A Protocol Driven Approach to Reduce Lengths of Stay for Pediatric Blunt Liver and Spleen Injury Patients.

BACKGROUND: Our institution updated blunt liver and spleen injury (BLSI) protocols in 2019 in adherence to updated American Pediatric Surgery Association (APSA) recommendations. This retrospective study compares resource utilization for pediatric BLSI patients treated under old and updated guidelines. METHODS: BLSI patients without severe non-abdomen injuries aged under 18 treated with prior (04/2015-06/2019) and updated (06/2019-12/2022) guidelines were retrospectively reviewed and compared. Each patient received an adjusted injury severity score (ISS) to control for non-BLSI injuries. Multivariate analysis examined protocol group differences while controlling for adjusted ISS and BLSI grades. Primary outcomes were ICU length of stay (LOS), hospital LOS (analyzed using Cox regression), and patient costs (linear regression). Secondary outcomes include readmission in two weeks and death rates (logistic regression). RESULTS: 176 and 170 BLSI patients were treated with old and updated protocols, respectively. Patient demographics, average BLSI grade, and adjusted ISS were similar in both groups. Patients treated with old protocols indicate decreased hazard, showing significantly more days before ICU discharge (coefficient = -0.3868, p < .0009) and hospital discharge (coefficient = -0.5507, p < .0001). Patient costs (coefficient = 0.0921, p = 0.1874) trend towards being lower in the new protocol. Readmission rates were significantly higher in the new protocol (coefficient = -1.1731, p = 0.0465), and death rates (coefficient = 0.0519, p = 0.9710) were comparable. CONCLUSIONS: BLSI patients treated under new APSA guidelines compared to old guidelines had significant decreases in ICU and hospital LOS, a decreasing trend in costs, comparable death rates, but higher readmission rates. Future studies with larger sample sizes and detailed cost analysis would explore whether updated guidelines reduce patient costs and help elucidate the veracity or potential cause of the increased readmission rates. LEVEL OF EVIDENCE: Level III, Therapeutic/Care Management.

Neurosurgical management of cervicomedullary compression, spinal stenosis, and hydrocephalus in pediatric achondroplasia: a systematic review.

OBJECTIVE: Pediatric achondroplasia is often associated with conditions requiring neurosurgical intervention, including CSF diversion and multilevel spinal decompression. However, there is a lack of clinical guidelines and reliable estimates of the benefits and risks of these interventions. This study aimed to summarize the literature on the neurosurgical management of pediatric achondroplasia patients in order to aid in determining optimal treatment and standardization of care. METHODS: A systematic review of peer-reviewed studies with an objective diagnosis of achondroplasia, patient demographic information, and available data on neurosurgical interventions performed before 18 years of age for cervicomedullary compression, spinal stenosis, and hydrocephalus was performed. Study quality and risks of bias were assessed using standardized scores. Independent patient data on surgical indications, outcomes, reoperations, and complication risks were aggregated using means and percentages. RESULTS: Of 204 records, 25 studies with 287 pediatric achondroplasia patients (mean age 25 ± 36 months) treated for cervicomedullary compression (n = 153), spinal stenosis (n = 100), and obstructive hydrocephalus (n = 34) were evaluated. Symptomatic cervicomedullary compression occurred early in life (mean age 31 ± 25 months), with apnea (48%), T2-weighted MRI cord signal (28%), myelopathy (27%), and delayed motor skills (15%) requiring foramen magnum decompression observed in 99% of patients, as well as cervical laminectomy in 65% of patients. Although 91% of treated patients had resolution of symptoms, 2% mortality, 9% reoperation, and 21% complication rates were reported. Spinal stenosis was treated in relatively older children (mean age 13 ± 3 years) with laminectomy (23%), as well as with instrumented fusion (73%) for neurogenic claudication (59%), back pain (15%), and sciatica (8%). Although 95% of patients had symptom resolution after surgery, 17% reported complications and 18% required reoperation. Of the hydrocephalus patients (mean age 56 ± 103 months), half were treated with endoscopic third ventriculostomy (ETV) and half had a shunt placed for progressive ventriculomegaly (66%), headaches (32%), and delayed cognitive development (4%). The shunted patients had a 3% mortality rate and an average of 1.5 shunt revisions per patient. None of the patients who underwent ETV as the primary procedure required a revision. CONCLUSIONS: Neurosurgical intervention for pediatric achondroplasia conditions, including cervicomedullary compression, spinal stenosis, and hydrocephalus, is associated with high recovery rates and good outcomes. However, complications and reoperations are common. Further studies with follow-up into adulthood are needed to evaluate the long-term outcomes.

