university-affiliated institutions showed somewhat higher rates of inclusive content. Importantly, even on websites that included gender-inclusive language, such content co-occurred with gender-exclusive terms, raising questions about how transgender and gender-diverse patients might interpret these mixed signals when deciding where to seek care. These findings underscore the need for hospitals to develop clear, service-specific standards for gender-inclusive obstetric communication and to ensure that online materials visibly and consistently signal their readiness to care for transgender and gender-diverse patients across the perinatal period.

An information most relevant to patients when deciding to accept a kidney offer is an estimate of its potential longevity. Using a novel machine learning approach, our aim was to develop a model that can output personalized curves estimating kidney graft and patient longevity to support clinical decision-making. We performed a retrospective cohort study in recipients of a first deceased donor kidney transplant aged ≥60 years between 2000 and 2020, using the United Network for Organ Sharing dataset. Outcomes were overall graft survival and patient survival. Independent variables included the Kidney Donor Risk Index (KDRI) and recipient-related variables. Random survival forest models were trained on 70% and validated on 30% of the dataset. The study cohort included 57, 280 patients, amongst whom 27, 244 (48%) experienced graft loss, while 25, 210 (44%) died during a median follow-up of 4.3 years. The most important variables in tree development for graft survival were recipient age, recipient diabetes, KDRI, recipient ethnicity, and time on dialysis. For patient survival, these variables were recipient age, recipient diabetes, time on dialysis, recipient cause of chronic kidney disease, and recipient HCV status. The difference in expected graft survival between low and high KDRI kidneys decreased when recipient characteristics, in particular age, were accounted for. KDRI had a negligible impact on mortality. While implementation studies are needed, the individualized curves provided by our novel machine learning approach have the potential to support shared decision-making to a greater extent than the KDRI alone.

Chronic wasting disease (CWD) is a fatal transmissible prion disease of cervids that continues to expand across North America. Although the spatiotemporal distribution of CWD in the central United States has been extensively documented, the direction and rate of disease spread remain poorly understood, limiting the implementation of proactive surveillance and mitigation strategies. We developed a data-driven spatiotemporal modeling framework to quantify the direction and rate of CWD spread across Kansas using surveillance data collected between 2005 and 2023. Kansas was partitioned into 20 km2 spatial grid cells, and disease dynamics within each cell were modeled using a system of differential equations representing susceptible, infected, and environmental compartments. Spatial migration processes were incorporated through a stochastic mixing matrix informed by empirically observed patterns of first infection among neighboring cells. Model parameters were optimized through a grid search of plausible values derived from published literature, and predictive performance was evaluated using receiver operating characteristic (ROC) analysis. To characterize spread dynamics, we applied a weighted centroid approach at the zonal scale and a migration-based vector flow analysis at the local scale. The model successfully reproduced the observed spatiotemporal progression of CWD across Kansas with high predictive accuracy (mean AUC = 0.88). Zonal analyses revealed a predominant northwest-to-southeast progression of infection, with substantial regional heterogeneity in both direction and velocity of spread. Local vector-flow analyses identified multiple transmission corridors and persistent hotspots that may function as regional sources of infection dissemination. Rates of spread quantified at both zonal and local scales corroborated the directional trends observed in the flow analyses and highlighted areas characterized by elevated transmission intensity and migratory spread. Importantly, the model demonstrated strong forecasting capability by anticipating emerging areas of infection prior to their confirmation through surveillance. By integrating mechanistic disease dynamics with empirically informed migration processes, our framework provides a quantitative characterization of both the direction and rate of CWD spread at two spatial scales. These findings offer actionable insights for wildlife disease management by supporting targeted surveillance, boundary monitoring, and region-specific intervention strategies.

