Sir Stanley Peart FRS in interview with Dr Max Blythe: Interview 4

In this interview Sir Stanley Peart talks about his time as professor of medicine at St Mary's Medical School 1956-1987. First, he outlines the medical unit's research on the substances released by tumours - early work on phaeochromocytomas and observations on the mechanism behind flushing in those with carcinoid syndrome - and acknowledges the contribution of his colleagues James Robertson, Jehoiada Brown, and David Grahame-Smith to this work. The interview moves on to research into blood pressure, the main strand of the unit's research during Sir Stanley's time there. He speaks of the unit's research on the link between renal artery stenosis and high blood pressure here; his collaboration with Charles Rob (professor of surgery at St Mary's) on diagnosis, David Sutton's use of arteriography, and Tony Lever and James Robertson's work on renin and angiotensin. The unit's increasing ability to attract international researchers, international developments in hypertension research, and Sir Stanley's links with the Western Ophthalmic Hospital and the contribution of this work to research on blood pressure are also summarised. Next, Sir Stanley reflects on his love of treating and communicating with patients: the importance of listening to the patient in reaching a diagnosis, understanding their use of language, and the dangers of time constraints and over-specialisation. A discussion of the ethics of using patients for research, the need for open debate about such issues within a hospital or medical school community follows, and the difficulty of admitting mistakes in a climate of legalised audit follows. Innovations in the treatment of patients with renal failure - Roy Calne's work on renal transplantation, and the development of long-term peritoneal dialysis (with James Mowbray) and haemodialysis at St Mary's - are then discussed. The interview ends with Sir Stanley looking back on the successful careers of many of his research fellows, and the challenge of leading an effective research team as a busy professor of medicine

Professor Charles Fletcher CBE FRCP in interview with Max Blythe: Interview 1

Part One: Penicillin Professor Charles Fletcher was the first doctor to administer penicillin to a patient, when he was working as a Nuffield research student in Professor Leslie Witt's department in Oxford in 1941. In this interview he discusses Howard Florey's and Ernst Chain's work on the development of penicillin at the Sir William Dunn School of Pathology, Oxford, following its discovery by Alexander Fleming in 1929. Encouraging results obtained from experiments with mice, and increased availability of the drug through improved extraction techniques, led to the first treatment of patients. He then outlines the cases of three patients suffering from bacterial infections, who were given penicillin, and the dramatic results observed. Next, Professor Fletcher tells of the initial scarcity of the drug, and the attempts of Howard Florey and Norman Heatley to interest pharmaceutical companies in America in the large-scale production of penicillin which led to its wider availability. He reflects on how Fleming receiving most of the publicity and credit for penicillin enabled Florey, who shunned publicity, to concentrate on his research and eventually become president of the Royal Society. In the final part of the interview Professor Fletcher discusses the search for other antibiotics, and the impact that the advent of antibiotic treatment of bacterial infections has had on clinical medicine with, for example, the closure of septic wards.Part Two: Television Medicine At the start of the interview, Professor Fletcher reflects on how he became involved in presenting television programmes on medicine for the BBC when he returned to London from Cardiff in 1952, and earlier programmes including 'Matters of Medicine', 'The Hurt Mind', and 'A Question of Science'.The discussion then moves to his involvement with the pioneering series 'Your Life in Their Hands', in which surgical operations were televised, from 1948 to 1962. Although the series had its critics in the medical profession when it began - the British Medical Journal argued that it was harmful to give patients too much information about disease - it proved immensely popular with the public. Also, the medical profession has come to accept the public discussion of medical issues over time. Next, Professor Fletcher speaks of his involvement in programmes aimed at general practitioners, and reflects on the contribution 'Your Life in Their Hands' has made to informing the public and de-mystifying medicine. The interview concludes with a discussion of the contribution television and video can make to medical education

Professor Cecil Gray CBE KCSG FRCS FRCP FRCA in interview with Dr Max Blythe: Interview 1

