Autonomic Stability Research Articles

Leptin signaling maintains autonomic stability during severe influenza infection in mice.

Leptin signaling maintains autonomic stability during severe influenza infection in mice.

A Novel Approach to Integrative Concussion Rehabilitation: A Pragmatic Study

Purpose: The purpose of this study is to evaluate the effectiveness of the novel Ziaks Integrative Neurological Concussion (ZINC) Protocol in evaluating and treating persistent post-concussion symptoms. Methods: Individuals with concussion were systematically evaluated for neurological impairments and subsequently received six modules of integrative and progressive therapies. Treatment addressed motor function impairment, oculomotor and binocular vision deficits, and central vestibular deficits while incorporating postural stability, dual task and cognitive loading skills and providing instruction in cardiovascular exercise to promote autonomic stability. Results: Of 30 patients, 15 completed all 6 protocol modules for inclusion in data analysis. Mean treatment duration was 6.6 (SD±.99) visits over 69.53 days (SD±21.92). The Post-Concussion Symptom Scale and Dizziness Handicap Inventory outcomes from pre- to post-treatment achieved clinical and statistical significance. Statistical significance was achieved for the Brain Injury Vision Symptom Survey, Brock String near point of convergence, King Devick and the novel binocular vision screening tool. Conclusions: A structured, integrative, and progressive rehabilitation program addressing the vestibulo-oculomotor and motor function domains of concussion may be effective in the management of persistent post-concussion symptoms. Impact Statement: This study details one potential comprehensive and sequential method to integrate the neurological domains of concussion rehabilitation while screening for impairments in the physical domains. There is a gap in knowledge regarding the most effective timing, sequencing, and implementation of intervention methods across the 4 concussion domains. This study provides the groundwork for future research to establish treatment protocols aimed to efficiently reduce symptoms associated with persistent post-concussion symptoms.

Use of Loco-regional Anesthesia in Austere Environments: A Review by and for Special Forces Medics.

Special Forces increasingly operate in austere environments, which are known to have limited medical support and prolonged evacuation times. On the battlefield, pain remains the first complaint of casualties and can impact direct autonomic stability, recovery, and the development of posttraumatic stress disorder. Although medical education has been improving, medical providers still encounter difficulties, such as lack of human and material resources, while trying to achieve pain management. This article summarizes a survey sent to 35 Special Operations medical providers and suggests possible strategies to address challenges to pain management on the battlefield. Potential solutions have been gathered through medical texts, medical/NATO documents, and medical expertise. Nerves blocks have been identified as valuable tools for pain management in the current battlefield environment, where prolonged evacuation and limited freedom of movement are the norm. The survey showed that, although the vast majority of providers had already received lectures on regional anesthesia, 83% were not trained in it, and 54% had never been made aware of multimodal analgesia. This lack of familiarity highlights knowledge and training gaps in nerve block techniques. Diffusion blocks are a very low-risk, useful, and safe pain management technique, which requires less skill sustainment and resources than more complex techniques. The use of epinephrine as adjunct can be useful for decreasing local anesthetic toxicity and increasing long-term pain management. The need for both education on and training in the use of nerve blocks has been identified by the Special Operations health provider community.

Association of accelerometer-measured sedentary time, light intensity physical activity levels with cardiometabolic disease risk in Indian office workers: Insights from the SMART-STEP study

Background and aimsSedentary time (ST) is found to be an independent risk for cardiometabolic disease (CMD). While moderate to vigorous physical activity has demonstrated clear benefits in reducing the risk of CMD, only a fraction of the world's population meets the recommended levels. The benefits of easily attainable light-intensity physical activity (LIPA) on CMD risk factors are seldom explored. Our study aimed to explore the association of accelerometer-measured ST and LIPA with CMD risk among Indian office workers. MethodsST and LIPA were recorded using a hip-worn accelerometer (Actigraph) for seven consecutive days, while CMD risk factors were evaluated in 130 insufficiently active office workers. The association of accelerometer-measured ST and LIPA with CMD risk factors were examined using multivariate regression. ResultsHigher ST were positively associated with high body mass index (β = 0.330, p < 0.001) and body fat percentage (β = 0.422, p < 0.001), while LIPA exhibited an inverse relationship with the above variables. Additionally, higher LIPA was associated to low fasting blood sugar levels (FBS) (β = −0.308, p = 0.023). Similarly, high ST was associated with low heart rate variability (HRV) (β = −0.407, p = 0.024) while high LIPA was associated with high HRV (β = 0.379, p = 0.003). However, the associations remain insignificant for majority of other CMD risk factors. ConclusionElevated ST is consistently linked to higher body mass, FBS and lower HRV (an indicator of autonomic stability). LIPA is associated with lower risk of above variables. Still, the association of ST and LIPA with other CMD risk factors remain uncertain. Longitudinal studies with larger samples of Indian office workers is needed to validate the present study findings.

