Clinicians should be aware of the inherent jurisdiction of the High Court in providing a ‘safety net’ to protect ‘vulnerable’ adults who are not within the scope of the Mental Capacity Act 2005 (MCA) or the Mental Health Act (MHA) 1983. Many situations in which the inherent jurisdiction has been deployed have been to safeguard vulnerable adults where there is abuse, coercion or undue influence, but the person does not lack decision-making capacity under the MCA. We explain the nature of the inherent jurisdiction, including descriptions of concepts surrounding ‘vulnerability’; as an intervention of last resort, we consider what statutory alternatives may exist, including safeguarding law under the Care Act 2014; we discuss decision-making capacity in relation to contact with others and, using real cases, the types of order that may be made under the court's inherent jurisdiction. It is important to be mindful that although there may be a legal remedy to safeguard this ‘vulnerable but capacitous’ group, there is a delicate and challenging balance between protecting those at risk and respecting their autonomy.

Negative emotionality (NE) was evaluated as a candidate mechanism linking prenatal maternal affective symptoms and offspring internalizing problems during the preschool/early school age period. The participants were 335 mother–infant dyads from the Maternal Adversity, Vulnerability and Neurodevelopment project. A Confirmatory Bifactor Analysis (CFA) based on self-report measures of prenatal depression and pregnancy-specific anxiety generated a general factor representing overlapping symptoms of prenatal maternal psychopathology and four distinct symptom factors representing pregnancy-specific anxiety, negative affect, anhedonia and somatization. NE was rated by the mother at 18 and 36 months. CFA based on measures of father, mother, child-rated measures and a semistructured interview generated a general internalizing factor representing overlapping symptoms of child internalizing psychopathology accounting for the unique contribution of each informant. Path analyses revealed significant relationships among the general maternal affective psychopathology, the pregnancy- specific anxiety, and the child internalizing factors. Child NE mediated only the relationship between pregnancy-specific anxiety and the child internalizing factors. We highlighted the conditions in which prenatal maternal affective symptoms predicts child internalizing problems emerging early in development, including consideration of different mechanistic pathways for different maternal prenatal symptom presentations and child temperament.

It has been common clinical practice for staff members to make an application to a mental health tribunal (the First-tier Tribunal (Mental Health) in England or the Mental Health Review Tribunal in Wales) on behalf of a patient detained in hospital for psychiatric treatment who may lack capacity to make that application, for example in dementia in-patient settings. Following a series of cases in the Upper Tribunal, such practice may not be appropriate and there is now a risk that the application will be struck out. It is important that clinicians are aware of developments in case law and therefore we provide guidance on how clinicians should approach applications to the tribunal and the assessments of capacity that may be required.

Food Based Dietary Guidelines (FBDG) are a set of recommendations that describe the quantity and types of foods to consume to promote healthy eating and prevent diseases such as obesity. However, when assessing compliance with FBDG, calculating contributions from composite dishes is challenging, since the specific recipe ingredients are often unknown. This project aims to establish proportional contribution of composite dishes to food groups defined by the Irish and UK FBDG. This will facilitate automated assessment of compliance with FBDG for users of novel technology such as Nutritics, a suite of integrated nutrition analysis software tools for healthcare professionals, educators and industries. Territory specific food composition data (n = 3291) for Ireland and the UK were downloaded from the 2015 McCance & Widdowson Composition of Foods Integrated Dataset (CoFIDs). Recipes were identified and classified into groups broadly aligned with the food groups defined in the Healthy Food for Life Ireland and the Eatwell Guide UK. Supplementary recipe details were accessed from McCance & Widdowson 7th Edition book and online resources. Recipes were categorised by recipe type and ingredients were categorised into food groups. Percentage contribution of each food group to the total recipe was calculated. Of the 3,291 foods, 1,108 were classified as recipes, details were available for 138 of these. Of the 138 recipes, there were fruit & vegetable dishes (n = 20), breads, potatoes, pasta and rice dishes (n = 12), meat, fish and alternative protein sources dishes (n = 40), dairy dishes (n = 23), high fat/oil, sugar, salt dishes (n = 43). For fruit & vegetable dishes, the median percentage contribution to the fruit & vegetable food group was 67% (15% min/ 100% max). For breads, potatoes, pasta and rice dishes the median percentage contribution to the breads, potatoes, pasta and rice food group was 53% (17% min/ 89% max). For meat, fish and alternative protein sources dishes, the median percentage contribution to meat, fish and alternative protein sources food group was 55% (16% min/ 85% max), for dairy dishes, the median percentage contribution to the dairy food group was 90% (53% min/ 96% max). For high fat/oil, sugar, salt dishes the median percentage contribution to the high fat/oil, sugar, salt food group was 22% (3% min/ 97% max). The calculation of recipes into percentage contribution to food groups can support assessment of adherence to FBDG when using reference recipes. This is a useful tool to support healthcare professionals when assessing dietary intake where specific recipe components are unknown.