Part One Professor T Cecil Gray, professor of anaesthesia at the University of Liverpool from 1959 to 1976, has a distinguished reputation for training, teaching and research in anaesthesia. He begins the interview with discussion  of a Liverpool background, and education at preparatory school and Ampleforth College, where he studied science and also developed an interest in music and drama. He goes on to speak of a two-month period as a novice monk at Ampleforth before deciding to study medicine at the University of Liverpool. As a student on the pre-clinical course he enjoyed the anatomy classes  of Professor Wood, and during his clinical training the professor of medicine,  Henry Cohen, and the surgeon Charles Wells were influential and supportive  figures. Professor Gray then talks of his marriage in 1937 and a decision  to become a partner in a general practice in Liverpool, and he goes on   to describe the work of the busy practice: holding surgeries, dispensing medicines, making home visits, providing a domiciliary obstetric service, and caring for many patients living in conditions of poverty. A discussion         then follows of Professor Gray's developing interest in anaesthesia, and  anaesthetic practice at this time, when the administration of general  anaesthesia was undertaken by general practitioners and hospital staff  who were not medically qualified .Part Two In the second part of the interview, Professor Gray talks of buying a  general practice in Liverpool in 1939, and the experience of working as a single-handed practitioner. At this time, wishing to gain specialist  knowledge of anaesthesia, he received training on two afternoons a week  from the renowned Liverpool general practitioner and anaesthetist, R J Minnitt, who was a prominent member of the Liverpool Society of Anaesthetists. Minnitt encouraged him to take the Diploma in Anaesthetics (DA), which required that one thousand anaesthetics should be recorded by the candidate. Professor Gray speaks of Minnitt's contribution to the specialty of anaesthesia, and of how he developed a machine for self-administration of nitrous oxide   and air for the relief of pain in labour, which was subsequently authorised  by the Central Midwives Board for supervision by midwives who had received suitable instruction. At the start of the Second World War, Professor Gray was turned down by the forces because he suffered from asthma. He continued in general practice, at the same time working as an anaesthetist,         until 1941, when he became a full-time anaesthetist at the Northern General Hospital in Liverpool. In the final part of the interview, Professor Gray talks of volunteering for service and acceptance by the Royal Army Medical Corps in 1942, active service attached to a neurosurgical unit in North  Africa, and the experience of being invalided home in 1944 after contracting bronchial pneumonia

The First Data Release of the Sloan Digital Sky Survey

The Sloan Digital Sky Survey has validated and made publicly available its First Data Release. This consists of 2099 square degrees of five-band (u, g, r, i, z) imaging data, 186,240 spectra of galaxies, quasars, stars and calibrating blank sky patches selected over 1360 square degrees of this area, and tables of measured parameters from these data. The imaging data go to a depth of r ~ 22.6 and are photometrically and astrometrically calibrated to 2% rms and 100 milli-arcsec rms per coordinate, respectively. The spectra cover the range 3800--9200 A, with a resolution of 1800--2100. Further characteristics of the data are described, as are the data products themselves.Comment: Submitted to The Astronomical Journal. 16 pages. For associated documentation, see http://www.sdss.org/dr

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

A history of the Central Council for Health Education, 1927-1968

This dissertation examines the organisational background to the modern British health education movement, largely by reference to the origins and forty years' history of the Central Council for Health Education (1927-1968), the first body attempting to impart leadership and national coherence to a diffuse and eclectic field of educational practice and health promotion which has found secure administrative foundations difficult to establish.The study begins with a review of nineteenth and early twentieth century influences contributing to the character and status of the movement in its pioneering years. The predominantly propagandist roots and voluntary sector affinities with which it emerged from half and century's precursory endeavours profoundly affected health education's opportunities to advance with other aspects of health care and education in the inter-war years. By then, health education had become a diffuse and unco-ordinated field of minor, local authority initiatives and separatist campaigning by specialist, national health charities, remaining largely outside the remit of health and education professions and neglected officially. How the challenge of countering developmental difficulties fell to a minor professional body rather than an officially promoted one, is a question critical to any interpretation of later developments, and the subject of further enquiry.Subsequent investigation focuses on the evolution of the central agency which resulted, the Central Council for Health Education, particularly its thirty years' quest for official recognition and stature, and the strategies and services devised in this cause. It is a story of persistent and widespread enterprise, significant in many of its ideas but constrained in their effective development by enduring failure to attract Government support and to progress beyond the limited subscription income and essentially propagandist aspirations of local public health services. Adjudged ineffective by the 'Cohen Enquiry' of 1960-64, Government intervation proved forty years late in seeking to redress the problems of inadequate central provision, when in 1968 an officially funded Health Education Council replaced its neglected predecessor.The investigation reveals the classical dilemma of a multi-disciplinary field failing to transcend the divisive character of its own interests, in search for developmental coherence, and failing, consequently, to command effective professional and political support.</p

Professor Max Bennett FAA in interview with Dr Max Blythe

Professor Max Bennett FAA, professor of neurophysiology at Sydney University, talks of his early family life and background, school and university influences in Melbourne, and a curious transfer from engineering studies to neurophysiology.He discusses his early contribution to research on the role of adenosine triphospate as a neurotransmitter, and calcium ion based action potentials, carried out in the laboratory of Geoff Burnstock in Melbourne. In addition to relating his work to that of other neurophysiologists of his generation, Professor Bennett also places his work in historical context, reviewing the contributions of Langley, Sherrington, Eccles, Katz, Kuffler and other major contributors to the field.He then discusses interests in neurone/motor end-plate associations, the chemical interactions governing their selection and survival. Finally he talks on concepts of consciousness and his own views of the subject