The population-level quality-of-life impact of nonfatal health outcomes, including prolonged hospitalizations and long COVID, remains poorly understood. In this study, we estimate the cumulative quality-adjusted life-year (QALY) loss attributable to fatal and nonfatal COVID-19 outcomes in the United States and compare that burden with that of other diseases. We developed a probabilistic model that accounts for the loss in population health due to COVID-19 symptoms, hospitalizations, long COVID, and deaths. The model was applied to weekly county-level data from July 2020 to December 2022. We used appropriate probability distributions to describe uncertainty in parameter values and used 1,000 repeated samples from these distributions to estimate the expected QALY loss and the 95% uncertainty interval (UI). We estimate the cumulative QALY loss as 9,242,000 (95% UI: 7,808,000-11,311,000) life-years. Following deaths, long COVID was the second most significant contributor to QALY loss, with an estimated annual QALY loss of approximately 865,000 (95% UI: 355,000-1,591,000). This burden is comparable to the total annual disability-adjusted life-years (DALYs) associated with liver cancer: 581,000 DALYs (95% UI: 549,000-607,000). Although symptomatic infections contributed less to overall QALY loss, their burden was comparable to that of HIV/AIDS (377,000 DALYs, 95% UI: 309,000-465,000). The quality-of-life burden of nonfatal COVID-19 outcomes, particularly long COVID, is on the same scale as that of major chronic and infectious diseases. As COVID-19 mortality declines and the pandemic transitions to an endemic phase, it is essential to recognize and address the long-term effects of nonfatal outcomes as public health priorities.

An increasing discrepancy between the measured reference air kerma rate (RAKR) of high-dose-rate (HDR) iridium-192 (192Ir) sources and that reported by the manufacturer on the source certificate was observed at a hospital in Australia. This study aimed to determine whether the drift recorded in a single clinic was a local anomaly or more widespread. A survey was distributed to physicists at brachytherapy clinics across Australia, New Zealand, the United Kingdom (UK), France, and Ireland, gathering details on HDR 192Ir source model and origin, well chamber model, well chamber calibration provider, and each department's history on the discrepancy between locally measured and manufacturer's source certificate RAKR. Data from each clinic was assigned to a separate series, with an additional series if a clinic changed well chamber calibration provider. Linear regression analysis was performed on data from each series. One thousand one hundred fifty observations from 32 clinics were analyzed, with RAKR measurement histories ranging from 2 to 20 years (mean, 9 years). The manufacturer of all sources included in this analysis was Curium. A trend of increasing local measurement value compared with the manufacturer certificate value was observed for all series, with 20 or more observations. Sites with well chambers calibrated at NPL or UWADCL showed an increase in discrepancy between measured and source certificate RAKR, approximately 0.2% per year on average, from 2015 to present. There is an increasing discrepancy between locally measured 192Ir HDR source strength compared with the manufacturer's certificate. The manufacturer's measurement procedure does not meet the same standard set for the user. Unless the agreement between the Curium and user measurements can improve, brachytherapy societies may need to re-examine the requirement for direct comparison between local and manufacturer's measurements.

Fibrotic diseases represent a major global health burden, with current therapies often limited by modest efficacy and substantial side effects. Traditional Chinese medicine (TCM) provides a rich yet underexplored reservoir for anti-fibrotic drug discovery, valued for its chemical diversity and extensive clinical history. Nonetheless, conventional approaches to deriving therapeutics from these multi-component formulas face significant challenges, including low tissue selectivity, limited target specificity, suboptimal scaffold optimization, and incomplete cross-scale validation. Here, we summarize recent advances in discovering TCM-derived anti-fibrotic compounds and highlight emerging strategies, including tissue-oriented active compound discovery, fibrosis-target mining, scaffold optimization guided by targets and biosynthesis, and cross-scale validation. Building on these developments, we introduce the Smart Herbal-based Innovation and Translational Engine (SHINE), an intelligent discovery platform that prioritizes promising herbal candidates using modern computational and experimental methods; innovative development of optimized compounds or novel derivatives; a translational pipeline to unite preclinical findings and clinical validation; and a closed-loop feedback system where real-world evidence continuously informs drug repositioning and secondary development. SHINE bridges TCM principles with state-of-the-art drug discovery technologies, enabling the development of well-defined, mechanism-based small-molecule candidates from classical formulas. By integrating empirical herbal knowledge with advanced multi-omics, artificial intelligence, and biosynthetic engineering, SHINE aims to deliver first-in-class anti-fibrotic therapeutics with defined targets, improved safety, and demonstrable clinical efficacy.

