Cayla Robinson

Estimated rates of child protective services (CPS)/child welfare reinvolvement among families vary widely across studies, but parental substance use consistently emerges as a modifiable risk factor. However, addressing this risk factor remains challenging due to the often complex and intersecting needs of parents using substances. This scoping review aims to map the existing literature in three ways: first, by examining the prevalence of CPS/child welfare reinvolvement among families with parental substance use; second, by identifying interventions and protective factors associated with reduced risk of reinvolvement in this population; and third, by exploring risk factors unique to this population that may inform new targets for intervention. Findings will help clarify the current evidence base and identify priorities for future research and practice aimed at reducing reinvolvement among this high-risk group.

OBJECTIVES: To identify biological findings underlying skeletal muscle dysfunction in adults with critical illness and meta-analyze myofiber cross-sectional area and protein turnover variables. DATA SOURCES: Six databases were electronically searched from inception to January 2025. STUDY SELECTION: We included original studies reporting biological findings obtained from skeletal muscle biopsies of adults with critical illness. DATA EXTRACTION: Bibliometrics, characteristics of the patients/controls, and biological findings were extracted in duplicate. Descriptive statistics of biological findings were performed. Random-effects meta-analyses investigated mean differences (MDs) in myofiber cross-sectional area and protein turnover compared with controls. DATA SYNTHESIS: From 22,035 titles screened, 75 studies ( n = 2,023 patients; n = 642 controls) published between 1988 and 2024 were included, with 48 unique patient datasets. Biopsies were mainly collected from vastus lateralis (64 [85%] studies) during the first ICU week (50% of studies) and post-ICU (9%). Biological findings included predominant type II myofiber atrophy with necrosis and structural degeneration, mitochondrial dysfunction, inflammatory/fibrotic changes, and upregulated ubiquitin-proteasome/autophagy pathways. Data from six studies ( n = 100 patients; 193 controls) indicated that cross-sectional area was 22% lower in patients with critical illness before (MD, –689 µm ² ; 95% CI, –1265 to –113 µm ² ; p = 0.02) and after (MD, –775 µm ² ; 95% CI, –1512 to –37 µm ² ; p = 0.04) ICU discharge. Across seven studies ( n = 126 patients; 61 controls) protein synthesis was not significantly different in patients with critical illness compared with controls (MD, 0.007%/hr; 95% CI, –0.010 to 0.027; p = 0.36). Protein degradation pathway markers were significantly higher (standardized MD ranging, 0.5–1.7) in data from 11 studies ( n = 439 patients; 163 controls). CONCLUSIONS: Muscle wasting during critical illness reflects multifaceted biological disturbances. While myofiber size is significantly lower in patients with critical illness, pooled analyses show no significant differences in muscle protein synthesis compared with non-ICU controls, whereas protein degradation markers are consistently higher.

Background: Patients with migraine are frequently referred to physical therapy, particularly when neck pain is present or symptoms remain inadequately controlled with medical management. Cervical strengthening and stabilization exercises are commonly prescribed; however, the quality and consistency of supporting evidence remain unclear. This review evaluated the effectiveness and safety of cervical-focused exercise interventions for migraine. Methods: A systematic search of nine medical and rehabilitation databases identified studies evaluating cervical or upper-body strengthening and stabilization interventions in individuals aged ≥14 years with migraine diagnosed according to International Classification of Headache Disorders criteria. Eligible studies reported headache or disability outcomes. Methodological quality and risk of bias were assessed using the Downs and Black Checklist, CARE guidelines, and Cochrane Risk of Bias 2 tool. Random-effects meta-analyses were performed for headache frequency, headache intensity, and migraine-related disability. Results: Twelve studies met inclusion criteria, including five randomized controlled trials, three observational studies, one case report, and three conference abstracts. Interventions varied in duration, supervision, and comparators. Meta-analysis demonstrated a moderate, statistically significant improvement in migraine-related disability (SMD=0.69; 95% CI, 0.19–1.18; I ² =70.7%). Effects for headache frequency (SMD=0.61; 95% CI, −0.25–1.47; I ² =73.7%) and headache intensity (SMD=0.41; 95% CI, −0.35–1.18; I ² =74.1%) were not statistically significant. Observational studies reported within-group improvements. Conclusions: Cervical strengthening and stabilization exercises may have potential for improving migraine-related disability; however, current evidence remains insufficient to establish clear benefit for migraine prevention outcomes. Findings are based on very low to low certainty evidence, limited by risk of bias and substantial heterogeneity. Future research should prioritize adequately powered, multicenter randomized controlled trials with rigorous methodology and standardized reporting to determine whether these interventions provide clinically meaningful benefit for individuals with migraine. Registration: Prospero ID: CRD420251051356.