Food Based Dietary Guidelines (FBDG) are dietary recommendations described in terms of amounts of foods that should be consumed. They are designed to support healthy eating through simple messaging and indicate how to achieve a nutritionally adequate diet. However, assessing compliance with FBDG targets can be difficult. The quantity of food either being consumed or prescribed and the amount of that food that constitutes a serving are needed to calculate the contribution of the food towards a food group target. The aim of this study was to define the serving weight of foods, guided by definitions from Irish FBDG, to the McCance and Widdowson Composition of Foods Integrated Dataset 2015 (CoFID). This will enable the automatic assessment of compliance to FBDG using Nutritics nutrition analysis software. Foods from CoFID were categorised into six food groups as defined by Ireland's FBDG. Quantified servings from the Irish FBDG were matched to foods. Calculation criteria were developed to establish a serving size for remaining foods within each food group. For fats and oils, as well as raw fruits and vegetables, household measurements were converted to grams, using Food Portion Sizes from the Food Standards Agency. Quantities for cooked fruits and vegetables were calculated using weight-change factors published by Bognar. For the breads, cereals and potatoes group a serving size was calculated using the midpoint for the calorie bands in this group, as defined by the Food Safety Authority of Ireland. For the dairy group, a serving size was determined by calculating the quantity needed to provide 250 mg of calcium. This was in line with achieving the total daily recommended amount of calcium from the dairy group from 3 servings. For meat, fish and alternatives (MFA), serving sizes were developed using the recommended amount of protein per body weight reference value for males and females. For foods high in fat, sugar and salt, serving sizes were defined using 100kcal as the recommended amount of energy provided for snacks. Out of 3,291 foods, 1,980 were grouped into 6 food groups. Quantified servings were available for 694 foods in 3 food groups. Calculated serving sizes were developed for the remaining 1,276 foods. The quantity of each food that constitutes a serving will be integrated into Nutritics to automatically assess compliance to FBDG. This will enable Health Care and Food Industry Professionals to deliver informed advice on meeting population health targets.

OBJECTIVES/SPECIFIC AIMS: Clostridium difficile infection (CDI) is the most common cause of antibiotic-associated diarrhea and an increasingly common infection in children in both hospital and community settings. Between 20% and 30% of pediatric patients will have a recurrence of symptoms in the days to weeks following an initial infection. Multiple recurrences have been successfully treated with fecal microbiota transplantation (FMT), though the body of evidence in pediatric patients is limited primarily to case reports and case series. The goal of our study was to better understand practices, success, and safety of FMT in children as well as identify risk factors associated with a failed FMT in our pediatric patients. METHODS/STUDY POPULATION: This multicenter retrospective analysis included 373 patients who underwent FMT for CDI between January 1, 2006 and January 1, 2017 from 18 pediatric centers. Demographics, baseline characteristics, FMT practices, C. difficile outcomes, and post-FMT complications were collected through chart abstraction. Successful FMT was defined as no recurrence of CDI within 60 days after FMT. Of the 373 patients in the cohort, 342 had known outcome data at two months post-FMT and were included in the primary analysis evaluating risk factors for recurrence post-FMT. An additional six patients who underwent FMT for refractory CDI were excluded from the primary analysis. Unadjusted analysis was performed using Wilcoxon rank-sum test, Pearson χ2 test, or Fisher exact test where appropriate. Stepwise logistic regression was utilized to determine independent predictors of success. RESULTS/ANTICIPATED RESULTS: The median age of included patients was 10 years (IQR; 3.0, 15.0) and 50% of patients were female. The majority of the cohort was White (89.0%). Comorbidities included 120 patients with inflammatory bowel disease (IBD) and 14 patients who had undergone a solid organ or stem cell transplantation. Of the 336 patients with known outcomes at two months, 272 (81%) had a successful outcome. In the 64 (19%) patients that did have a recurrence, 35 underwent repeat FMT which was successful in 20 of the 35 (57%). The overall success rate of FMT in preventing further episodes of CDI in the cohort with known outcome data was 87%. Unadjusted predictors of a primary FMT response are summarized. Based on stepwise logistic regression modeling, the use of fresh stool, FMT delivery via colonoscopy, the lack of a feeding tube, and a lower number of CDI episodes before undergoing FMT were independently associated with a successful outcome. There were 20 adverse events in the cohort assessed to be related to FMT, 6 of which were felt to be severe. There were no deaths assessed to be related to FMT in the cohort. DISCUSSION/SIGNIFICANCE OF IMPACT: The overall success of FMT in pediatric patients with recurrent or severe CDI is 81% after a single FMT. Children without a feeding tube, who receive an early FMT, FMT with fresh stool, or FMT via colonoscopy are less likely to have a recurrence of CDI in the 2 months following FMT. This is the first large study of FMT for CDI in a pediatric cohort. These findings, if confirmed by additional prospective studies, will support alterations in the practice of FMT in children.