Stemless shoulder arthroplasty utilizes epiphysometaphyseal fixation, eliminating the need for humeral canal reaming. Extending stemless technology to reverse total shoulder arthroplasty (rTSA) introduced distinct biomechanical challenges. In the absence of diaphyseal support, concerns regarding humeral component subsidence, varus tilting, and aseptic loosening arise. In the United States, stemless rTSA remains investigational, with the Fx Easytech Reversed system currently under evaluation through an Investigational Device Exemption clinical trial. Explanted components were submitted to an independent orthopaedic laboratory for systematic, non-destructive analysis comprising high-magnification microscopy. Bony ongrowth was assessed using a non-standardized, semi-quantitative grading scale applied across four fixation surface quadrants (Q1-Q4), estimating tissue coverage from 0 (none) to 4 (75-100%). Bony ongrowth was observed on all three titanium-hydroxyapatite (Ti/HA)-coated humeral anchor bases across implantation durations ranging from 39 days to 3 years and 8 months, with semi-quantitative scores of Q1: 2-4, Q2: 4, Q3: 3-4, Q4: 3. No case was revised for fixation failure. Ti/HA-coated stemless humeral components demonstrated osseointegration under the compressive-dominant loading environment of rTSA. Bony ongrowth was evident as early as 39 days postoperatively. Larger retrieval series and long-term follow-up are necessary to confirm the durability of stemless humeral implants. Level IV, Case Report.

Chronic pain affects over 50 million adults in the United States and is associated with autonomic nervous system dysfunction assessed through measurements of heart rate variability (HRV). While exercise has been shown to improve HRV in healthy individuals, the effects of different exercise protocols in chronic pain populations on HRV remain underexplored. The purpose of this systematic review investigated how exercise interventions influence HRV and pain in individuals with chronic pain. A literature search was conducted in accordance with PRISMA guidelines across four electronic databases. Six randomized controlled trials met the inclusion criteria and were critically appraised for methodological quality. Studies were included if they involved an exercise intervention and reported HRV. If pain was assessed, it was included as an outcome measure. Six randomized controlled trials were identified with 283 participants. All studies measured HRV, while four reported pain outcomes. Five studies reported significant improvements in HRV following exercise interventions (p <0.05), while findings related to pain outcomes were mixed. Methodological reporting of HRV procedures was generally insufficient. Due to heterogeneity across studies, it remains unclear whether exercise improves pain or HRV sufficiently. While pain outcomes are commonly reported, HRV is the only measure specific to \autonomic function, and its reliability as a clinical metric in individuals with chronic pain remains uncertain. Limited research across diverse chronic conditions, sexes, and methodological approaches restricts generalizability. This highlights the need for greater methodological rigor and broader inclusion to strengthen the use of HRV metrics in chronic pain populations.

