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A 5 slide presentation of the systematic review of psychiatric disorders in adolescent cancer survivors. Presented at the European Public Health Conference in Ljubljana, Slovenia, Nov. 2018

Introduction Emergency workers dedicate their lives to promoting public health and safety, yet suffer higher rates of post-traumatic stress disorder (PTSD) and major depression (MD) compared with the general population. They also suffer an associated increased risk for physical health problems, which may be linked to specific immunological and endocrine markers or changes in relevant markers. Poor physical and mental health is costly to organisations, the National Health Service and society. Existing interventions aimed at reducing risk of mental ill health in this population are not very successful. More effective preventative interventions are urgently needed. We first conducted a large-scale prospective study of newly recruited student paramedics, identifying two cognitive factors (rumination and resilience appraisals) that predicted episodes of PTSD and MD over a 2-year period. We then developed internet-delivered cognitive training for resilience (iCT-R), a supported online intervention, to modify cognitive predictors. This protocol is for a randomised controlled trial to evaluate the efficacy of the resilience intervention. Methods and analysis 570 student paramedics will be recruited from participating universities. They will be randomly allocated to iCT-R or to supported online training of an alternative, widely available intervention or to training-as-usual. Follow-up will occur after the intervention/standard practice period and at 6, 12 and 24 months. Primary outcomes include rates of PTSD and MD and subsydnromal PTSD and MD, measured by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fifth edition, the Patient-Health Questionnaire-9 and the Post-traumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition. Secondary outcomes include measures of resilience, rumination, anxiety, psychological distress, well-being, salivary cortisol, plasma levels of C-reactive protein, smoking and alcohol use, weight gain, sleep problems, health-related quality of life, health resource utilisation and productivity. Ethics and dissemination The Medical Sciences Inter-Divisional Research Ethics Committee at the University of Oxford granted approval, reference: R44116/RE001. The results will be published in a peer-reviewed journal. Access to raw data and participant information will be available only to members of the research team. Trial registration number ISRCTN16493616; Pre-results.

Emergency service workers, military personnel, and journalists working in conflict zones are regularly exposed to trauma as part of their jobs and suffer higher rates of posttraumatic stress compared with the general population. These individuals often know that they will be exposed to trauma and therefore have the opportunity to adopt potentially protective cognitive strategies. One cognitive strategy linked to better mood and recovery from upsetting events is concrete information processing. Conversely, abstract information processing is linked to the development of anxiety and depression. We trained 50 healthy participants to apply an abstract or concrete mode of processing to six traumatic film clips and to apply this mode of processing to a posttraining traumatic film. Intrusive memories of the films were recorded for 1 week and the Impact of Events Scale–Revised (IES-R; Weiss & Marmar, 1997) was completed at 1-week follow-up. As predicted, participants in the concrete condition reported significantly fewer intrusive memories in response to the films and had lower IES-R scores compared with those in the abstract condition. They also showed reduced emotional reactivity to the posttraining film. Self-reported proneness to intrusive memories in everyday life was significantly correlated with intrusive memories of the films, whereas trait rumination, trait dissociation, and sleep difficulties were not. Findings suggest that training individuals to adopt a concrete mode of information processing during analogue trauma may protect against the development of intrusive memories., Highlights • We compared abstract versus concrete information processing of traumatic stimuli • Concrete processing led to fewer intrusive memories than abstract processing • Concrete processing led to reduced severity of PTSD symptoms than abstract processing • Concrete processing led to lower emotional reactivity to a subsequent stimulus relative to abstract processing • Proneness to intrusive memories was associated with outcome

Metabolomics is the systematic analysis of low-molecular weight compounds (metabolites) within biological systems that represent molecular endpoints of gene expression and environmental exposures. A major goal of metabolomics is achieving better understanding of the pathophysiology of complex disease processes while elucidating mechanisms of action of nutrients, toxins, and/or drugs. Multisegment injection-capillary electrophoresis-mass spectrometry (MSI-CE-MS) is a high-throughput microseparation platform that is ideal for the analysis of polar/ionic metabolites from volume-restricted biological samples. This thesis includes two major metabolomics projects using MSI-CE-MS that are aimed at contributing new advances in public health and chronic disease prevention. Chapter II presents an analysis of the metabolome from patients with phenylketonuria (PKU) — a genetic disease affecting phenylalanine (Phe) metabolism that requires lifelong dietary restriction to prevent irreversible intellectual disabilities. A targeted and nontargeted metabolomics approach using matching urine and plasma samples was conducted to confirm known markers of PKU and identify new markers associated with dietary adherence and disease progression. Along with increased excretion of Phe catabolites in urine, high plasma Phe was associated with decreased excretion of acylcarnitines and greater excretion of histidine catabolites, suggesting impaired fatty acid oxidation and micronutrient deficiencies, respectively. Overall, this may provide a strategy to objectively monitor dietary adherence beyond standard dietary records or patient recall. Chapter III investigates the impact of electronic cigarette smoke exposure on the placental metabolome as a model cell line of fetal development. Evidence of altered amino acid metabolism, in addition to changes in acylcarnitines and metabolites associated with cellular proliferation, were observed in more susceptible first trimester placental cells and were attributed to flavouring agents irrespective of nicotine dosage. This work supports the hypothesis that flavoured e-cigarette formulations pose a significant health risk in comparison to unflavoured formulations and supports the need for further risk assessment and careful regulation of these products to prevent deleterious birth outcomes in pregnant mothers. Thesis Master of Science (MSc)

On dit que j’ai la voix qui traîne En chantant mes rengaines C’est vraiLorsque ça monte trop haut, moi je m’arrêteEt d’ailleurs on n’est pas ici à l’Opéra. On dit que j’ai l’nez en trompette, Mais j’ s’rais pas MistinguettSi j’étais pas comme ça. (Mistinguett, « C’est Vrai », dans Conway, p. 70) Dans des multiples textes théoriques féministes parus depuis les années 1970, la voix de la femme est analysée non seulement en tant qu’objet sonore mais aussi en tant qu’énoncé facilitant la mise en ...