B-082 Diagnostic and Clinical Characteristics of Neuroimmune Markers in a Tertiary Care Hospital

Abstract Background Neuroimmune disorders are a complex group of inflammatory conditions of the nervous system and remarkable discoveries over the last two decades have elucidated the autoimmune basis of several, previously poorly understood, neurological disorders. Autoimmune Encephalitis has been linked to a wide variety of neuronal autoantibodies targeting both intracellular and plasma membrane antigens. Paraneoplastic encephalitis syndromes are often associated with antibodies against intracellular neuronal proteins like anti-Hu, anti-Ri, anti-GAD65 and others and the encephalitis associated with antibodies against neuronal cell surface/synaptic proteins like NMDA and VGKC is referred to as “autoimmune encephalitis.” The diagnosis of these neuroimmune disorders can be challenging due to the wide spectrum of clinical presentations, frequent absence of diagnostic abnormalities on conventional brain MR-imaging and non-specific findings on EEG testing. The importance of early diagnosis and appropriate treatment is paramount. The objective of this study is to examine the diagnostic and clinical characteristics of these disorders with the goals of assisting clinicians in differential diagnosis. Methods This study took place from January 2016 to January 2023, at Kokilaben Dhirubhai Ambani Hospital and Research Centre, Mumbai, Maharashtra. We reviewed the laboratory records in our hospital to identify patients diagnosed with positive anti-NMDA receptor antibody, VGKC antibodies like LG1, CASPR2, GABBAR B1/B2, AMPA1, and AMPA2, positive NMO and MOG antibodies and also for antibodies against intracellular antigens like anti-Ri, anti-Hu. Inclusion criteria were adults and adolescents (aged 12–90 years) and pediatric population was excluded. The cohort was categorized into four groups according to different antibodies: NMDA group, VGKC group, NMO-MOG and paraneoplastic groups. Each cohort was further divided into two groups : Group I (positive patients) and Group II (negative patients) and their clinical characteristics were compared. Results A total of 650 patients aged from 12–90 years for whom NMDA, VGKC, NMO-MOG and paraneoplastic antibody testing was requested were identified for this retrospective study. Prominent differences became apparent when comparing the basic demographic variables, age and gender. Positive rate for autoimmune encephalitis was found to be 6.82% and for NMO-MOG antibodies, it was found to be 11.11 %. Most common synaptic autoimmune encephalitis was associated with LG1 (55%), followed by NMDA (27 %). Most common onco-neuronal paraneoplastic encephalitis series were GAD65, Yo and Zic. Clinical features, MRI and EEG findings have been evaluated in all groups. Conclusion Neuroimmune disorders are a complex group of inflammatory conditions and the clinical presentations and features are highly diverse and largely dependent on the particular neuronal antibodies. Focal seizures were the common symptom associated with anti-NMDA and anti-VGKC positive patients, whereas difficulty walking and lower limb weakness was the most common presentation associated with paraneoplastic antibodies. Autonomic stability and neoplastic etiologies were not noted in synaptic autoimmune encephalitis but were seen in paraneoplastic encephalitis. Patients with MOG antibodies also were found to have neoplastic etiologies and blurring of vision was the most prevalent symptom noted. Earlier recognition and treatment of these disorders can lead to improved outcomes and reduced disability.

Ideal Mode of Auditory Stimulation in Preterm Neonates in Neonatal Intensive Care Unit: A Systematic Review.

