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Metabolic bariatric surgery reduces weight in youth with severe obesity; however, its impacts on youth-onset type 2 diabetes (T2D) are unclear. We evaluated short-term outcomes in youth with T2D 3 months after vertical sleeve gastrectomy (VSG). Longitudinal, observational study in the Impact of Metabolic surgery on Pancreatic, Renal, and cardiOVascular hEalth in youth with T2D study (IMPROVE-T2D). Academic medical university and children's hospital. Fourteen youth with T2D [mean age ± SD 16.8 ± 1.4 years; 50% female, pre-VSG hemoglobin A1c (HbA1c) 6.6 ± 0.2%; diabetes duration 17.6 ± 13.8 months; age at diabetes diagnosis 15.9 ± 1.4 years; body mass index (BMI) 46.7 ± 2 kg/m ]. Participants underwent a mixed-meal tolerance test (MMTT), body composition, and indirect calorimetry before and 3 months after VSG. Glycemic control (HbA1c, diabetes medications), insulin sensitivity (Matsuda Index, Homeostasis Model of Insulin Sensitivity, oral minimal model), and secretion (C-peptide model). After VSG, weight and BMI decreased (25.2 ± 5.6 kg [19%], -8.7 ± 2 kg/m [18%], respectively, < .001). Body fat decreased (4.5%, = .012), with reductions of 14.1 ± 5.4 kg of fat mass ( = .005) and 4.5 kg of fat-free mass ( = .034). HbA1c decreased from 6.6 ± 0.2% to 5.7 ± 0.2% ( = .003), with 86% of participants no longer requiring diabetes medications. Glucose was lower throughout the MMTT, with insulin, C-peptide, free fatty acids, glucagon-like peptide-1, and peptide-YY significantly changing postsurgery ( < .05 for all). Insulin sensitivity and insulin secretion rate during the MMTT significantly improved. Three months post-VSG, youth showed significant improvements in weight, body composition, insulin sensitivity and secretion, and glycemic control, with most no longer requiring diabetes medications.

OBJECTIVES/GOALS: The goal of this study is to investigate the potential independent relationship between epicardial adipose tissue (EAT) and cardiometabolic health in youth-onset type 2 diabetes (T2D) and explore changes in EAT as a potential mediator of changes in cardiometabolic health in response to vertical sleeve gastrectomy (VSG). METHODS/STUDY POPULATION: We will assess glycemic control, insulin sensitivity and secretion in youth with T2D before and 3 months after VSG. Fasting labs, anthropometrics, and a 4-hour, frequently sampled liquid mixed meal tolerance test (45g carbohydrates, 14g fat, and 14g protein) were performed. Calculations included glucose, insulin, and GLP-1 area under the curve (AUC), Matsuda Index, HOMA-IR, and oral disposition index (DI). These cardiometabolic outcomes will then be assessed for associations between total EAT volume, measured from cardiac MRI. RESULTS/ANTICIPATED RESULTS: Previous studies have shown that individuals with obesity have higher EAT than lean controls, and adults with T2D have even higher EAT than obese controls. Therefore, we anticipate that our participants will have higher volume of EAT than what has been reported in the literature and that they will have worsening cardiometabolic outcomes without MBS. Our anticipated results will include: Weight and BMI, hemoglobin A1c, diabetes medications, Matsuda Index, HOMA-IR, DI, and glucose and insulin AUC during an MMTT. Cardiac MRI's are being analyzed and will give total EAT volume and will be analyzed for correlations with the cardiometabolic outcomes of body composition, aortic stiffness, blood pressure, cardiac structure and function, as well as lipid panel and insulin sensitivity. DISCUSSION/SIGNIFICANCE: This study is the first to specifically assess EAT in adolescents with T2D. The assessment of EAT will be done with gold-standard MRI and correlated with cardiometabolic health assessed by gold-standard methods. Together, the results will give insight into EAT as a potential independent cardiometabolic risk factor in adolescents undergoing VSG.