Revealing biological mechanisms leading to respiratory muscle dysfunction is essential to improve clinical outcomes in patients with critical illness. The purpose was to identify biological mechanisms associated with respiratory muscle dysfunction in patients with critical illness during mechanical ventilation or sepsis. Six databases were electronically searched from inception to January 2025, examining studies with muscle biopsies. Screening, data collection, and risk-of-bias were conducted in duplicate by two independent assessors. Meta-analysis was performed to determine differences in muscle biological parameters of patients with critical illness requiring mechanical ventilation compared with controls. From 22,036 titles screened, eight studies ( n = 187 patients and n = 161 controls) published between 2000 and 2024 met eligibility criteria. Muscle biopsies were taken between days 1 and 7 in the intensive care unit from the diaphragm ( n = 110; 3 studies), rectus abdominis ( n = 68; 5 studies), external intercostal ( n = 10; 1 study), and latissimus dorsi ( n = 3; 1 study). Diaphragmatic fiber cross-sectional area was 30% smaller (mean difference [95% confidence interval] = −629 [−876, −382] μm ² ), with lower proportion of type II fibers (−1.94 [−3.40, −0.49]%) compared with controls. Diaphragmatic fiber force of patients was more than two standard deviations lower (standardized mean difference = −2.49 [−3.84, −1.14]), and ubiquitinated protein levels were higher (2.09 [−0.14, 4.32]) than controls. Extramyocellular, mitochondrial, and gene expression parameters were assessed in some studies, but low sample size and high heterogeneity prevented meta-analyses. In conclusion, muscle biopsies from ventilated patients revealed atrophy, contractile weakness, and proteolysis markers. Standardized methodologies assessing respiratory muscles are needed to clarify biological mechanisms leading to muscle dysfunction and to guide respiratory muscle interventions.

Background: Evidence synthesis (ES) tasks for librarians require significant time and effort. For those unfamiliar with ES, acquiring the necessary skills can be challenging. Various training opportunities are available that address topics like methodology, effective search strategies, and project management. However, developing soft skills such as negotiation, collaboration, reflective practice, and mentoring typically requires direct experience managing projects. This paper outlines an experiential learning model designed to offer librarians new to ES practical training and guidance. The purpose of the model is to facilitate knowledge of ES work and to enable librarians to mentor others in this area. Experience: This paper outlines the model's layers—Beginner, Novice, Competent, and Proficient—and shares perspectives from participants. As librarians advance through the model, they develop expertise and practical soft skills. Reflections from various library professionals highlight the advantages of this self-sustaining framework. Takeaways: The model effectively integrates technical and interpersonal skills, cultivating library professionals who are equipped to lead teams, instruct on methodological standards, and manage authorship negotiation and conflict resolution. By promoting competence and confidence, this approach empowers librarians to advocate for their own contributions and expertise. Furthermore, it encourages a culture of mentorship among both mentors and mentees, preparing new librarians in evidence synthesis to eventually guide their peers. In summary, the model underscores the value of embedding education and mentorship within library practice.