Child and youth physical activity throughout the COVID-19 pandemic: The changing role of the neighbourhood built and social environments.

We explored associations between neighbourhood environments and children and youths' moderate-to-vigorous physical activity (MVPA) during three different waves of the COVID-19 pandemic: spring 2020, fall 2020 and spring 2021, using three nationally representative cross-sectional surveys. In wave 2, higher dwelling density was associated with lower odds of a child achieving higher-level MVPA, however, the odds were higher in neighbourhoods with higher density that also had better access to parks. With regard to the social environment, ethnic concentration (wave 3) and greater deprivation (waves 1 and 3) were associated with lower odds of a child achieving higher-level MVPA. Results indicate that built and social environments were differently associated with MVPA levels depending on pandemic restrictions.

Impact of an outdoor loose parts play intervention on Nova Scotian preschoolers' physical literacy: a mixed-methods randomized controlled trial.

BACKGROUND: Physical activity participation among preschoolers in childcare settings are low, and interventions to increase physical activity levels have produced mixed results. The Physical Literacy in the Early Years (PLEY) project implemented a six-month childcare-based outdoor loose parts play intervention in childcare centres in Nova Scotia, Canada. The purpose of this study was to examine the impact of the PLEY project on the development of domains of physical literacy (physical activity, physical competence, confidence and motivation, knowledge and understanding) in preschoolers attending childcare centres using mixed-methods. METHODS: Preschoolers (3-5 years) were recruited from 19 childcare centres in Nova Scotia and centres were randomized (parallel design) to the outdoor loose parts play intervention group (n = 11) or control (n = 8) group for 6 months. Participants, early childhood educators, and assessors were not blinded to group assignment. Quantitative and qualitative measures were used to comprehensively assess the impact of the PLEY project on all domains of physical literacy. At 3- and 6-months, early childhood educators participated in focus groups to assess how the intervention supported the development of 4 physical literacy domains: physical activity, physical competence, confidence and motivation, and knowledge and understanding. Physical activity and physical competence were also assessed with accelerometry and the Test of Gross Motor Development-3, respectively. RESULTS: Two hundred and nine preschoolers participated in the study (intervention group: n = 115; control group: n = 94). Accelerometer data showed that while baseline physical activity was similar between groups, children in the intervention group had higher physical activity at 3- (F(1,187) = 8.30, p = 0.004) and 6-months (F(1,187) = 9.90, p = 0.002) post-intervention. There was no intervention effect on physical competence scores. Thematic analysis of focus group data revealed that outdoor loose parts play contributed to development in all 4 physical literacy domains, including increased movement repertoires, social development, and enjoyment of physical activity. No adverse events or side effects of the intervention were reported. CONCLUSIONS: Participation in the PLEY project was associated with increased development of various domains of physical literacy and perceived physical literacy among preschoolers, and outdoor loose parts play may be encouraged as an effective strategy to increase physical literacy in early learning settings. TRIAL REGISTRATION: Biomed Central (ISRCTN14058106), 20/10/2017.

Ciliated sensory neurons can regenerate axons after complete axon removal.

Axon regeneration helps maintain lifelong function of neurons in many animals. Depending on the site of injury, new axons can grow either from the axon stump (after distal injury) or from the tip of a dendrite (after proximal injury). However, some neuron types do not have dendrites to be converted to a regenerating axon after proximal injury. For example, many sensory neurons receive information from a specialized sensory cilium rather than a branched dendrite arbor. We hypothesized that the lack of traditional dendrites would limit the ability of ciliated sensory neurons to respond to proximal axon injury. We tested this hypothesis by performing laser microsurgery on ciliated lch1 neurons in Drosophila larvae and tracking cells over time. These cells survived proximal axon injury as well as distal axon injury, and, like many other neurons, initiated growth from the axon stump after distal injury. After proximal injury, neurites regrew in a surprisingly flexible manner. Most cells initiated outgrowth directly from the cell body, but neurite growth could also emerge from the short axon stump or base of the cilium. New neurites were often branched. Although outgrowth after proximal axotomy was variable, it depended on the core DLK axon injury signaling pathway. Moreover, each cell had at least one new neurite specified as an axon based on microtubule polarity and accumulation of the endoplasmic reticulum. We conclude that ciliated sensory neurons are not intrinsically limited in their ability to grow a new axon after proximal axon removal.