The objective of this review was to find out the best mode of auditory stimulation for preterm neonates admitted to the neonatal intensive care unit. We also aimed to find out the different effects of different types of auditory stimulation in these neonates. Advanced neonatal care and technological advances in neonatal intensive care units have led to increased survival of preterm-born neonates, but this in turn leads to increased incidences of disabilities like cerebral palsy, visual impairment, delayed social development, etc. Early intervention is provided to facilitate further development and prevent delays in all domains. Auditory stimulation is proven to benefit these neonates to stabilize their vitals and improve their auditory performance in later life.Different modes of auditory stimulation have been studied worldwide, but none of the studies has presented the ideal mode of auditory stimulation for these preterm neonates. In this review, we have discussed the effects produced by different types of auditory stimulation and compared their pros and cons. For conducting a systematic review, a search strategy adopted by MEDLINE is used. A total of 78 articles published between 2012 and 2017, on the effects of auditory stimulation on preterm infants' performance were reviewed.Out of that, eight studies that met the inclusion criteria and focused on short-term and long-term effects were included in this systematic review. Search terms included preterm neonates, auditory stimulation, and early intervention. Randomized controlled trials and cohort studies were included. Auditory stimulation by maternal sound provides physiological and autonomic stability, but the behavioral states of preterm neonates improved with auditory stimulation by music therapy with lullabies. Maternal singing during kangaroo care may be recommended for providing physiological stability.

The features of social and autonomic adaptation to study conditions depending on age, gender and socio-pedagogical educational environment

The study is concerned with a pressing issue of assessing social adaptation (SA) and autonomic stability (AS) in the young people studying in various educational institutions. It is necessary to determine the students’ social adaptation and autonomic stability at different ages. The study included 100 schoolchildren who living in the big city; 89 schoolchildren living in rural areas; 70 schoolchildren living and studying in the city boarding school. The schoolchildren were aged 14–15. The group of youth included 248 first‑year students aged 17–18 and 136 6th year students aged 22–23. The study was performed with the use of the two‑factor personality questionnaire by M. Gavlinova approved by the European Union for School and University Health and Medicine and adapted to Russian conditions. The authors provide data for determination of social adaptation and autonomic stability in young people aged 17–23. When analyzing the findings, it was found that the differences in social adaptation and autonomic stability between schoolchildren were partially dependent on their gender, type of learning, and place of residence. Given equal starting opportunities in young males and females in the beginning of high school training, young males showed higher SA and AS values compared to young females by the end of training. A group was distinguished that included students showing low SA and AS values, which, in our view, required psychological and medical rehabilitation. Given the findings, we believe that physicians should further examine the patients with low AS values, and psychologists (neuropsychiatrists) should further assess patients with low SA values during medical check‑ups in order to ensure prevention and management of the disorders identified in schoolchildren and students.

Neurobehavioural challenges experienced by HIV exposed infants: a study in South Africa

BackgroundThe newborn infant is a complexly organized, competent being, who plays an active role in shaping their environment through their increasing skills in autonomic regulation, motor control, regulation of state and social interaction. Infants born to HIV positive mothers, are exposed to HIV and antiretroviral therapy inutero, and may experience adverse effects from this.MethodsA cross-sectional study of 132 mother-infant dyads from a large public health hospital in South Africa. Infants were assessed using the Neonatal Behavioural Assessment Scale on day two of life, and mothers mental health assessed using the Edinburugh Postnatal Depression Scale. Medical and demographic data on mothers and infants was collected, including maternal age, HIV status, length of time on antiretrovirals, relationship status, employment status, gravid status, mode of delivery, infant anthropometrics and infant gender. Data was input into IBM SPSS statistics 21, where frequencies and percentages for descriptive analysis, and Chi-square and student’s two sample t-tests were run to compare data from HIV infected-exposed and HIV uninfected-unexposed mothers and infants.ResultsHIV exposed infants were smaller than HIV unexposed infants, even though low birth weight was an exclusion criteria. Statistically significant differences were found between HIV exposed and unexposed infants in neurobehavioiral items of social interaction (p = 0.00), motor system (p = 0.00) and state organization (p = 0.01), with HIV exposed infants performing less optimally in these domains. HIV exposed infants also presented with more abnormal reflexes. Infants born to depressed mothers showed superior motor skills, state organization and state regulation than infants born to mothers who did not score in the possibly depressed range.ConclusionsHIV exposed infants have inferior neurobehavioural functioning, which may affect their quality of life and ability to develop a reciprocal relationship with a primary caregiver. This may have an effect on development, behaviour and mental health in later childhood. HIV exposed infants shoud be monitored closely and their functioning in autonomic stability, motor control, resualtion of state and social interaction assessed regularly. Guidance for caregivers in incorporating strategies into the care of these infants is essential to buffer the possible long term negative effects on development.

