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Energy expenditure prediction equations developed for able-bodied populations may be inaccurate for para-athletes, a population characterized by different types of impairments. Sufficient data do not exist currently to generate or validate energy expenditure predictive equations for para-athletes to establish dietary recommendations to cover the demands of sport. The purpose of this observational study was to assess energy expenditure and substrate usage from a trained para-athlete at rest and while performing the athlete’s specific mode of exercise. One para-athlete recruited from the Challenged Athletes Foundation (female; age 32) participated in the study. The participant was a left leg Syme’s amputee triathlete. Resting metabolic rate was measured for the triathlete. Energy expenditure was also measured at moderate (64-76% of age-predicted HRmax) and vigorous intensity exercise (77-95% of age-predicted HRmax) on a stationary cycle ergometer on a separate day. The triathlete’s energy expenditure during exercise was higher than that predicted by the metabolic equivalent of task (MET) matched by exercise type at a moderate (measured: 7.0 kcal/min, predicted: 5.0 kcal/min) and vigorous intensity (measured: 9.3 kcal/min, predicted: 7.0 kcal/min). The Revised Harris-Benedict and the Mifflin-St Jeor equations underestimated resting metabolic rate in the triathlete (measured: 2,194 kcal/day, predicted: 1,348 ± 39 kcal/day). This study indicates that equations developed for able-bodied populations underestimate energy expenditure in a Syme’s amputee when compared to the measured energy expenditure values assessed by indirect calorimetry at rest and during a workout on both a stationary cycle ergometer and while running on the track.

Introduction Waiting times for gender identity services, even before the Covid-19 pandemic, have been a cause of concern. Despite the waiting time standard for planned elective care in the NHS being a maximum of 18 weeks, the average waiting time for a first appointment with a gender identity clinic is 18 months. This study aims to analyse the effect that these timings have on the transgender community, and whether they impact the risk of developing mental health conditions such as depression or anxiety. Objectives This study’s main aim is to analyse the correlation between waiting times and mental health burden in the transgender community. Methods A literature review and analysis on a transgender individual’s mental health and waiting times for Gender Identity Clinics; looking at any key themes and conclusions. Research papers were taken from MEDLINE, The International Journal of Transgender Health, Oxford Academic, SpringerLink and Emerald Insight, with studies publishing date ranging from 2014 – 2021. Results The transgender population were found to have higher rates of suicidal ideation, depression and self harm compared to the general population. Longer waiting times were found to contribute to feelings of low mood and suicidal ideation, as well as decreasing overall quality of life. Conclusions Longer waiting times can decrease a transgender individual’s quality of life and impact their overall mental wellbeing: especially with the impact of COVID-19 and the rise in referrals. Disclosure No significant relationships.

Introduction The dawn of COVID-19 brought new rules, restrictions, and lockdowns but this led to the unlikely fall of many sectors, including the charitable sector. There has been a significant decline in funding received by mental health charities, especially during the pandemic. This study looks at the subsequent impact on fundraisers and mental health promotion during COVID-19. Objectives The main aim was to uncover how the COVID-19 pandemic has affected the way that mental health charities fundraise, raise awareness, and promote mental health. This aimed to look at the impact of the COVID-19 pandemic on fundraisers supporting mental health charities and their opinion on whether fundraising has either helped or hindered mental health promotion. Methods Accounts from fundraisers and local representatives for mental health charities during the COVID-19 pandemic were analysed. Common themes looked at the impact, adaptation, and reasons why fundraisers decided to help during a tough period for the charitable sector. Results Mental health charities expressed difficulty in sourcing funds to support their users, especially in a vulnerable time. Fundraisers tried innovative ways to promote mental health and raise money for charities. Conclusions Altruism and understanding how precious services such as mental health charities are for the population was the main driver for fundraisers. Mental health charities adapted by turning to online communication and reached out to fundraisers to continually highlight the importance of mental health to their users and fundraisers. Disclosure No significant relationships.