Surgical treatment of craniovertebral junction instability in children with Down syndrome: a systematic review.

OBJECTIVE: Down syndrome (DS) affects 1 in 700 live births and approximately one-third of patients develop craniovertebral junction (CVJ) instability, diagnosed by clinical examination and radiological measures such as the atlantodens interval (ADI) and space available for the cord (SAC). Patients with symptomatic CVJ instability are at increased risk for spinal cord injury. There are no guidelines for surgical management of CVJ instability in DS, the existing literature is sparse, and there is a lack of consistent pediatric data. This systematic review aimed to synthesize practice patterns of the surgical management of CVJ stability in pediatric DS patients to facilitate future standardization of care. METHODS: Peer-reviewed studies reporting surgical management of CVJ instability in pediatric DS patients were systematically reviewed. Inclusion criteria were studies reporting primary data on patients younger than 18 years with DS, who had CVJ instability evaluation and underwent surgical treatment. Bias risk was assessed. Descriptive statistics of the independent patient data were presented. Interval variables were analyzed using the Wilcoxon rank-sum test. RESULTS: Of 1056 records, 38 studies were included. Of the included patients, 169 (6%) underwent surgery. The surgical indication was symptomatic, radiologically confirmed CVJ instability in 81% of the patients, presenting with myelopathy (30%), weakness (25%), abnormal gait (24%), torticollis (15%), and neck pain (14%). A cutoff of ADI ≥ 4 mm or SAC ≤ 14 mm, cord compression, cord signal change, and anomalous bony anatomy were used in diagnosing CVJ instability. Surgical approaches focused on internal fixation with posterior occipitocervical or atlantoaxial instrumented fusion in 57% and 44% of patients, respectively. Autograft, wiring, and allograft constructs were used in 48%, 45%, and 9% of patients. Anterior cervical approaches were performed in 6% of patients. Preoperative and postoperative external orthoses were used in approximately 50% of patients. The surgical mortality rate was 3%, and the complication rate was 36%. CONCLUSIONS: Assessment of CVJ instability in DS is based on radiographic and clinical factors. Surgery is recommended if symptoms are present, and the procedure type depends on patient factors, degree of instability, anomalous bony anatomy, and reduction results to relieve cord compression. Most commonly, posterior instrumented fusion is used. However, further research is required to determine the strength of evaluation methods, create standardized guidelines for evaluation and surgical treatment, and investigate the long-term results of different surgical techniques.

The exocyst complex is required for developmental and regenerative neurite growth in vivo.

The exocyst complex is an important regulator of intracellular trafficking and tethers secretory vesicles to the plasma membrane. Understanding of its role in neuron outgrowth remains incomplete, and previous studies have come to different conclusions about its importance for axon and dendrite growth, particularly in vivo. To investigate exocyst function in vivo we used Drosophila sensory neurons as a model system. To bypass early developmental requirements in other cell types, we used neuron-specific RNAi to target seven exocyst subunits. Initial neuronal development proceeded normally in these backgrounds, however, we considered this could be due to residual exocyst function. To probe neuronal growth capacity at later times after RNAi initiation, we used laser microsurgery to remove axons or dendrites and prompt regrowth. Exocyst subunit RNAi reduced axon regeneration, although new axons could be specified. In control neurons, a vesicle trafficking marker often concentrated in the new axon, but this pattern was disrupted in Sec6 RNAi neurons. Dendrite regeneration was also severely reduced by exocyst RNAi, even though the trafficking marker did not accumulate in a strongly polarized manner during normal dendrite regeneration. The requirement for the exocyst was not limited to injury contexts as exocyst subunit RNAi eliminated dendrite regrowth after developmental pruning. We conclude that the exocyst is required for injury-induced and developmental neurite outgrowth, but that residual protein function can easily mask this requirement.

Parent Risk Perceptions, Physical Literacy, and Fundamental Movement Skills in Children With Juvenile Idiopathic Arthritis.