Clinical Management of Sleep and Sleep Disorders With Cannabis and Cannabinoids: Implications to Practicing Psychiatrists.

Phytocannabinoid derivatives are among the several compounds found in the cannabis plant. The phytocannabinoid chemicals Δ9-tetrahydrocannabinol (THC) and cannabidiol are mostly responsible for the drug's behavioral effects. Chronic cannabis administration has been shown to disrupt circadian rhythms and reduce the duration of the deepest phase (stage N3) of nonrapid eye movement sleep. Cannabidiol is thought to be responsible for the disruption of the circadian rhythm, whereas THC is thought to be accountable for the changes in sleep architecture. The quality of one's sleep has a significant impact on cannabis abstinence or relapse. As a result, the diminished sleep-promoting efficiency of cannabis in chronic users, as well as the resulting sleep difficulties once cannabis use is stopped, may sabotage attempts to quit and raise the risk of relapse. In individuals with obstructive sleep apnea who do not complain about the treatment process known as continuous positive airway pressure, cannabinoids are one of the treatments being considered. In this regard, preclinical investigations have demonstrated that combining the agent oleamide and THC aids in the stabilization of respiration in all stages of sleep as well as the maintenance of autonomic stability during sleep. The synthetic THC dronabinol was found to lower the apnea-hypopnea index in a clinical investigation and is regarded safe for the short-term treatment of obstructive sleep apnea. Patients experiencing nightmares who had been diagnosed with posttraumatic stress disorder were given the synthetic endocannabinoid receptor agonist nabilone. When compared with a placebo, the chemical proved helpful in reducing the frequency of nightmares. It is worth noting that a single study that looked at the effects of cannabidiol on REM behavior disorder found that symptoms improved. Based on the available findings, cannabinoids can be used as an alternate treatment for various sleep disorders. However, additional research is needed to corroborate the conclusions of these investigations.

Effects of Live Music Therapy on Autonomic Stability in Preterm Infants: A Cluster-Randomized Controlled Trial.

Unbuffered stress levels may negatively influence preterm-infants’ autonomic nervous system (ANS) maturation, thus affecting neurobehavior and psycho-emotional development. Music therapy (MT) is an evidence-based treatment modality in neonatal care. When coupled with skin-to-skin care (SSC), it may reduce stress responses in both preterm infants and their parents and enhance family-centered care. Accordingly, we aimed to compare the effects of combined MT and SSC and SSC alone on ANS stabilization in preterm infants. In a single-center, cluster-randomized trial design, ten two-month time-clusters were randomized to either combined MT and SSC or SSC alone. Families of preterm infants were offered two sessions of the allocated condition in the NICU, and a three-month follow up session at home. The primary outcome variable was stabilization of the ANS, defined by change in the high frequency (HF) power of heart rate variability (HRV) during the second session. Secondary outcomes included other HRV measures, parent–infant attachment, and parental anxiety at each session. Sixty-eight families were included. MT combined with SSC improved infants’ ANS stability, as indicated by a greater increase in HF power during MT compared to SSC alone (mean difference 5.19 m2/Hz, SE = 1.27, p < 0.001) (95% confidence interval 0.87 to 2.05). Most secondary outcomes were not significantly different between the study groups. MT contributes to preterm-infants’ autonomic stability, thus laying an important foundation for neuro-behavioral and psycho-emotional development. Studies evaluating longer-term effects of MT on preterm infants’ development are warranted.

Heart rate variability improves in 3-5-year-old children following a 6-month physical activity-based intervention: the Active Early Learning (AEL) cluster randomised controlled trial.