To examine the association between systemic Janus kinase (JAK) inhibitor use and the incidence of newly diagnosed dry eye disease (DED) in patients with rheumatoid arthritis (RA). This multi-institutional retrospective cohort study used de-identified electronic health records from the United States Collaborative Network. Adults aged 18 years or older with RA were categorized according to systemic JAK inhibitor use or non-use. A secondary active-comparator analysis compared JAK inhibitor users with rituximab-treated patients. Propensity score matching was performed to balance demographic characteristics, comorbidities, medication history, ocular conditions, and healthcare utilization. The primary outcome was newly diagnosed DED. Time-to-event analyses were conducted using Kaplan-Meier methods and Cox proportional hazards models. A total of 25,149 JAK inhibitor users and 150,250 non-users with RA were identified. After matching, each cohort contained 23,343 patients with balanced baseline characteristics. JAK inhibitor use was associated with a lower incidence of newly diagnosed DED compared with non-use within 1 year of follow-up (hazard ratio [HR], 0.633; 95% CI, 0.545-0.736). In the secondary active-comparator analysis, 6,637 JAK inhibitor users were matched to 6,637 rituximab-treated patients, and JAK inhibitor use remained associated with a lower incidence of newly diagnosed DED (HR, 0.613; 95% CI, 0.476-0.791). Individual-agent analyses showed directionally consistent associations for tofacitinib and upadacitinib. Findings were consistent across sensitivity analyses using varying follow-up durations and landmark definitions. In this large real-world cohort study, JAK inhibitor use was associated with a lower incidence of newly diagnosed DED among patients with RA, with similar findings in a rituximab active-comparator analysis. However, the observational design, residual confounding, and coding-based outcome definition preclude causal inference. Prospective studies incorporating standardized ocular surface assessments and direct RA disease activity measures are needed to clarify the clinical relationship between systemic JAK inhibition and DED.

AI shows substantial potential in health care; however, the absence of standardized evaluation frameworks limits its safe and effective clinical implementation because of inconsistent validation requirements and fragmented ethical principles. Existing guidelines vary in structure, methodological rigor, and ethical integration, creating uncertainty. This study aimed to systematically map, characterize, and critically analyze existing evaluation frameworks for clinical AI, focusing on three core dimensions: methodological rigor, validation strategies (internal validation, including reporting of technical and clinical performance; external validation, including real-world applicability), and alignment with the United Nations Educational, Scientific and Cultural Organization (UNESCO) AI ethical considerations. A scoping review was conducted following PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Six databases (PubMed, Embase, BVS, EBSCOhost, ProQuest, and Sage) and the Enhancing the Quality and Transparency of Health Research Network were searched without language or date restrictions up to February 2026. Eligible documents included peer-reviewed papers, gray literature, and organizational guidelines describing evaluation or reporting frameworks for clinical AI. Editorials, commentaries, and conference abstracts lacking a clearly defined evaluative framework or clinical applicability were excluded. Two reviewers independently screened records and extracted data. Data were extracted across three domains: (1) general characteristics, (2) methodological rigor and validation parameters, and (3) ethical integration and were synthesized using a dot plot-based gap map. Ethical adherence was assessed using a 10-domain UNESCO-based scoring matrix. No formal risk-of-bias assessment was conducted, consistent with scoping review methodology. From 3363 records, 46 frameworks met the inclusion criteria. Mapping revealed a rapidly expanding but fragmented landscape. Most frameworks targeted investigational use (88%), with limited focus on clinical applicability. Frameworks varied in structure, methodology, and scope, with a predominance of reporting guidelines and few validated tools. Most (63%) were developed through multi-institutional collaborations, and 32.6% incorporated transdisciplinary participation. Only 31.8% reported technical metrics (commonly area under the curve, sensitivity, and specificity), and 15.9% provided clinical indicators (eg, predictive values or calibration). Only 11.4% achieved methodological rigor, incorporating validation aligned with intended use, while most relied on partial validation strategies, highlighting a gap between model development and clinical evaluation. Ethical integration was heterogeneous: only 5 frameworks achieved high compliance (&#x2265;80%), whereas 4 scored <10%. The most frequently addressed UNESCO principles were awareness and education (71.1%) and transparency and explainability (70%), while human oversight (24.4%) and adaptive governance (33.3%) were least represented. Findings indicate a misalignment between framework design, validation requirements, and clinical implementation. Evaluation frameworks for clinical AI remain heterogeneous and oriented toward investigational contexts. Critical gaps persist in methodological rigor, validation aligned with intended use, and fragmented ethical coverage. These findings highlight the need for standardized, robust, and ethically grounded frameworks to enable safe, reliable, and scalable integration of AI into clinical practice.