Changes in health policy require clinical participation and leadership to drive implementation.9 WHO has identified deficiency in the management and leadership capacity of many developing countries as a key reason for the seemingly inevitable failure to meet their Millennium Development Goals.10 The USA has pioneered clinician-management training, with doctors readily taking on health-systemmanagement roles as physician executives.11 Training starts at undergraduate level, with many universities (eg, Harvard, Stanford, and University of California, Los Angeles) offering special study modules in medical management and joint MD and MBA or Masters degrees in medical leadership.12 For qualified physicians, the American College of Physician Executives and the Institute for Health Improvement contribute to physician leadership training and accreditation. Acknowledgments We thank Martin Else, Peter Lees, and Bruce Keogh for ensuring the continuation of the scheme under the auspices of the Faculty of Medical Leadership and Management; Richard Thompson, Sue Shepherd, Richard Horton, and the Royal College of Physicians for hosting and participating in an event to allow discussion and initiation of thisViewpoint; and all host organisations for their support of the CMO's Clinical Advisors Scheme: Bupa, UK Department of Health, National Institute for Health and Clinical Excellence, NHS Institute for Innovation and Improvement, NHS Kidney Care, NHS London, National Patient Safety Agency, Medicines and Healthcare products Regulatory Agency, Royal College of Physicians, South West Strategic Health Authority.

AimsThe aim of this project is to improve the training experience of Psychiatry trainees across CNWL. In QI terms, we want to achieve a satisfaction rating of above 7/10 for all themes identified by August 2021.MethodCollected baseline data on satisfaction and priority ratings on 7 training themes Held discussion groups with trainees for specific themes to generate issues and solutions Developed and provided Quality Improvement training for trainees and trainers, 1:1 support and QI clinics – empowering trainees to develop their own local project and to make changes to issues on the ground Enacted central changes in communication, responsiveness, recognising success.Reassessed and fedback to the trainees throughout.ResultOur baseline satisfaction survey was completed in June 2020. Trainees their satisfaction for each theme out of 10 and to rank their priorities for change. Results showed satisfaction was lowest in morale and in safety and highest in education and supervision. Their highest priorities for change were safety, then morale, with induction as the lowest priority.We repeated the survey in October 2020. This showed improvements in most themes (apart from induction, perhaps due to induction having to be delivered virtually). Satisfaction in key priority areas of morale and safety increased from 4.53 to 6.37, and 5.12 to 6.70 respectively. We also asked what ‘one thing’ would they improve about their training. Key phrases included teaching, on-call, communication and induction.From this data, and softer feedback from trainees, it is encouraging that we are moving in a positive direction, but we are continuing to make changes.Conclusion• Trainees must be central to the work in improving their training• Using QI methodology helps – developing a structure and breaking down a bigger task helps make a plan• Feedback is key – but people are busy and receive a lot of emails and requests to fill surveys – catching people ‘in person’ (virtually) was the best way to ensure a lot of responses• Trainees have loads of great ideas, but they need support, time and resources to be able to develop their projects and changes• Flexibility is crucial: some topics work better locally, driven by trainees and some require a more coordinated, central roleWe hope that developing a structured approach to a large task like improving training will help make changes sustainable, and enables us to share our learning with others.

Within my artistic practice I use mixed media to address the concept of trauma, specifically its transformative qualities, by presenting notions of strength, the correlation of damage and repair, and the act of mending. Combining the softness of textiles with the rigidity of clay in this work presents creative opportunities for depicting the negative and gruesome aspects of physical traumas that are often concealed or ignored. I am able to subvert these more disturbing subjects by converting them into enticing focal points, essentially freezing physical and emotional wounds in time, reframing and reclaiming them as indicators of the process of transformation and all stages of healing. Many of my works consider the psychology of trauma and suffering, expressly focusing on how lived experience is part of an individual, no matter the phase of one’s own metamorphosis. Other works point to more observable traces or visible manifestations of trauma, like a bruise or a scar. Manifesting trauma in multiple ways allows my work to individually resonate with viewers, who are presented with the latitude to enter into the work from a familiar place, despite coming from different experiences. When working with clay, I explicitly hand build vessels using porcelain, a method which highlights my appreciation for the intimacy of the material. Porcelain signifies my interest in the female body’s characteristics of softness, resiliency, and memory. The micro-structure of porcelain remembers actions of manipulation similar to the body. Structuring voluminous sculptures with subtle curves finished with organ- and flesh-like hues evokes our own physical being. In this regard, viewers can relate forms to the interior body, or perceive the exterior body in its many visceral tones. Additionally, layers of pliable and translucent textiles are used to reflect and enhance ideas of skin and speak to the impression of what lies upon and beneath its surface. In harmony with clay, soft and hard textile elements communicate resiliency and affect, and engage the contradiction of conceal/reveal regarding the intimate narratives surrounding trauma. Anonymity is often preferred over a specific narrative, and many viewers prefer to engage with artwork that asks questions rather than artwork that strives for the answers. Through continued research and creative practice, I actively search for ways in which my pieces can not only initiate conversations rather than expelling a detailed story in its entirety, but evolve into a greater discourse between materials, maker, and viewers.