Heart rate variability (HRV) measurement provides non-invasive assessment of autonomic stability and cardiometabolic disease risk. Insufficient physical activity in early childhood may contribute to negative cardiometabolic health. The Active Early Learning (AEL) study was a 6-month randomised controlled trial investigating the effects of a physical activity-based program incorporating movement within the daily curriculum of preschool children. The current study assessed the effects of the AEL intervention on HRV as a measure of cardiac vagal control. Children aged between 3-5years and enrolled in a preschool with an attendance of ≥15 children were eligible. Physical activity was recorded using an Actigraph wGT3x accelerometer worn at the waist of participants over 3 consecutive days. A Polar H10 chest strap measured HRV with the HF-band and RMSSD representing cardiac vagal control. After 6months of the AEL trial, linear mixed model analyses revealed a significant intervention effect for increased HF (p = 0.044). The control group did not demonstrate changes in cardiac vagal control after the intervention ceased. Independent of age, sex, physical activity and BMI, the AEL study elicited significant improvements in the cardiac vagal control of participants who received the intervention. Findings highlight the importance of investigating HRV for assessing the cardiometabolic health in young children. ANZCTR trial registration number: ACTRN12619000638134. Novelty: The AEL curriculum improved child HRV independent of age, sex, physical activity and BMI. Heart rate and RR intervals did not demonstrate changes for the intervention and control groups. Multivariate programs for developing physical competence, confidence, knowledge and motivation may improve child health.

Sedentarism and chronic disease risk in COVID 19 lockdown - a scoping review.

Background & AimsThough viewed as a critical measure to prevent the spread of the virus, a prolonged homestay may result in unfavourable sedentary behaviour and chronic disease risk. This systematic review focuses on sedentary behaviour resulting from this quarantine period which may elevate the cardiovascular disease risk, obesity, hypertension, cancer and mental health illness.MethodsEvidence of breaking sedentary behaviour and global recommendations were investigated. Potential unanswered questions regarding sedentary behaviour and physical activity during lockdown were explored.ResultsFive systematic reviews and six prospective trials explored the effect of sedentarism affecting chronic disease through potential pathophysiological mechanisms. Sedentary behaviour especially prolonged sitting is found to be a pleiotropic risk factor with altered energy expenditure, adipogenic signalling, immunomodulation, autonomic stability and hormonal dysregulation perpetuating underlying chronic diseases such as obesity, cardiovascular disease, cancer and mental health disorders.ConclusionBreaking sitting and physical activity are found to reverse the adverse effects associated with excessive sitting during the lockdown.

Immediate parent-infant skin-to-skin study (IPISTOSS): study protocol of a randomised controlled trial on very preterm infants cared for in skin-to-skin contact immediately after birth and potential physiological, epigenetic, psychological and neurodevelopmental consequences

IntroductionIn Scandinavia, 6% of infants are born preterm, before 37 gestational weeks. Instead of continuing in the in-utero environment, maturation needs to occur in a neonatal unit with support of...

The Role of Negative Emotions in the Aetiology of Non-Impact Sports Injuries: Interactions of the Stress Response and Motor Control Systems

The Role of Negative Emotions in the Aetiology of Non-Impact Sports Injuries: Interactions of the Stress Response and Motor Control Systems

MEASUREMENT-TO-MEASUREMENT BLOOD PRESSURE VARIABILITY AS A PREDICTOR OF CARDIOVASCULAR DISEASE OUTCOMES

Short-term fluctuations in blood pressure (BP) reflect autonomic regulation stability and arterial elasticity. We hypothesized that short-term, measurement-to-measurement blood pressure variability (BPV) has an independent association with cardiovascular disease (CVD) outcomes in a nationally

Didgeridoo Health Promotion Method Improves Mood, Mental Stress, and Stability of Autonomic Nervous System.

A potential method of health promotion using the traditional wooden brass instrument the didgeridoo was examined, especially in terms of mood, stress, and autonomic nerve stabilization. Twenty Japanese healthy subjects undertook 10 lessons of the Didgeridoo Health Promotion Method (DHPM) and a moods questionnaire, blood pressure, salivary amylase (sAmy) as a stress marker, pulse rate and autonomic balance expressed by Ln[low frequency (LF)/High frequency (HF) were examined twice before the entire lessons and once before and after each lesson. The subjects had improved total mood disturbance (TMD: overall mood disorder degree) as measured by the Japanese version of the Profile of Mood States 2nd Edition (POMS2) as a result of taking the lessons. The pulse of the subjects decreased after the lessons, which correlated with a reduction in sAmy. Additionally, it was found that sAmy decreased after the lessons with increasing age of the subject, subjects with higher TMD before the lessons, or subjects with higher sAmy values before the lessons. With autonomic balance measured by Ln[LF/HF], subjects who had parasympathetic dominance as a result of the lesson were significantly more frequent. Additionally, it has been shown that Ln[LF/HF] decreased over 10 weeks, and it is also clear that the effect is sustained. Health promotion is an important concern for societies as a whole. In this study, it became clear that the DHPM affected mood, stress, and autonomic stability. Future studies should focus on monitoring the effects of continuing the lessons for a longer period of time. Additionally, physical effects such as strength of respiratory muscles should be examined. DHPM may be employed in the work place to promote the mental health of workers as well as in regional neighborhood associations/communities.