PURPOSE: This pilot study sought to examine the fundamental movement skills (FMS) and physical literacy (PL) of children with juvenile idiopathic arthritis (JIA) and to explore their relationship with physical activity (PA) and parent perceptions of PA-related risks. METHODS: Twenty-five children with JIA and their parents completed questionnaires. Fundamental movement skills were assessed in the laboratory and PA through accelerometry data. RESULTS: Children spent a median of 39.4%, 40.9%, and 18.2% of their day sedentary, in light, and in moderate to vigorous PA, respectively. Fundamental movement skills and PL scores were within the average range, although were related to which joints (upper/lower body) were affected by JIA. Parents who viewed activities such as biking and climbing as risky tended to have children with weaker locomotor skills and lower PL. CONCLUSION: Children with JIA had age-appropriate PA, FMS, and PL; however, parent perceptions of PA-related risks are related to their child's FMS and PL.

An Intervention to Increase Outdoor Play in Early Childhood Education Centers (PROmoting Early Childhood Outside): Protocol for a Pilot Wait-list Control Cluster Randomized Trial.

BACKGROUND: Participation in outdoor play has been extensively documented as beneficial for the health, well-being, and development of children. Canadian early childhood education centers (ECECs) are important settings in young children's lives and provide opportunities to participate in outdoor play. However, there are barriers to the provision of outdoor play opportunities at ECECs, such as adverse weather conditions, poorly designed outdoor spaces, outdoor time policies, and early childhood educator comfort levels. OBJECTIVE: The PROmoting Early Childhood Outside (PRO-ECO) study is a wait-list control cluster randomized trial that evaluates the impact of the PRO-ECO intervention, an innovative outdoor play intervention, on children's outdoor play behavior. The purpose of this paper was to provide a detailed overview of the pilot study protocol and the methods that will be used to develop, implement, and evaluate the PRO-ECO intervention. METHODS: A total of 8 ECECs delivering licensed care to children aged 2.5 to 6 years in the Greater Vancouver region of British Columbia, Canada, and operated by the YMCA of Greater Vancouver (YMCA GV) are included in this study. Using a wait-list control cluster randomized trial design, we randomly allocated ECECs to either the PRO-ECO intervention arm (n=4) or the wait-list control arm (n=4). The primary outcome measures include changes in the proportion and diversity of observed outdoor play behavior during dedicated outdoor times at the ECECs as measured through observational behavior mapping. Secondary outcome measures include changes in educator attitudes; quality of ECECs' outdoor play space; and children's psychosocial strengths, physical activity levels, and social behaviors. A process evaluation of the acceptability of the PRO-ECO intervention in the 8 YMCA GV ECECs will also be assessed. Outcome data will be collected at baseline, 6-month follow-up, and 12-month follow-up. Mixed effect models will test the effect of the PRO-ECO intervention on quantitative outcomes. Baseline and postintervention data will be included in the analysis, controlling for the cluster design. Qualitative data will support quantitative findings and provide evidence for the acceptability of implementation. RESULTS: Participant recruitment for this study began in August 2021, and baseline data collection was completed at all 8 ECECs in November 2021. As of April 2022, a total of 130 children have been recruited to participate in this study. CONCLUSIONS: The PRO-ECO pilot study will develop, implement, and evaluate the PRO-ECO intervention within 8 YMCA GV ECECs in the Vancouver region of British Columbia, Canada. The findings of this study will be useful for early childhood educators, ECEC providers, and policy makers to consider means for enhancing outdoor play provision and assessing the sustainability of the intervention in ECEC settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT05075580; https://clinicaltrials.gov/ct2/show/NCT05073380. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/38365.

Dendrite regeneration in the vertebrate spinal cord.

Axon regeneration in response to injury has been documented in many animals over several hundred years. In contrast, how neurons respond to dendrite injury has been examined only in the last decade. So far, dendrite regeneration after injury has been documented in invertebrate model systems, but has not been assayed in a vertebrate. In this study, we use zebrafish motor neurons to track neurons after dendrite injury. We address two major gaps in our knowledge of dendrite regeneration: 1) whether post-synaptic dendrites can regenerate and 2) whether vertebrate dendrites can regenerate. We find that motor neurons survive laser microsurgery to remove one or all dendrites. Outgrowth of new dendrites typically initiated one to three days after injury, and a new, stable dendrite arbor was in place by five days after injury. We conclude that zebrafish motor neurons have the capacity to regenerate a new dendrite arbor.