Introduction Culture is used to refer to the aspects of thinking, feeling, and behaviour related to nation, heritage, place of birth and ethnicity. I look at how the cultural context of mental disorders and the cultural context of mental disorders and the challenges of addressing ethnic diversity in psychiatric services because there is an over-representation of black people detained under the MHA. Objectives My aim is to understand what current data shows and use this to find a way forward which identify issues with culture and independently and challenge policies, services systems and address culture in clinical practice to provide culture complement care. Methods . research on rates of detention Results The MHA acts tells us POC are 4 times more likely to be detained, arrested under 136 twice as much, and are 8 times as likely to be put on CTOS. 40% of black people will more likely asses care through the police system. (mind.org, Uk) This further shows us just how unrepresented POCs are when it comes to their diagnosis, treatment, and care, especially compared to their white counterparts. Conclusions In conclusion regulatory bodies and clinicians have to work towards understanding and identifying the reasons for these disparities and then implementing measures to address this. Such as putting people of color in higher positions in mental health positions in mental health positions to add diversities, also teaching the staff members and other people in high positions of power how much culture really impacts mental health, culturally appropriate advocacy, and improving research done. Disclosure No significant relationships.

Introduction TikTok is a free mobile application, that enables users to create short videos. TikTok has an estimated one billion monthly active users, comprised of a mostly younger audience. There has been a noticed rise in content discussing ADHD – hashtag ADHD on TikTok has 6.3 billion views. The discussions continue on Twitter, where users are reporting watching TikTok content explaining ADHD symptomatology, subsequently relating to the condition and requesting referrals to specialist psychiatry services. This study aims to identify key themes in discussions around TikTok and ADHD, and its ramifications. Objectives This study’s objective is to discuss the relationship between viewing ADHD content of TikTok and self-diagnoses of ADHD in young people. Methods In our study, Twitter posts were identified with the words ‘ADHD’ and ‘TikTok’ and established key themes relating to self-diagnosis of ADHD. Results Numerous tweets were found discussing individual’s experiences of self-diagnosis of ADHD after watching TikTok videos and relating with the symptomology. Furthermore, many users discussed their efforts to seek diagnosis from psychiatrists. These posts highlighted positive discussion of mental health, and the improvement in quality of life since diagnosis. Conclusions Many young people are self-diagnosing ADHD after viewing TikTok videos. This may improve mental health stigma, however the expertise of the video creators should be scrutinised. Furthermore, the impact on already stretched waiting lists should be considered, with individuals who’s perceived ADHD traits are not impacting on their quality of life. Disclosure No significant relationships.

Introduction The COVID-19 pandemic has impacted medical students in many ways. They are not exempt from personal struggles caused by the health crisis, and many have faced similar challenges adapting to a new learning experience. The University of East Anglia (UEA) has initiatives in place to support medical students including the society Headucate UEA and the Wellbeing Champions scheme established by Norwich Medical School (NMS). Objectives Headucate aims to improve mental wellbeing by educational online webinars and social events aimed at university students. NMS Wellbeing Champions offer support and signpost students to resources and the wider student support system at the UEA. Methods Headucate was established in 2012 by NMS students that began running workshops at local secondary schools. Their work has expanded to include wellbeing workshops, social events for students and mental health first aid training, so members can provide peer support. Wellbeing Champions are medical student representatives responsible for completing mental health first aid training, communication between students and faculty, providing resources and signposting, creating mental health bulletin newsletters, and running socials exclusively for medical students. Results 100% of Headucate workshop attendees who completed anonymous feedback agreed that they enjoyed it and that it was useful. No feedback has been collected regarding the success of the Wellbeing Champions. This should be carried out to assess and enhance the project further. Conclusions More data is needed to establish the success of the initiatives at NMS and their impact on medical student’s wellbeing. Disclosure No significant relationships.

SummaryPsychotherapy is an essential part of being a psychiatrist. International professional associations including the World Psychiatric Association (WPA), European Psychiatric Association (EPA), Union of European Medical Specialists (UEMS), European Federation of Psychiatric Trainees (EFPT) are involved in sustaining the role of psychotherapy training as part of psychiatric education as a matter of policy. This article presents results of a survey by trainees from different European countries concerning the postgraduate training in psychotherapy. We explore how national or international organisations have influenced and changed psychotherapy training in this region. Short descriptions of the situation in a few European countries offer an overview of different approach. There is no “one size fits all” solution concerning the training in psychotherapy like part of psychiatric training; however local resources and international exchanges could be used towards harmonising standards and quality.