What Are the Effects of the Maternal Voice on Preterm Infants in the NICU?

Premature infants often experience extended stays in the neonatal intensive care unit (NICU) as opposed to home with parents. This prolonged separation creates a strain for both parents and infants, decreasing attachment and parental caregiving. One strategy to combat this shared stress is increasing parental participation, particularly through the use of their voices whether parents are present or not. This Evidence-Based Practice Brief column explores the connection between mother and child, specifically the effects of maternal voice on infant autonomic stability, weight gain, and behavioral states. A systematic search of CINAHL, PubMed, and PsycInfo was used to identify studies involving the use of maternal voice intervention with preterm infants in the NICU. Fifteen studies were identified. Three intervention categories emerged: (1) live maternal speech, (2) recorded maternal speech (subcategories included whether intervention content was prescribed or not), and (3) recorded maternal speech that was combined with biological maternal sounds (heart rate). Within each category, studies were organized chronologically to reflect how knowledge has changed overtime. Maternal voice has physiological as well as behavioral and emotional effect on preterm infants. Several studies found that maternal voice increased autonomic stability improving (heart rate and respirations) as well as weight gain. No negative effects were identified. Given these findings, incorporating different types of maternal voice into routine care by the bedside nurse can assist the mother in feeling more involved in her infant's care without seemingly being a distraction or obstacle to providers. A major limitation for generalizability was sample size; more research is needed with larger sample sizes replicating interventions types to discern best outcomes.Video Abstract available at https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?videoId=31&autoPlay=true.

Negative impact of maternal antenatal depressive symptoms on neonate's behavioral characteristics.

Prenatal maternal depression is associated with developmental disorders in offspring. However, the specific effects of the intensity of prenatal depressive symptoms on infant behavior remain poorly explored. The aim of this work is to explore the links between early neonatal behavior and maternal prenatal depressive symptoms, independently from maternal pre- and postnatal anxiety and early postnatal maternal depressive symptoms. Five hundred and ninety-eight women and their newborns from the MATQUID cohort were prospectively evaluated during the 8th month of pregnancy (T1) and at day 3 postpartum (T2). We analyzed the independent associations between neonates' behavior (Neonatal Behavioral Assessment Scale-NBAS) at T2 and the intensity of maternal prenatal depressive symptoms (CES-D), taking into account confounding factors including depressive symptoms at T2 and anxiety (T1 and T2). The presence of a major depressive episode (MDE) based on MINI at T1 was also studied, independently. Our results show a significant negative correlation between prenatal CES-D scores and NBAS scores on "habituation" (p = 0.0001), "orientation" (p = 0.015), "motor system" (p < 0.0001), "autonomic stability" (p < 0.0001) dimensions, independently of other variables, including pre/postnatal anxiety and postnatal depressive symptoms. A prenatal MDE was independently associated with lower scores on the "orientation" dimension (p = 0.005). This study reports a specific effect of prenatal depressive symptoms on newborn's behavior. These results highlight the crucial necessity for antenatal screening and adjusted treatments of maternal depressive symptoms and not only of MDE. Particular attention must be paid to infants of mothers presenting prenatal depressive symptoms to provide them with early developmental care when necessary.

Does heart rate variability improve prediction of failed extubation in preterm infants?