Parents and Children Should Be More Active Together to Address Physical Inactivity and Sedentary Behaviours.

Increasing rates of physical inactivity and sedentary behaviours among children and the youth are important determinants of chronic disease. Supporting children's participation in organised physical activities like sports has been promoted as a public health strategy to increase physical activity. Evidence shows that successful interventions are family-focused, although research on how parental eating and physical activity behaviours influence children's behaviours is deficient. In this commentary, we argue that interventions for countering physical inactivity and sedentary behaviours should include greater focus on home and social environments, specifically the influence and involvement of parents, siblings, and friends in supporting these health behaviours. We conclude that the design of interventions to prevent chronic diseases in children should also consider more carefully the conditions in which the behaviours of children and their parents occur. This means encouraging parents and children to be active together to address physical inactivity and sedentary behaviours, while being mindful of unintended consequences of focusing on one behaviour over another.

Impact of an outdoor loose parts intervention on Nova Scotia preschoolers' fundamental movement skills: a multi-methods randomized controlled trial.

Development of fundamental movement skills in early childhood supports lifelong health. The potential for outdoor play with loose parts to enhance fundamental movement skills has not been investigated. A multi-methods randomized controlled design was used to determine the efficacy of integrating outdoor loose parts play into Nova Scotia childcare centers (19 sites: 11 interventions, 8 control). Movement skills (n = 209, age 3-5 years) were assessed over a 6-month period to investigate changes in fundamental movement skills over time and between groups. Qualitative data was also collected on the educators' perceptions of outdoor loose parts play. Quantitative data (fundamental movement skills) revealed a non-intervention effect, however, educators spoke of outdoor loose parts play providing opportunities to combine/ repeat movements and take risks; supporting physical, cognitive and socio-emotional (holistic) development; and increasing awareness of children's physical development and how to support it. Our findings demonstrate value in outdoor loose parts play for the development of fundamental movement skills in childcare settings.

Microtubule organization of vertebrate sensory neurons in vivo.

Dorsal root ganglion (DRG) neurons are the predominant cell type that innervates the vertebrate skin. They are typically described as pseudounipolar cells that have central and peripheral axons branching from a single root exiting the cell body. The peripheral axon travels within a nerve to the skin, where free sensory endings can emerge and branch into an arbor that receives and integrates information. In some immature vertebrates, DRG neurons are preceded by Rohon-Beard (RB) neurons. While the sensory endings of RB and DRG neurons function like dendrites, we use live imaging in zebrafish to show that they have axonal plus-end-out microtubule polarity at all stages of maturity. Moreover, we show both cell types have central and peripheral axons with plus-end-out polarity. Surprisingly, in DRG neurons these emerge separately from the cell body, and most cells never acquire the signature pseudounipolar morphology. Like another recently characterized cell type that has multiple plus-end-out neurites, ganglion cells in Nematostella, RB and DRG neurons maintain a somatic microtubule organizing center even when mature. In summary, we characterize key cellular and subcellular features of vertebrate sensory neurons as a foundation for understanding their function and maintenance.

Trim9 and Klp61F promote polymerization of new dendritic microtubules along parallel microtubules.

Axons and dendrites are distinguished by microtubule polarity. In Drosophila, dendrites are dominated by minus-end-out microtubules, whereas axons contain plus-end-out microtubules. Local nucleation in dendrites generates microtubules in both orientations. To understand why dendritic nucleation does not disrupt polarity, we used live imaging to analyze the fate of microtubules generated at branch points. We found that they had different rates of success exiting the branch based on orientation: correctly oriented minus-end-out microtubules succeeded in leaving about twice as often as incorrectly oriented microtubules. Increased success relied on other microtubules in a parallel orientation. From a candidate screen, we identified Trim9 and kinesin-5 (Klp61F) as machinery that promoted growth of new microtubules. In S2 cells, Eb1 recruited Trim9 to microtubules. Klp61F promoted microtubule growth in vitro and in vivo, and could recruit Trim9 in S2 cells. In summary, the data argue that Trim9 and kinesin-5 act together at microtubule plus ends to help polymerizing microtubules parallel to pre-existing ones resist catastrophe.