Clostridioides difficile infection (CDI) is a major cause of antibiotic-associated diarrhea in the United States. Gut dysbiosis and chronic inflammation are key contributors to CDI susceptibility and severity. Metabolic syndrome (MetS)-defined by central obesity, hypertriglyceridemia, low HDL cholesterol, hypertension, and type 2 diabetes mellitus (T2DM)-is increasingly prevalent worldwide and is characterized by chronic immune dysregulation and alterations in gut microbiota. These pathophysiologic features may overlap with mechanisms that predispose individuals to CDI and its complications. Using a large electronic health record database encompassing 102 health care organizations, we examined the association between metabolic conditions (MetS, obesity, and T2DM) and the risk of CDI diagnosis and severe clinical outcomes. Individuals with a diagnosis of each metabolic condition were compared with matched controls. All 3 metabolic conditions were associated with an increased risk of CDI. The strongest association was observed in patients with MetS (odds ratio [OR], 1.94), followed by obesity (OR, 1.14) and T2DM (OR, 1.11). The impact of metabolic disorders on CDI severity varied based on the specific condition. Patients with MetS and obesity were more likely to develop sepsis, leukocytosis, and neutrophilia and to require ICU admission; however, they had lower risk of hypoalbuminemia, recurrent CDI, and all-cause mortality. In contrast, patients with T2DM had greater odds of developing all of the CDI-associated complications. MetS, obesity, and T2DM were all associated with an increased likelihood of CDI diagnosis. However, their effects on CDI severity varied among the 3 conditions examined-patients with T2DM had the greatest risk of adverse outcomes, including sepsis, ICU admission, recurrent CDI, and mortality.

Human adenovirus type C (HAdV-C) causes upper respiratory infections in children and may lead to severe pneumonia. During the implementation and subsequent relaxation of non-pharmaceutical interventions, HAdV-C emerged as a transiently dominant circulating strain in Beijing. However, the fine-scale genomic architecture and the evolutionary trajectories governing its recombination remains insufficiently characterized. Between March 2023 and August 2024, respiratory samples from Beijing patients were collected and screened by quantitative PCR. In conjunction with high-throughput whole-genome sequencing, five complete HAdV-C genomes were characterized, predominantly identified as genotypes C1 and C108, maintaining over 98% intra-typic sequence identity. Phylogenetic analysis based on whole genomic sequences revealed at least five evolutionary branches within C108. Phylogenetic reconstruction revealed a complex diversification within C108, delineating at least five distinct evolutionary clades. Specifically, the four C108 strains partitioned into two divergent sub-lineages, exhibiting close phylogenetic affinities with sequences from China and the United States. Furthermore, recombination analysis identified six discrete recombination patterns. Selection pressure analysis further demonstrated heterogenous evolutionary constraints across the genome; notably, immune-relevant early genes such as E1a_26KD exhibited elevated dN/dS ratios, harbouring multiple positive selection sites. These adaptive mutations were distributed across 23 of 33 annotated genes (69.7%), suggesting extensive diversifying selection. These findings elucidate that HAdV-C evolution is synergistically driven by frequent recombination events and potent selective pressures. This study provides critical evidence for the spatiotemporal dynamics and genomic surveillance of the emerging HAdV-C variants.