Background Prematurity and its respective comorbidities may result in longer periods of mechanical ventilation in intensive care units (ICU). A method for the assessment of organic maturity would be useful for this population. Heart rate variability (HRV), as an indicator of homeostasis, is a well-established tool for this approach. The objective of the study was to assess HRV in intubated preterm infants in ICU immediately prior to extubation and correlate HRV with clinical evaluation outcomes. Methods A total of 46 preterm infants, 13 (28.2%) males, were prospectively studied and divided into a group with failed extubation (FEG: n=11) and a group with successful extubation (SEG: n=35). HRV was evaluated in time, frequency and nonlinear domains with a Polar RS800 device. HRV measurements were assessed with Kubios HRV Premium Software and statistically analyzed with the StatsDirect Statistical Software, version 1.9.2015 (2002). P<0.05 values were considered as statistically significant. Results There were no significant differences between heart rate variables of failed and successful extubation when analyzing the total group. However, the analysis of the sub-group of preterm infants weighing less than 1000 g showed a clear differentiation between the groups, when the nonlinear variables (approximate entropy, sample entropy and multiscale entropy 1, 2 and 3) were used, demonstrating that the group with successful extubation shows greater complexity and, therefore, relatively greater autonomic stability. Conclusion HRV was effective in predicting failed extubation in preterm infants when evaluated in a nonlinear domain and in preterm infants weighing less than 1000 g.

2298 Central autonomic network dysfunction implicated in alcohol-related intimate partner violence

OBJECTIVES/SPECIFIC AIMS: Most incidents of partner violence occur when one or both partners have been drinking, however, the mechanism through which this association exists is unclear. The neural circuits that support self-regulation of emotion and social behavior, as well as autonomic influences on the heart, are co-localized in the brain and represent an integrated bidirectional regulatory system. These physiological regulatory processes are mediated by a neural substrate known as the central autonomic network which includes the peripheral autonomic nervous system. The central autonomic network modulates biobehavioral resources in emotion by flexibly responding to physiological arousal in response to changing situational demands, and serves a fundamental role in emotion regulation and goal-directed motor behavior, and this circuit can be indexed with heart rate variability (HRV). METHODS/STUDY POPULATION: In total, 17 distressed violent (DV) partners (11 females, 6 males) were matched to a sample of distressed nonviolent (DNV) partners (7 female, 6 males) were matched on age, sex, and relationship satisfaction and participated in a placebo-controlled alcohol administration study with an emotion-regulation task during which electroencephalography, HRV, and galvanic skin response (GSR) measures were collected. In the alcohol condition, participants were administered a mixture of 100 proof vodka and cranberry juice calculated to raise their blood alcohol concentration to 0.08%. In the placebo condition, participants consumed a volume of juice equivalent to that consumed in the alcohol condition, but without alcohol. Alcohol and placebo conditions were counter-balanced across participants as were the presentation the blocks of evocative and neutral partner stimuli and emotion-regulation condition (watch vs. do not react). RESULTS/ANTICIPATED RESULTS: Results show that DV partners show greater cortical arousal than DNV partners on measures event-related spectral perturbations, which are mean log event-loced deviations from baseline-mean power at each frequency of the electroencephalography power spectra, when intoxicated and viewing evocative partner stimuli in the “do not react” emotion regulation condition. Results also show a statistically significant 2 (alcohol vs. placebo)×2 (watch vs. do not react)×2 (DV partners vs. DNV partners) interaction of the respiratory sinus arrhythmia measure of HRV when viewing evocative partner behavior (F=7.102, p=0.019, partial η2=0.353). Findings indicate that DV partners have lower HRV than DNV partners across conditions, but particularly when acutely intoxicated and trying not to react to their partners’ evocative behavior. Similarly, results also show a statistically significantly 2 (alcohol vs. placebo)×2 (watch vs. do not react)×2 (DV partners vs. DNV partners) interaction on GSR (F=71.452, p=0.000, partial η2=0.749). GSR findings indicate that DV partners also have lower GSR when acutely intoxicated and trying not to react to their partners’ evocative behavior. DISCUSSION/SIGNIFICANCE OF IMPACT: These results suggest that increases in intimate partner violence under acute alcohol intoxication may be the result of dysfunction of the central autonomic network, especially when DV partners are trying to suppress a behavioral response to their partners’ evocative behavior in conflict. The neurophysiological patterns evidenced by DV partners is consistent with a state of vigilance to threat, and reduced ability inhibit prepotent, but inappropriate responses. They also suggest that HRV may be an important target for intervention with partner with a history of intimate partner violence. One method may be heart rate variability biofeedback which has been shown to increase parasympathetic nervous system functioning, autonomic stability, and emotion regulation.