This research aimed to explore the trainee perspective on factors affecting recruitment into old age psychiatry higher training in the UK. A qualitative survey was created by the Faculty of Old Age Psychiatry and distributed to current higher trainees in all psychiatric subspecialties. A total of 324 higher trainees responded to the survey, representing a broad demographic range. Thematic analysis was carried out, with sufficient responses to achieve saturation. Key themes included concerns about the future of the specialty, issues with social care, lack of support with patients’ physical health needs, issues with training posts, and workload. The need to improve core trainees’ experience of the specialty was highlighted. Many positive themes arose from the data; however, a number of barriers to recruitment were also identified. The findings have implications for recruitment to the specialty and should be used to inform recruitment strategy moving forward.

Correspondence to Dr Lynsey McAlpine, Medical Education Department, East London Foundation Trust, London E1 8DE, UK; lynseymcalpine@nhs.net Introduction Simulation training is increasingly being recognised as a valuable teaching modality in mental health professions.1 With recent expansion of the number of psychiatry foundation training posts in the UK,2 there is a strong imperative to develop high-quality simulation training which is tailored to the learning needs of foundation doctors and aligned with the UK Foundation Programme curriculum. Educational needs assessment To ensure that our training met the educational needs of foundation trainees, we explored the needs of the various stakeholders including the UK Foundation Programme,3 Health Education England,2 clinical supervisors, the Royal College of Psychiatrists (RCPsych)4 and focus groups with foundation trainees. The use of serial simulation is a novel way of developing clinical skills in the context of chronic illness management; it may also help to challenge negative perceptions about mental illness.

In 2001, Enochs's celebrated flat cover conjecture was finally proven, and the proofs (two different proofs were presented in the same paper) have since generated a great deal of interest among researchers. The results have been recast in a number of other categories and, in particular, for additive categories. In 2008, Mahmoudi and Renshaw considered a similar problem for acts over monoids but used a slightly different definition of cover. They proved that, in general, their definition was not equivalent to that of Enochs, except in the projective case, and left open a number of questions regarding the ‘other’ definition. This ‘other’ definition is the subject of the present paper and we attempt to emulate some of Enochs's work for the category of acts over monoids, and concentrate, in the main, on strongly flat acts. We hope to extend this work to other classes of acts, such as injective, torsion free, divisible and free, in a future report.

We set out to determine whether the central action of growth hormone (GH) secretagogues to induce Fos protein expression in the arcuate nucleus is influenced by central somatostatin action. Conscious male rats were injected i.v. with 100 µg sandostatin (octreotide, a long-acting somatostatin analogue) or saline, 10 min before an i.v. injection of either 50 µg GH-releasing peptide (GHRP-6), 50 µg MK-0677 (a non-peptide GH secretagogue) or saline. In a separate study, conscious male rats were injected i.c.v. with either 2 µg sandostatin or artificial cerebrospinal fluid (aCSF) vehicle 20 min before an i.v. injection of 50 µg GHRP-6. In all studies, rats were anaesthetized 90 min following GH secretagogue injection, perfused with fixative and the brains processed for the immunocytochemical detection of Fos protein. The number of Fos-positive nuclei detected in the arcuate nucleus of the i.v. sandostatin/i.v. GHRP-6 treated rats (28 ± 5 nuclei/section) and the i.v. sandostatin/i.v. MK-0677-injected rats (8 ± 2 nuclei/section) was significantly less than the i.v. saline/i.v. GHRP-6-treated group (56 ± 5 nuclei/section) and the i.v. saline/ i.v. MK-0677-treated group (20 ± 2 nuclei/section) respectively. Intracerebroventricular sandostatin injection attenuated the GHRP-6-induced Fos response, from 53 ± 6 nuclei/section in the i.c.v. aCSF/i.v. GHRP-6 group, to 39 ± 5 nuclei/section in the i.c.v. sandostatin/i.v. GHRP-6 group. Thus, the central action of GH secretagogues to induce Fos protein expression in the arcuate nucleus appears to be subject to central inhibitory control by somatostatin.