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"Thomson, Alistair"
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Changes in the sublingual microcirculation and endothelial adhesion molecules during the course of severe meningococcal disease treated in the paediatric intensive care unit
Purpose
The sublingual microcirculation can be visualised in real time using sidestream dark-field (SDF) imaging. Endothelial activation mediated through adhesion molecules may alter flow patterns in the microcirculation. We studied sublingual microcirculatory disturbances in children with meningococcal disease (MCD) and simultaneously measured plasma levels of adhesion molecules.
Method
Twenty children admitted to the paediatric intensive care unit (PICU) with MCD were studied. Forty healthy children were controls. The sublingual microcirculation was assessed at admission and at timed intervals until extubation. The microvascular flow index (MFI), capillary density (CD), proportion of perfused vessels (PPV) and perfused vessel density (PVD) were measured using SDF imaging. Plasma intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), E-selectin and P-selectin were measured at admission and at timed intervals during the course of PICU treatment.
Results
Significant reductions in MFI, CD, PPV and PVD were found in children with MCD compared with controls (
p
< 0.005). These differences had resolved prior to extubation. Initial MFI values predicted the duration of mechanical ventilation, irrespective of the stage of illness at the time of presentation to PICU. There were negative correlations between the ICAM-1, VCAM-1 and E-selectin levels and the microcirculatory MFI and PPV values at the time of admission to PICU (
p
< 0.005).
Conclusions
Microcirculatory dysfunction is present in children with severe MCD with improvement alongside clinical recovery. Microcirculatory dysfunction correlated with markers of endothelial activation. Sublingual SDF imaging is feasible in children ventilated on PICU for severe sepsis and may prove useful in studies assessing illness severity and therapy.
Journal Article
Oral history and photography
\"This essay collection explores the \"photographic turn\" in oral history. Contributors ask how oral historians can best use photographs in their interviewing practice and how they can best understand photographs in their interpretation of oral histories. The authors present a dozen case studies from Australia, Brazil, Canada, Germany, the United Kingdom, and the United States. In exploring the intersection of oral history and photography, they complicate and move beyond the use of photographs as social documents and memory triggers and demonstrate how photographs frame oral narratives and how stories unsettle the seeming fixity of photographs' meanings\"-- Provided by publisher.
Book
Meningococcal Disease in Children in Merseyside, England: A 31 Year Descriptive Study
Meningococcal disease (MCD) is the leading infectious cause of death in early childhood in the United Kingdom, making it a public health priority. MCD most commonly presents as meningococcal meningitis (MM), septicaemia (MS), or as a combination of the two syndromes (MM/MS). We describe the changing epidemiology and clinical presentation of MCD, and explore associations with socioeconomic status and other risk factors. A hospital-based study of children admitted to a tertiary children's centre, Alder Hey Children's Foundation Trust, with MCD, was undertaken between 1977 to 2007 (n = 1157). Demographics, clinical presentations, microbiological confirmation and measures of deprivation were described. The majority of cases occurred in the 1-4 year age group and there was a dramatic fall in serogroup C cases observed with the introduction of the meningococcal C conjugate (MCC) vaccine. The proportion of MS cases increased over the study period, from 11% in the first quarter to 35% in the final quarter. Presentation with MS (compared to MM) and serogroup C disease (compared to serogroup B) were demonstrated to be independent risk factors for mortality, with odds ratios of 3.5 (95% CI 1.18 to 10.08) and 2.18 (95% CI 1.26 to 3.80) respectively. Cases admitted to Alder Hey were from a relatively more deprived population (mean Townsend score 1.25, 95% CI 1.09 to 1.41) than the Merseyside reference population. Our findings represent one of the largest single-centre studies of MCD. The presentation of MS is confirmed to be a risk factor of mortality from MCD. Our study supports the association between social deprivation and MCD.