Early childhood educator perceptions of risky play in an outdoor loose parts intervention.

Free play is important in early childhood and offers physical and mental health benefits. Outdoor play offers opportunity for children to use natural elements and promotes physical activity, among other health benefits, including exploring their environment and taking risks. Risky outdoor play may involve challenges, heights, speed, and the potential for injury, but has been associated with increased physical activity levels, decreased sedentary behaviour, improved mental health, and social benefits. The integration of loose parts, or open-ended, unstructured materials, into play environments, has been associated with positive social behaviours, creativity, and improved problem-solving, confidence, and resilience. As opportunities for risky play in early childhood are determined by adults, including early childhood educators, it is important to understand their perspectives on these types of play. The purpose of this study was to explore early childhood educators' perspectives of risky play, in the context of the Physical Literacy in the Early Years (PLEY) intervention. PLEY was a mixed methods study that aimed to evaluate a loose parts intervention in early childcare settings. This paper used Qualitative Description to explore educators' perspectives. Data were collected from 15 focus groups with early childhood educators. Four themes were identified through thematic analysis. The first explains how risky play with loose parts contributes to evolution in educator perceptions; the second describes how educators' perceptions of risk are connected to institutions and systems; the third illustrates how educators developed strategies to facilitate risky play with loose parts; and the fourth demonstrates how educators perceive risky play as beneficial for children's healthy development. This project highlights societal shifts in play and how loose parts and risky play fit into the ongoing evolution in play, from the perspectives of early childhood educators.

Marine water quality of a densely populated Pacific atoll (Tarawa, Kiribati): Cumulative pressures and resulting impacts on ecosystem and human health.

The resilience of coastal ecosystems and communities to poor environmental and health outcomes is threatened by cumulative anthropogenic pressures. In Kiribati, a developing Pacific Island country where human activities are closely connected with the ocean, both people and environment are particularly vulnerable to coastal pollution. We present a survey of environmental and human health water quality parameters around urban South Tarawa, and an overview of their impacts on the semi-enclosed atoll. Tarawa has significant water quality issues and decisions to guide improvements are hindered by a persistent lack of appropriate and sufficient observations. Our snapshot assessment identifies highest risk locations related to chronic focused and diffuse pollution inputs, and where mixing and dilution with ocean water is restricted. We demonstrate the importance of monitoring in the context of rapidly changing pressures. Our recommendations are relevant to other atoll ecosystems where land-based activities and ocean health are tightly interlinked.

Physical activity, sedentary time and sleep in cystic fibrosis youth: A bidirectional relationship?

PURPOSE: Physical activity (PA) and sleep are highly important for those with cystic fibrosis (CF), yet, despite this and suggestions of a bidirectional relationship between these factors in healthy children, their relationship is yet to be investigated. METHODS: PA, sedentary time (SED), and sleep were objectively derived over seven days in 58 youth (11.9 ± 2.7 years; 29 CF). Generalized linear latent and mixed models with a random intercept and slope at child-level were adjusted for age, sex, wear-time, type of day, group and mean PA/SED and sleep. RESULTS: Every additional 10 min sedentary was associated with 5.6 and 5.0 min less sleep and 10.6 and 12.0 min less wake after sleep onset (WASO) that night, in CF and healthy children, respectively. PA, regardless of intensity, was not associated with total sleep time but every additional 10 min of light PA (LPA) was associated with 3.0 min less WASO in healthy participants. Ten mins more sleep was associated with 3.1 and 1.7 min less SED in CF and healthy children, respectively. In CF, greater sleep time led to less LPA (3.6 min) the following day, whereas, in healthy children, poor sleep quality (greater WASO) was associated with more LPA (1.4 min) and moderate-to-vigorous PA (5.2 min) the following day. CONCLUSION: A bidirectional relationship between SED and subsequent total sleep time was evident, irrespective of group, whereas the relationship between sleep and PA was group dependent. These findings have important implications regarding the reciprocal effects of promoting PA or sleep quantity or quality.

Diabetes risk status and physical activity in pregnancy: U.S. BRFSS 2011, 2013, 2015, 2017.