Culturally linked family influences during adolescence are important predictors of health and well-being for Latino youth, yet few studies have examined whether these familial influences are associated with indicators of typical physiological stress processes. Following a cultural neurobiology framework, we examined the role of family in the everyday lives of Latino adolescents (N = 209; Mage = 18.10; 85.1% Mexican descent; 64.4% female) by investigating familism values and perceptions of parent support as well as daily family assistance behaviors in relation to hypothalamic–pituitary–adrenal axis diurnal patterns, indexed by salivary cortisol five times a day for 3 weekdays. Three-level growth curve analyses revealed that perceptions of parental support were associated with greater cortisol awakening responses, whereas familism values were not associated with diurnal cortisol patterns. In day-to-day analyses, assisting family during the day (compared to not assisting family) was associated with lower waking cortisol levels and flatter diurnal slopes the next day. Our findings highlight the dynamic associations and multiple time courses between cultural values and behaviors, daily experiences, and physiological stress processes for Latino adolescents. Further, we identified important cultural risk and promotive factors associated with physiological regulation in daily life and potential pathways toward health outcomes in adulthood.

Prenatal adversity shapes child neurodevelopment and risk for later mental health problems. The quality of the early care environment can buffer some of the negative effects of prenatal adversity on child development. Retrospective studies, in adult samples, highlight epigenetic modifications as sentinel markers of the quality of the early care environment; however, comparable data from pediatric cohorts are lacking. Participants were drawn from the Maternal Adversity Vulnerability and Neurodevelopment (MAVAN) study, a longitudinal cohort with measures of infant attachment, infant development, and child mental health. Children provided buccal epithelial samples (mean age = 6.99, SD = 1.33 years, n = 226), which were used for analyses of genome-wide DNA methylation and genetic variation. We used a series of linear models to describe the association between infant attachment and (a) measures of child outcome and (b) DNA methylation across the genome. Paired genetic data was used to determine the genetic contribution to DNA methylation at attachment-associated sites. Infant attachment style was associated with infant cognitive development (Mental Development Index) and behavior (Behavior Rating Scale) assessed with the Bayley Scales of Infant Development at 36 months. Infant attachment style moderated the effects of prenatal adversity on Behavior Rating Scale scores at 36 months. Infant attachment was also significantly associated with a principal component that accounted for 11.9% of the variation in genome-wide DNA methylation. These effects were most apparent when comparing children with a secure versus a disorganized attachment style and most pronounced in females. The availability of paired genetic data revealed that DNA methylation at approximately half of all infant attachment-associated sites was best explained by considering both infant attachment and child genetic variation. This study provides further evidence that infant attachment can buffer some of the negative effects of early adversity on measures of infant behavior. We also highlight the interplay between infant attachment and child genotype in shaping variation in DNA methylation. Such findings provide preliminary evidence for a molecular signature of infant attachment and may help inform attachment-focused early intervention programs.