Journal Article
Meningococcal disease and its management in children
In the meningitis belt of sub-Saharan Africa, meningococcal disease presents predominantly as meningitis alone. 2 Meningococcal infection What causes it The meningococcus is solely a human pathogen, and up to 50% of the population may carry meningococci in the nasopharynx. 3 w1 Factors that lead to invasion and production of disease include complex inter-relationships of genetic predisposition, host status, environmental conditions, and virulence of the organism. 4 w2 Literature searches We searched Medline in May 2006 (PubMed, since 1966, except where stated) with the terms meningococcus, meningococcal infection, meningococcal disease, meningococcal disease and predisposition (English, reviews, past 5 years), meningococcal disease and carriage (English, reviews, past 5 years), meningococcal disease and symptoms, meningococcal disease and signs, meningococcal disease and treatment, meningococcal disease and outcome, and meningococcal disease and prevention. (Most general practitioners will see thousands of children with non-specific, non-blanching rashes for every child presenting with meningococcal disease.\\n Improvements in outcome are likely to have resulted from multiple factors. 26 w7 Among survivors, 10% have deafness, 10% have neurodevelopmental sequelae such as cerebral palsy, and 5% have more subtle neurodevelopmental abnormalities. 27 Over the past 15 years, improved recognition and earlier treatment may have led to a higher survival rate, although data need to be examined carefully,w8 but with the emergence of \"survival at a cost\" peripheral amputations especially have increased.
Journal Article
A predominantly anti-inflammatory cytokine profile is associated with disease severity in meningococcal sepsis
This study aimed to determine whether an anti-inflammatory profile in meningococcal disease is associated with an increased risk of severe disease or septic shock.
Prospective observational study in a tertiary care children's hospital.
63 children with confirmed meningococcal disease.
Plasma concentrations of interleukin-1 receptor antagonist (IL-1Ra), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumour necrosis factor-alpha (TNF) were assayed on admission. Receiver operator characteristic curve analysis was used to determine optimum thresholds for IL-1Ra:TNF, IL-1Ra:IL-6 and IL-1Ra:IL-8 ratios.
Median IL-1Ra:TNF and IL-1Ra:IL-6 ratios were significantly higher in severe disease with septic shock than in severe disease without septic shock and in non severe disease (IL-1Ra:TNF 263 vs. 185 vs. 108; IL-1Ra:IL-6 139 vs. 23 vs. 17). Median IL-1Ra:IL-8 ratios were not significantly different in the three groups. A significantly larger proportion of children with high IL-1Ra:TNF-alpha and IL-1Ra:IL-6 ratios developed severe disease with septic shock than those with a low ratios (95.2% vs. 4.8%; 76.2% vs. 23.8%).
An anti-inflammatory profile appears to be associated with the development of severe disease and septic shock in meningococcal sepsis. This may imply that experimental new therapies of pro-inflammatory cytokine inhibition and anti-inflammatory cytokines in meningococcal disease could be detrimental.
Journal Article
Anzac Memories Revisited: Trauma, Memory and Oral History
In this article I return to interviews I conducted in the 1980s with Australian World War One veteran Fred Farrall, armed with new historical sources and new ways of thinking about war, suffering and memory. My interpretation of Fred's war and its consequences was central to the approach to individual and collective memory, and their complex interaction across time, which I articulated in my book Anzac Memories. Focusing on Fred's experience and narrative of shell shock and pacifism, this article complicates my understanding of Fred's war and postwar life, and of how he created and recreated his war memory in different contexts and relationships, including the relationship between interviewer and interviewee, historian and witness. I investigate ideas about trauma, intersubjectivity, and memory composure that have become important theoretical tools for oral historians.
Journal Article
'When's dad home?': an oral history of inter-war Australian fatherhood
Drawing upon interviews recorded in Australia four decades ago, this article considers the challenges of using archived oral history and how these interviews contribute to a history of fatherhood between the wars, traversing three temporal moments: research in the 2010s; interviews in the late 1970s and early 1980s; and events in the 1920s and 1930s, when narrators were children and young parents. The interviews show how and why most interwar Australian families aspired to the ideal of a division of family roles along gender lines, with fathers primarily breadwinners and mothers responsible for the home and childcare. They also reveal how different catastrophes – the aftermath of the First World War, the Depression and the loss of a parent through death or desertion – played havoc with that family ideal.
Journal Article
Digital Aural History: An Australian Case Study
Digital technologies and tools are transforming the presentation, interpretation, and use of oral history. Using a case study of the Australian Generations Oral History Project, this article focuses on how we have documented interviews and are presenting and interpreting them through writing in online formats that integrate aural material. I consider the interpretative opportunities and challenges posed in four elements of our digital oral history practice: the online discussion forum though which interviewers share their account of each interview; the searchable timed summaries that are linked to the audio recording for each interview; the ZOTERO database that we use to access, search, and share the material generated by the project; and an aural history book that will combine text and audio.
Journal Article