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In early 2024, Lao People's Democratic Republic experienced a surge in dengue cases approaching levels of its 2013 epidemic, underscoring the persistent threat of dengue during the monsoon season. Although awareness of preventive behaviours is high, inconsistent adoption has limited their effectiveness. In response, the Ministry of Health, in collaboration with the World Health Organization, implemented an innovative, humour-driven risk communication and community engagement (RCCE) campaign targeting individuals who perceived dengue as a routine health concern. To capture attention and increase message retention, the April to September campaign employed an actor dressed as a giant mosquito who deliberately and humorously interrupted daily activities. The strategy used pre-tested materials, a strong social media presence, and television and radio to promote mosquito control, symptom recognition and timely medical care for severe dengue. The impact was assessed through nationwide phone and online surveys and social media analytics. The campaign reached almost 2.9 million unique users (68.2% of whom were using the country's most popular social media platform), generating more than 27 million content views and 86&#xa0;342 interactions. Post-campaign surveys indicated a sharp rise in public concern about dengue (from 21% [42/200] to 56% [224/400], indicating they were "very concerned") and high awareness of key messages, with 81% (324/400) stating they would seek immediate care for severe symptoms. The humour-based approach was rated as appealing or very appealing by 76% (304/400) of respondents, with 90% (360/400) reporting increased likelihood of preventive action. These findings demonstrate that culturally relevant, humour-based RCCE, integrated across digital and traditional media, may be effective in enhancing awareness and shifting perceptions.

Much debate exists about the relative contribution of the skeletal muscle pump and rapid vasodilation to exercise hyperemia. This investigation examined the contribution of the skeletal muscle pump to the immediate increase in muscle blood flow (MBF) following a single muscle contraction. Prior vasodilation using glyceryl tri-nitrate (GTN) abolished the impact of contraction-induced vasodilation following a single contraction. Eight healthy individuals completed a series of three, single muscle contractions at 10% of MVIC, each separated by 90 seconds of recovery for the control (CON) condition. For the GTN condition, participants were given a 0.4 mg dose of GTN sublingually and given enough time for brachial artery diameter to reach a new steady-state. The single contraction model from CON was repeated for GTN condition. Each condition was repeated twice for a total of 6 contractions. Brachial artery diameter and blood velocity were obtained using an ultrasound system operating in Duplex mode. Brachial artery diameter was significantly greater following GTN administration prior to contraction (CON: 0.48 &#xb1; 0.07&#xa0;cm; GTN: 0.56 &#xb1; 0.07&#xa0;cm, p< 0.05, d = 1.15). Forearm blood flow (FBF) was significantly lower (greater retrograde flow in GTN) during the contractile phase following GTN administration (CON: 0.75 &#xb1; 38.23 mL/min; GTN: -100.87 &#xb1; 45.00 mL/min, p< 0.05, d = 2.43), and significantly greater immediately (within 1 s) following the release of contraction (CON: 160.80 &#xb1; 72.91 mL/min; GTN: 232.87 &#xb1; 102.78 mL/min, p< 0.05, d = 0.81). This suggests that the immediate increase in FBF with GTN administration is due to rapid vasodilation and mechanical contraction.

Feed efficiency remains a central goal in livestock production because it determines both economic viability and environmental performance. Yet conventional measures such as feed conversion ratio and residual feed intake often treat efficiency as a host-level outcome and do not fully capture the biological processes that govern nutrient transformation and use. This perspective argues that the gastrointestinal microbiome is a critical, and still underappreciated, mediator of feed efficiency across livestock systems. In ruminants, rumen microbial communities drive the conversion of fibrous feeds into volatile fatty acids and microbial protein, thereby shaping host energy supply, nitrogen utilization, and methane loss. In monogastrics, intestinal microbiota influence nutrient salvage, short-chain fatty acid production, barrier integrity, immune tone, and metabolic signaling, with direct consequences for growth and productive performance. We contend that feed efficiency should be reframed as an emergent property of diet-microbiome-host interactions rather than as a simple input-output trait. From this viewpoint, microbial mediation helps explain between-animal variation in nutrient bioavailability, digestive stability, inflammatory burden, and resilience under commercial production conditions. We further highlight how microbiome-informed feeding strategies, including dietary bioactives, probiotics, prebiotics, enzymes, and precision nutrition approaches, could improve nutrient conversion while reducing methane emissions and reliance on antibiotics. Recognizing the microbiome as a functional regulator of feed efficiency offers a more mechanistic and sustainability-oriented framework for livestock nutrition research and practice, with important implications for breeding, management, and future multi-omics innovation.