The benefits of hematopoietic stem cell transplantation, a therapy used to treat a variety of hematologic and immunologic disorders, are often outweighed by the risks of acute graft-versus-host disease (GVHD), where donor T cells attack and destroy host tissues. Our lab has previously shown that targeting lymphocyte metabolism is a promising and novel strategy for the treatment of GVHD. More recently, we have found that AMP-activated protein kinase (AMPK), a major cellular energy sensor, plays a significant role in T-cell proliferation during disease pathogenesis. To explore this relationship further, we treated alloreactive T cells generated during a mixed leukocyte reaction (MLR) with 5-aminoimidazole-4-carboxamide ribonucleoside (AICAR), an AMP mimetic that strongly activates AMPK. AICAR treatment of MLR cultures strongly repressed T cell proliferation, with a 70% decrease in total cells by 96 hours. Interestingly this decrease in T cell proliferation was independent of AMPK, as similar results were obtained using AMPK−/− cells. Mechanistically AICAR repressed AKT signaling in stimulated T cells, with a 50% decrease in AKT phosphorylation when cells were concurrently treated with 100 μM AICAR. Cytokine driven STAT5 activation was also significantly blunted by simultaneous AICAR exposure. In summary, despite its wide use as an AMPK agonist, we found that AICAR exerts significant inhibitory effects on T cell allo-activation independent of AMPK. This inhibition occurs, at least in part, through decreased phosphorylation of AKT and down-regulation of STAT signaling, making AICAR a potential therapy to combat GVHD and similar inflammatory disorders.

Background/Aims Aberrant c-Jun N-terminal kinase (JNK) activation has been linked to hepatocellular carcinoma (HCC) in mouse models. It remains unclear whether JNK activation plays an important role in human HCC and, if so, how JNK signaling contributes to the initiation or progression of HCC. Methods The JNK activation, global gene expression, and the status of histone H3 methylations were measured in 31 primary human hepatocellular carcinoma (HCC) samples paired with the adjacent non-cancerous (ANC) tissues. Results Enhanced JNK1 activation was noted in 17 out of 31 HCC samples (55%) relative to the corresponding ANC tissues, whereas JNK2 activation was roughly equal between HCC and ANC tissues. This enhancement in JNK1 activation is associated with an increased tumor size and a lack of encapsulation of the tumors. In addition, an association of JNK1 activation with the histone H3 lysines 4 and 9 tri-methylation was observed in the HCC tissues, which leads to an elevated expression of genes regulating cell growth and a decreased expression of the genes for cell differentiation and the p450 family members in HCC. Conclusions These results, thus, suggest that JNK1 plays important roles in the development of human HCC partially through the epigenetic mechanisms.

IntroductionThe study was triggered by the first author's own experience on an undergraduate elective at the National Mental Wellness Centre in St Lucia. This was an eye-opening experience of psychiatry in a less economically developed environment. It highlighted disparities between practice in the developed and the developing world. Notably significant differences were apparent in facilities, epidemiology of presenting complaints, the interaction of cultural beliefs as well as the method of assessment and management.Aims/objectivesTo review the literature on the educational impact of electives in psychiatry.MethodsA literature search using Ovid MEDLINE was conducted using the keywords’medical student’ AND’elective’ AND’psychiatry’. A total of 229 results were returned. These were then analysed for their relevance.ResultsOnly one paper was found emphasising the importance of electives in psychiatry. This reported on one individual's personal experience. There also were reports highlighting the importance of undergraduate elective experience and the need to increase exposure to psychiatry to improve the uptake of postgraduate training programmes. There were no papers objectively assessing the educational quality or impact of a psychiatric elective experience.ConclusionsAn overseas elective experience was subjectively beneficial for the author but there is a lack of objective research to show the educational benefit of psychiatry electives on a wider scale. Further research regarding the educational benefits of electives in psychiatry is needed.