BACKGROUND: Pregnant women without complications are advised to engage in physical activity (PA) to mitigate adverse outcomes. Differences may exist among pregnant women of diverging diabetes status in meeting national PA recommendations. We sought to examine differences in aerobic activity (AA) and muscle strengthening activity (MSA) by diabetes risk status (DRS) among pregnant women in the United States. METHODS: The sample (n = 9,597) included pregnant women, age 18-44 years, who participated in the 2011, 2013, 2015, and 2017 Behavioral Risk Factor Surveillance System. Levels of DRS include: no diabetes (ND), high risk for diabetes (HRD) due to self-reported gestational diabetes or pre-diabetes, and overt diabetes due to self-reported, clinically diagnosed diabetes (DM). Odds ratios (ORs) and 95% confidence intervals (CI) for meeting PA recommendations were obtained. Covariates included age, race, education, household child count, alcohol consumption, and smoking status. RESULTS: Findings revealed that on average, DM had 46.5 fewer minutes of weekly AA compared to ND. Furthermore, a significantly lower OR (0.39; CI 0.19-0.82) for meeting both recommendations was observed in DM as compared to ND after adjustment. CONCLUSIONS: We observed that pregnant women with overt diabetes had a lower odds of engaging in PA, while those at high risk were similar in their PA engagement to ND. Future studies aimed at assessing determinants of PA behavior may help guide efforts to promote exercise in pregnant women with diabetes.

Cytoskeletal and synaptic polarity of LWamide-like+ ganglion neurons in the sea anemone Nematostella vectensis.

The centralized nervous systems of bilaterian animals rely on directional signaling facilitated by polarized neurons with specialized axons and dendrites. It is not known whether axo-dendritic polarity is exclusive to bilaterians or was already present in early metazoans. We therefore examined neurite polarity in the starlet sea anemone Nematostella vectensis (Cnidaria). Cnidarians form a sister clade to bilaterians and share many neuronal building blocks characteristic of bilaterians, including channels, receptors and synaptic proteins, but their nervous systems comprise a comparatively simple net distributed throughout the body. We developed a tool kit of fluorescent polarity markers for live imaging analysis of polarity in an identified neuron type, large ganglion cells of the body column nerve net that express the LWamide-like neuropeptide. Microtubule polarity differs in bilaterian axons and dendrites, and this in part underlies polarized distribution of cargo to the two types of processes. However, in LWamide-like+ neurons, all neurites had axon-like microtubule polarity suggesting that they may have similar contents. Indeed, presynaptic and postsynaptic markers trafficked to all neurites and accumulated at varicosities where neurites from different neurons often crossed, suggesting the presence of bidirectional synaptic contacts. Furthermore, we could not identify a diffusion barrier in the plasma membrane of any of the neurites like the axon initial segment barrier that separates the axonal and somatodendritic compartments in bilaterian neurons. We conclude that at least one type of neuron in Nematostella vectensis lacks the axo-dendritic polarity characteristic of bilaterian neurons.

Neurons survive simultaneous injury to axons and dendrites and regrow both types of processes in vivo.

Neurons extend dendrites and axons to receive and send signals. If either type of process is removed, the cell cannot function. Rather than undergoing cell death, some neurons can regrow axons and dendrites. Axon and dendrite regeneration have been examined separately and require sensing the injury and reinitiating the correct growth program. Whether neurons in vivo can sense and respond to simultaneous axon and dendrite injury with polarized regeneration has not been explored. To investigate the outcome of simultaneous axon and dendrite damage, we used a Drosophila model system in which neuronal polarity, axon regeneration, and dendrite regeneration have been characterized. After removal of the axon and all but one dendrite, the remaining dendrite was converted to a process that had a long unbranched region that extended over long distances and a region where shorter branched processes were added. These observations suggested axons and dendrites could regrow at the same time. To further test the capacity of neurons to implement polarized regeneration after axon and dendrite damage, we removed all neurites from mature neurons. In this case a long unbranched neurite and short branched neurites were regrown from the stripped cell body. Moreover, the long neurite had axonal plus-end-out microtubule polarity and the shorter neurites had mixed polarity consistent with dendrite identity. The long process also accumulated endoplasmic reticulum at its tip like regenerating axons. We conclude that neurons in vivo can respond to simultaneous axon and dendrite injury by initiating growth of a new axon and new dendrites.