The aim of the present study was to investigate the acute effects of varying exercise complexity on trunk muscle activity in recreationally trained adults during seven trunk-specific body-weight (BW) exercises. Twenty-eight participants were recruited (15 women and 13 men, age: 32&#x2009;&#xb1;&#x2009;9 years, height: 173&#x2009;&#xb1;&#x2009;9&#x2005;cm, body mass: 73&#x2009;&#xb1;&#x2009;10&#x2005;kg, training experience: 15&#x2009;&#xb1;&#x2009;9 years). Participants performed seven trunk-specific BW exercises in a randomized, counter-balanced order. Each exercise was performed isometrically (15&#x2005;s) at 3-4 complexity levels, induced by changing the base of support, altering lever arms (using body tilt or body position), and applying bilateral versus unilateral execution. Electromyographic activity was collected from the rectus abdominis, external oblique, and spinal erector muscles. After completing each complexity level, participants rated their perceived exertion (RPE). Muscle activation was significantly higher at larger complexity levels (p&#x2009;<&#x2009;0.05, &#x3b7; p 2&#x2009;=&#x2009;0.12-0.89), and this effect was most pronounced in the primary target muscles for each exercise. Higher levels of muscle activation were accompanied by higher levels of perceived exertion (p&#x2009;<&#x2009;0.05, w&#x2009;=&#x2009;0.19-0.90). In conclusion, increasing instability, applying unilateral performance, and/or changing body position led to increased activation of trunk muscles and RPE during BW exercises in recreationally trained adults, with the highest activation observed in primary target muscles for each specific exercise.

Cephalopina titillator (C. titillator) is the causative agent of camel nasopharyngeal myiasis and is widespread in camel-rearing regions worldwide, causing impaired health, reduced productivity, and economic losses. However, despite the veterinary importance of C. titillator, global epidemiological evidence remains limited and fragmented, and no comprehensive synthesis of prevalence data across camel-rearing regions has previously been conducted. The objective of this review was to estimate the global pooled prevalence of C. titillator infestation in camels. In addition, subgroup analyses were made to assess the effect of camel species, geographic region, and study period on the pooled prevalence of C. titillator infestation. The review was conducted in accordance with PRISMA 2020 guidelines. The review protocol was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD420261344750. A literature search was conducted in multiple databases including PubMed/MEDLINE, Scopus, Web of Science (WoS), Google Scholar, and CAB Direct (Centre for Agriculture and Bioscience International database; CABI). Pooled prevalence was estimated by a random-effects meta-analysis using R software. Heterogeneity of the prevalence reports was assessed using Cochran's Q and the I2 statistic. Funnel plot and Egger's test were used for assessing study bias. Forty-one epidemiological studies involving 18,959 camels from 11 countries were included in this review. The pooled prevalence of C. titillator infestation was 67% (95% CI: 59-75%). Heterogeneity among studies was very high (I2&#x202f;=&#x202f;99.1%, p&#x202f;<&#x202f;0.001). Subgroup analyses revealed significant differences in pooled prevalence among study regions (p&#x202f;=&#x202f;0.0016), whereas pooled prevalence was not significantly affected by study period or camel species (p&#x202f;>&#x202f;0.05). Although the funnel plot showed slight asymmetry, Egger's regression test did not indicate statistically significant small-study effects (p&#x202f;=&#x202f;0.497). This meta-analysis demonstrated a high pooled prevalence of C. titillator infestation (67%; 95% CI: 59-75%) and revealed important geographical variation across camel-rearing countries, highlighting the substantial epidemiological burden of infestation and the need for region-specific surveillance and control strategies. PROSPERO, Registration No. CRD420261344750. Publicly accessible at: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=1344750.